Science
Are 'deaths of despair' really more common for white Americans? A UCLA report says no
Nakeya Fields has seen how the stresses that come with being Black — racial injustice, financial strain, social isolation — can leave people feeling hopeless and push some into substance abuse.
It’s one of the reasons the Pasadena social worker started offering “therapeutic play” gatherings for Black mothers like herself and children.
“I’m trying to host more safe spaces for us to come and share that we’re suffering,” the 32-year-old said. “And honestly, the adults need play more than kids.”
Yet while Black and brown mental health practitioners such as Fields have labored to address these issues within their communities, a very different conversation has been occurring in the nation at large.
For years, discussions about America’s substance-abuse crisis have focused almost exclusively on the narrative that it is white, middle-age adults who face the greatest risk of dying from drug overdoses, alcoholic liver disease and suicide.
The theory, which was presented by two Princeton economists in 2015 and based on data from 1999 to 2013, argued that despair was behind rising premature mortality rates among white Americans, especially those who were less educated.
Virtually overnight, the “deaths of despair” concept began to drive the national discourse over populist far-right politics; the rise of Donald Trump; and deepening political polarization over such topics as addiction treatment, law enforcement and immigration.
But after roughly a decade, researchers at UCLA and elsewhere have begun to dismantle this idea.
In a study published recently in the journal JAMA Psychiatry, authors found that deaths of despair rates for middle-age Black and Native Americans have surged past those of white Americans as the overdose crisis moves from being driven by prescription opioids to illegal drugs such as fentanyl and heroin.
While the opioid crisis did raise drug overdose deaths among white Americans for a time, it was an anomaly, said Joseph Friedman, a social medicine expert at UCLA’s David Geffen School of Medicine who was the lead author of the journal analysis. In fact, by 2022 the rate for white Americans had started to dip.
“What’s really important is that now, with these three causes of death, the gap has closed, and it’s moving in the other direction,” Friedman said.
Sandra Mims, a community health worker with Community Health Project L.A., puts out boxes of Narcan — a naloxone nasal spray that reverses the effects of opioid overdose — at an event at MacArthur Park in Los Angeles on International Overdose Awareness Day.
(Mel Melcon / Los Angeles Times)
The analysis found that deaths of despair for Black Americans hit a rate of 103.81 per 100,000 people in 2022, compared with 102.63 for white Americans. The rate for Native American and Alaska Native populations was even higher at 241.7 per 100,000 people in 2022.
The UCLA analysis doesn’t specify the midlife personal issues that might have led to addiction or suicide.
But the authors say that flaws in the methodology of the 2015 deaths of despair report skewed its conclusions about who was most at risk. Specifically, Friedman said that it failed to give enough consideration to long-standing racial inequities that Black Americans experience in income, educational attainment, incarceration and access to quality medical care, all of which can contribute to drug use and poor mental health outcomes. And statistics for Native Americans weren’t factored in at all.
“It was burned into the American psyche that it was white people in the rural U.S.,” Friedman said. “It was just a very small piece of the truth that was very interesting but was widely sold as something it wasn’t.”
Another recent worrying sign, Friedman says: Deaths of despair among Latinos are starting to catch up to those among Black and Native Americans.
Princeton professors Anne Case and her husband Angus Deaton, winner of the 2015 Nobel Prize in economic sciences, were thrust into the media spotlight when their deaths of despair findings were first published. Deaton told NPR that during a visit to the White House, even President Obama asked him about the phenomenon.
Their 2020 book, “Deaths of Despair and the Future of Capitalism,” was described by publisher Princeton University Press as “a troubling portrait of the American dream in decline.”
“For the white working class, today’s America has become a land of broken families and few prospects. As the college educated become healthier and wealthier, adults without a degree are literally dying from pain and despair,” the publisher said.
Fields, who employs yoga and pottery in her therapy, said this framing was misleading and racially biased.
“I’m actually flabbergasted that somebody has a term called ‘deaths of despair,’” Fields said. “It’s ‘despair’ when white people experience this suffering. But when we experience it, it’s just what we have to deal with.”
Nakeya Fields says it’s important to address mental wellness issues early, before people reach a crisis point and become another statistic.
(Jason Armond / Los Angeles Times)
Both Friedman and Fields say their critiques are not intended to minimize deaths among white Americans.
Still, Friedman wonders: “How do we empower Black and Native American communities in a way that enables them to treat these problems?”
Racism must be considered when trying to make sense of the crisis in premature deaths, says Dr. Helena Hansen, head of UCLA’s Department of Psychiatry and a senior author on Friedman’s analysis. Hansen, who is Black and specializes in addiction psychiatry, also co-authored the book “Whiteout: How Racial Capitalism Changed the Color of Opioids in America.”
For years, pharmaceutical companies steered expensive prescription pain medications, such as the opioid Oxycontin, as well as the most effective medications for opioid-use disorder, to white Americans with good access to healthcare, she said.
But at the same time, Black and brown Americans were unfairly subjected to law enforcement policies that prioritized incarceration for illegal drug use over increasing access to more humane medical strategies to help them, further harming already vulnerable communities, Hansen said.
“In our society, people with access to the new technologies and pharmaceuticals are more likely to be white,” Hansen says. “None of this is by accident. All of this is the direct result of careful racially and class-segmented marketing strategies by pharmaceutical companies.”
This two-tiered system arose because drug manufacturers, doctors and policymakers have for too long failed to see people from historically marginalized communities who live with addiction and mental health crises as worthy of the same sympathy and treatments that many white Americans receive, Hansen says.
Joseph Gone, a professor of anthropology at Harvard who has spent 25 years studying the intersection of colonialism, culture and mental health in Indigenous communities, agreed.
“Deaths of despair have been a reality for Indigenous communities since conquest and dispossession,” he said.
“It’s amazing how much grief our people contend with from early deaths — there are not that many communities in America that bear it quite the way we do,” said Gone, who is a member of the Aaniiih-Gros Ventre tribal nation of north-central Montana. “Until we acknowledge and take responsibility for the casualties of colonization, which endure to this day through deaths of despair, it’s going to be very hard to turn this around.”
Gone, who has collaborated with Friedman on previous research, says the mental health crisis in tribal nations is aggravated by widespread joblessness and generational poverty, and a lack of healthcare resources to treat people in need of immediate or long-term treatment.
Just one traveling psychiatrist serves reservations spread across both Montana and Wyoming — a region covering more than 243,300 square miles — mostly to manage patients’ prescriptions, he says.
And “for all of Indian country, we’re talking about a very small number of in-patient psychiatric facilities,” Gone says.
General practitioners can serve as a first line of defense, but they are not necessarily equipped to address the ongoing life crises that can lead to excessive drug and alcohol use, Gone says.
Fields says it’s important to address mental wellness issues early, before people reach a crisis point and become another statistic.
While her focus remains on Black women, she’s developed additional programming for adults, families and children, such as developmental screenings that measure for high stress levels. In June, Fields will co-present “Rap 4 Peace,” a conference and gala featuring hip-hop artists talking about mental health and reducing gun violence.
“This ‘tragedy of despair’ lives in us,” Fields says. “We breathe it. We go outside hoping that nobody will harm us or our children because they feel threatened by us. This is truly harmful to our bodies.”
Science
Pediatricians urge Americans to stick with previous vaccine schedule despite CDC’s changes
For decades, the American Academy of Pediatrics and the U.S. Centers for Disease Control and Prevention spoke with a single voice when advising the nation’s families on when to vaccinate their children.
Since 1995, the two organizations worked together to publish a single vaccine schedule for parents and healthcare providers that clearly laid out which vaccines children should get and exactly when they should get them.
Today, that united front has fractured. This month, the Department of Health and Human Services announced drastic changes to the CDC’s vaccine schedule, slashing the number of diseases that it recommends U.S. children be routinely vaccinated against to 11 from 17. That follows the CDC’s decision last year to reverse its recommendation that all kids get the COVID-19 vaccine.
On Monday, the AAP released its own immunization guidelines, which now look very different from the federal government’s. The organization, which represents most of the nation’s primary care and specialty doctors for children, recommends that children continue to be routinely vaccinated against 18 diseases, just as the CDC did before Robert F. Kennedy Jr. took over the nation’s health agencies.
Endorsed by a dozen medical groups, the AAP schedule is far and away the preferred version for most healthcare practitioners. California’s public health department recommends that families and physicians follow the AAP schedule.
“As there is a lot of confusion going on with the constant new recommendations coming out of the federal government, it is important that we have a stable, trusted, evidence-based immunization schedule to follow and that’s the AAP schedule,” said Dr. Pia Pannaraj, a member of AAP’s infectious disease committee and professor of pediatrics at UC San Diego.
Both schedules recommend that all children be vaccinated against measles, mumps, rubella, polio, pertussis, tetanus, diphtheria, Haemophilus influenzae type B (Hib), pneumococcal disease, human papillomavirus (HPV) and varicella (better known as chickenpox).
AAP urges families to also routinely vaccinate their kids against hepatitis A and B, COVID-19, rotavirus, flu, meningococcal disease and respiratory syncytial virus (RSV).
The CDC, on the other hand, now says these shots are optional for most kids, though it still recommends them for those in certain high-risk groups.
The schedules also vary in the recommended timing of certain shots. AAP advises that children get two doses of HPV vaccine starting at ages 9 to12, while the CDC recommends one dose at age 11 or 12. The AAP advocates starting the vaccine sooner, as younger immune systems produce more antibodies. While several recent studies found that a single dose of the vaccine confers as much protection as two, there is no single-dose HPV vaccine licensed in the U.S. yet.
The pediatricians’ group also continues to recommend the long-standing practice of a single shot combining the measles, mumps and rubella (MMR) and varicella vaccines in order to limit the number of jabs children get. In September, a key CDC advisory panel stocked with hand-picked Kennedy appointees recommended that the MMR and varicella vaccines be given as separate shots, a move that confounded public health experts for its seeming lack of scientific basis.
The AAP is one of several medical groups suing HHS. The AAP’s suit describes as “arbitrary and capricious” Kennedy’s alterations to the nation’s vaccine policy, most of which have been made without the thorough scientific review that previously preceded changes.
Days before AAP released its new guidelines, it was hit with a lawsuit from Children’s Health Defense, the anti-vaccine group Kennedy founded and previously led, alleging that its vaccine guidance over the years amounted to a form of racketeering.
The CDC’s efforts to collect the data that typically inform public health policy have noticeably slowed under Kennedy’s leadership at HHS. A review published Monday found that of 82 CDC databases previously updated at least once a month, 38 had unexplained interruptions, with most of those pauses lasting six months or longer. Nearly 90% of the paused databases included vaccination information.
“The evidence is damning: The administration’s anti-vaccine stance has interrupted the reliable flow of the data we need to keep Americans safe from preventable infections,” Dr. Jeanne Marrazzo wrote in an editorial for Annals of Internal Medicine, a scientific journal. Marrazzo, an infectious disease specialist, was fired last year as head of the National Institute of Allergy and Infectious Diseases after speaking out against the administration’s public health policies.
Science
‘We’re not going away’: Rob Caughlan, fierce defender of the coastline and Surfrider leader, dies at the age of 82
Known by friends and colleagues as a “planetary patriot,” a “happy warrior” and the “Golden State Eco-Warrior,” Rob Caughlan, a political operative, savvy public relations specialist and one of the early leaders of the Surfrider Foundation, died at his home in San Mateo, on Jan. 17. He was 82.
His wife of nearly 62 years, Diana, died four days earlier, from lung cancer.
Environmentalists, political operatives and friends responded to his death with grief but also joy as they recalled his passion, talent and sense of humor — and his drive not only to make the world a better place, but to have fun doing it.
“He’d always say that the real winner in a surfing contest was the guy who had the most fun,” said Lennie Roberts, a conservationist in San Mateo County and longtime friend of Caughlan’s. “He was true to that. It’s the way he lived.”
“When he walked into a room, he’d have a big smile on his face. He was a great — a gifted — people person,” said Dan Young, one of the original five founders of the Surfrider Foundation. The organization was cobbled together in the early 1980s by a group of Southern California surfers who felt called to protect the coastline — and their waves.
They also wanted to dispel the stereotype that surfers are lackadaisical stoners — and show the world that surfers could get organized and fight for just causes, said Roberts, citing Caughlan’s 2020 memoir, “The Surfer in the White House and Other Salty Yarns.”
Before joining Surfrider in 1986, Caughlan was a political operative who worked as an environmental adviser in the Carter administration. According to Warner Chabot, an old friend and recently retired executive director of the an Francisco Estuary Institute, Caughlan got his start during the early 1970s when he and his friend, David Oke, formed the Sam Ervin Fan Club, which supported the Southern senator’s efforts to lead the Watergate investigation of President Nixon.
According to Chabot, Caughlan organized the printing of T-shirts with Ervin’s face on them, underneath the text “I Trust Uncle Sam.”
“He was an early social influencer — par extraordinaire,” he said.
Glenn Hening, a surfer, former Jet Propulsion Laboratory space software engineer and another original founder of the Surfrider Foundation, said one of the group’s initial fights was against the city of Malibu, which in the early 1980s was periodically digging up sand in the lagoon right offshore and destroying the waves at one of their favorite surf spots.
According to Hening, it was Caughlin’s unique ability to persuade and charm politicians and donors that put Surfrider’s efforts on the map.
Caughlan served as the foundation’s president from 1986 to 1992.
The foundation grabbed the national spotlight in 1989 when it went after two large paper mills in Humboldt Bay that were discharging toxic wastewater into an excellent surfspot in Northern California. The foundation took aim and in 1991 filed suit alongside the U.S. Environmental Protection Agency; the paper mills settled for $5.8 million.
Hening said the victory would never have happened without Caughlan.
The mills had tried to brush off the suit by offering a donation to the foundation, Hening said. But Caughlan and Mark Massara — an environmental lawyer with the organization — rebuffed the gesture.
“The paper mill guys said, ‘Well, what can we do here? How can we make this go away?’” said Hening, recalling the conversation. “And Rob said, ‘It’s not going to go away. We’re not going away. We’re surfers.”
Roberts said Caughlan’s legacy can be felt by anyone who has ever spent time on the San Mateo County coastline. In the 1980s, the two spearheaded a successful ballot measure still protects the coast from non-agricultural development and ensured access to the beaches and bluffs. It also prohibits onshore oil facilities for off-shore facilities.
The two also worked on a county measure that led to the development of the Devil’s Slide tunnels on Highway 1 between Pacifica and Montara, designed to make that formerly treacherous path safer for travelers.
The state had wanted to build a six-lane highway over the steep hills in the area. “It would have been dangerous because of the steep slopes, and it would be going up into the fog bank and then back down out of the fog. So it was inherently dangerous,” Roberts said.
Chad Nelsen, the current president of the Surfrider Foundation, said he was first drawn into Caughlan’s orbit in 2010 when Surfrider got involved with a lawsuit pertaining to a beach in San Mateo County. Silicon Valley venture capitalist Vinod Khosla purchased 53 acres of Northern California coastline for $32.5 million and closed off access to the public — including a popular stretch known as Martin’s Beach — so Surfrider sued.
Nelsen said that although Caughlan had left the organization about 20 years before, he reappeared with a “sort of unbridled enthusiasm and commitment to the cause,” and the organization ultimately prevailed — the public can once again access the beach “thanks to ‘Birdlegs.’”
Birdlegs was Caughlan’s nickname, and according to Nelsen, it was probably coined in the 1970s by his fellow surfers.
“He had notoriously spindly legs, I guess,” Nelsen said.
Robert Willis Caughlan was born in Alliance, Ohio, on Feb. 27, 1943. His father, who was a parachute instructor with the U.S. Army, died when Caughlan was 4. In 1950, Caughlan moved with his mother and younger brother to San Mateo, where he saw the ocean for the first time.
He rode his his first wave in 1959, at the age of 16, from the breakwater at Half Moon Bay.
Science
LAUSD says Pali High is safe for students to return to after fire. Some parents and experts have concerns
The Los Angeles Unified School District released a litany of test results for the fire-damaged Palisades Charter High School ahead of the planned return of students next week, showing the district’s remediation efforts have removed much of the post-fire contamination.
However, some parents remain concerned with a perceived rush to repopulate the campus. And while experts commended the efforts as one of the most comprehensive post-fire school remediations in modern history, they warned the district failed to test for a key family of air contaminants that can increase cancer risk and cause illness.
“I think they jumped the gun,” said a parent of one Pali High sophomore, who asked not to be named because she feared backlash for her child. “I’m quite angry, and I’m very scared. My kid wants to go back. … I don’t want to give him too much information because he has a lot of anxiety around all of these changes.”
Nevertheless, she still plans to send her child back to school on Tuesday, because she doesn’t want to create yet another disruption to the student’s life. “These are kids that also lived through COVID,” she said.
The 2025 Palisades fire destroyed multiple buildings on Pali High’s campus and deposited soot and ash in others. Following the fire, the school operated virtually for several months and, in mid-April of 2025, moved into a former Sears department store in Santa Monica.
Meanwhile, on campus, the U.S. Environmental Protection Agency and the U.S. Army Corps of Engineers cleared debris from the destroyed structures, and LAUSD hired certified environmental remediation and testing companies to restore the still-standing buildings to a safe condition.
LAUSD serves as the charter school’s landlord and took on post-fire remediation and testing for the school. The decision to move back to the campus was ultimately up to the charter school’s independent leadership.
The Los Angeles Department of Water and Power tested the drinking water for a slew of contaminants, and environmental consultants tested the soil, HVAC systems, indoor air and surfaces including floors, desks and lockers.
They tested for asbestos, toxic metals such as lead and potentially hazardous organic compounds often unleashed through combustion, called volatile organic compounds, or VOCs.
“The school is ready to occupy,” said Carlos Torres, director of LAUSD’s office of environmental health and safety. “This is really the most thorough testing that’s ever been done that I can recall — definitely after a fire.”
Construction workers rebuild the Palisades Charter High School swimming pool.
(Allen J. Schaben / Los Angeles Times)
A handful of soil samples had metal concentrations slightly above typical post-fire cleanup standards, which are designed to protect at-risk individuals over many years of direct exposure to the soil — such as through yard work or playing sports. An analysis by the environmental consultants found the metals did not pose a health risk to students or staff.
On indoor surfaces, the consultants found two areas with lead and one with arsenic, spaces they recleaned and retested to make sure those metals were no longer present.
The testing for contamination in the air, however, has become a matter of debate.
Some experts cautioned that LAUSD’s consultants tested the air for only a handful of mostly non-hazardous VOCs that are typically used to detect smoke from a wildfire that primarily burned plants. While those tests found no contamination, the consultants did not test for a more comprehensive panel of VOCs, including many hazardous contaminants commonly found in the smoke of urban fires that consume homes, cars, paints, detergents and plastics.
The most notorious of the group is benzene, a known carcinogen.
At a Wednesday webinar for parents and students, LAUSD’s consultants defended the decision, arguing their goal was only to determine whether smoke lingered in the air after remediation, not to complete more open-ended testing of hazardous chemicals that may or may not have come from the fire.
Andrew Whelton, a Purdue University professor who researches environmental disasters, didn’t find the explanation sufficient.
“Benzene is known to be released from fire. It is known to be present in air. It is known to be released from ceilings and furniture and other things over time, after the fire is out,” Whelton said. “So, I do not understand why testing for benzene and some of the other fire-related chemicals was not done.”
For Whelton, it’s representative of a larger problem in the burn areas: With no decisive guidance on how to remediate indoor spaces after wildland-urban fires, different consultants are making significantly different decisions about what to test for.
LAUSD released the testing results and remediation reports in lengthy PDFs less than two weeks before students plan to return to campus, while the charter school’s leadership decided on a Jan. 27 return date before testing was completed.
At the webinar, school officials said two buildings near the outdoor pool have not yet been cleared through environmental testing and will remain closed. Four water fixtures are also awaiting final clearance from the Los Angeles Department of Water and Power, and the school’s food services are still awaiting certification from the L.A. County Department of Public Health.
For some parents — even those who are eager to ditch the department store campus — it amounts to a flurried rush to repopulate Pali High’s campus that is straining their decisions about how to keep their kids safe.
Torres stressed that his team acted cautiously in the decision to authorize the school for occupancy, and that promising preliminary testing helped school administrators plan ahead. He also noted that the slow, cautious approach was a point of contention for other parents who hoped their students could return to the campus as quickly as possible.
Experts largely praised LAUSD’s efforts as thorough and comprehensive — with the exception of the VOC air testing.
Remediation personnel power washed the exterior of buildings, wiped down all surfaces and completed thorough vacuuming with filters to remove dangerous substances. Any soft objects such as carpet or clothing that could absorb and hold onto contamination were discarded. The school’s labyrinth of ducts and pipes making up the HVAC system was also thoroughly cleaned.
Crews tested throughout the process to confirm their remediation work was successful and isolated sections of buildings once the work was complete. They then completed another full round of testing to ensure isolated areas were not recontaminated by other work.
Environmental consultants even determined a few smaller buildings could not be effectively decontaminated and consequently had them demolished.
Torres said LAUSD plans to conduct periodic testing to monitor air in the school, and that the district is open to parents’ suggestions.
For Whelton, the good news is that the school could easily complete comprehensive VOC testing within a week, if it wanted to.
“They are very close at giving the school a clean bill of health,” he said. “Going back and conducting this thorough VOC testing … would be the last action that they would need to take to determine whether or not health risks remain for the students, faculty and visitors.”
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