These women are trying to survive an epidemic of self-destruction in small-town and rural America. Death rates have risen sharply among whites, particularly women, particularly those with a high school education or less — the white working class that played a key role in the November election. Last year, overall life expectancy in the United States fell for the first time since 1993, when HIV was rampant.
Today there is no emergent virus running amok. Instead, Americans are dying from a rash of pathologies, sicknesses and addictions that experts call “diseases of despair.”