As the federal government debates the financial stimulus needed to address the economic fallout from the coronavirus pandemic, the last recession offers an important reminder of the long-term health effects of a slow and uneven recovery. As large parts of the U.S.—particularly rural areas—failed to fully recover economically following the Great Recession, they experienced markedly different health fortunes from areas that experienced a robust recovery. If the pandemic exacerbates these economic trends, the U.S. may be left with an even greater disparity in the health and well-being of Americans living in different parts of the country.

The decade following the Great Recession saw the average life expectancy of Americans decline for the first time since the Spanish Flu pandemic of 1918. Studies have noted the rise in so-called “deaths of despair,” or deaths from substance abuse and suicide, particularly among the middle-aged white population during this period. The decline in deaths from heart disease, one of the major health advancements of the second half of the 20th century, has also slowed down, and may now be rising again.

What is driving these trends? A new study published in the Journal of the American Medical Association, finds that the diverging economic fortunes of different parts of the country in the post-recession period is linked to differing death rates from heart disease and stroke among middle-aged Americans.

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