Why are so many middle-aged white Americans dying?

“On a range of social and economic indicators, middle-aged whites have been falling behind in the 21st century,” they write. “They have lower incomes, fewer are employed, and fewer are married.”

This does not mean whites are worse off than minorities, they note. But it could mean that they are the canaries of a coal mine of broader societal problems that have deleterious health effects, such as “less-educated workers’ increasing disengagement from the mainstream economy; declining levels of social connectedness; weakened communal institutions; and the splintering of society along class, geographic, and cultural lines,” they write.

The findings are also concerning because four of the seven worst-off states the researchers highlighted have opted not to expand Medicaid as part of Obamacare. And although health insurance alone likely won’t be enough to turn the tide of premature deaths, it’s certainly one of the few immediate interventions that could help.