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Rebuilding the Floor for Women

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HILLARY CLINTON
BRENDAN SMIALOWSKI via Getty Images

Last week, at the National Council for Behavioral Health Conference in Washington, my colleagues and I arrived nearly an hour early to snag seats to watch Hillary Rodham Clinton's keynote address. By 10 a.m. that morning, the ballroom was packed with people eager to hear the former First Lady, Senator and Secretary of State's take on the state of mental health care.

Hillary walked on stage in one of her signature pantsuits and delivered an impassioned speech about the "constellation of issues" that surround mental illness and addiction. Citing a recent New York Times article about the rise of heroin abuse on Staten Island, she linked these issues to a "toxic cocktail of economic and social pressures" -- pressures to which women are increasingly susceptible.

Despite the progress we've made as a society, she noted that American women today are living shorter lives than their mothers. In fact, their lifespans are shorter on average than their counterparts in any other industrialized country. This surprising trend, she explained, "correlates strongly to unemployment and economic stress... It's worst in communities that have been hollowed out by teen pregnancy and domestic violence... where families are fractured." For these women, it's not a question of leaning in or shattering the glass ceiling. "They don't just face ceilings," Hillary observed. "It's as if the floor has collapsed beneath them."

I was grateful that Hillary had chosen to highlight this troubling issue -- and I wanted to know more about the decline in women's life expectancy. Later that day, my Google searches confirmed Hillary's assertion that the problem is highly influenced by socioeconomics. Studies have shown that a particular demographic is suffering this shortened lifespan: white female high school dropouts. And there is a geographic component as well; the decline has disproportionately impacted women in Appalachia, the Cotton Belt, the Ozarks and the Great Plains.

Women living in these economically depressed areas are more likely to face the pressure of providing 100% of the financial and emotional support for their families. As studies indicate, such demands are taking a toll on their physical and mental health. Addiction, particularly to prescription drugs and heroin, is a growing issue. In women, the rate of prescription drug overdose has increased 400 percent over the past 15 years.

These statistics paint a bleak portrait, but so too do the stories of individual women who struggle with addiction and mental illness. In a raw and real New York Times Magazine profile, reporter Susan Dominus recounts the tale of Ann, a 25-year-old mother from a former mining town in eastern Pennsylvania. Exhausted from her late shift at the local Hershey factory coupled with the demands of parenting, Ann revived an old cocaine habit, then turned to heroin. Ann's addiction caused her to lose her home and her family and eventually landed her in jail. It also put a tremendous strain on her mother Lucy who, at 63, struggled to get her daughter help and raise her two young grandchildren.

The question, of course, is what can we do to help women like Ann and Lucy and reverse the trend of declining lifespans? Hillary pointed to the need to prevent mental health and addiction issues before they start. To do this, we must build a sturdier floor for women to stand on. This means advocating for equal pay for equal work, affordable childcare, paid family leave and early childhood education. In Ann's case, by 24, she had two children and was working the 11-to-7 night shift at the factory. She was lonely and getting by on almost no sleep when a co-worker offered her cocaine, a drug she'd previously given up. Soon, the quick fix and feeling of euphoria became impossible to resist -- and switching to heroin was easy. The odds were stacked against Ann -- her husband was already a heroin addict and her town was ravaged by the drug -- but one has to wonder whether greater social supports could have made a difference.

In addition to changing our social institutions to reduce the pressures on women and families, we must expand access to care for women already caught in the throes of mental illness and addiction. Ann's town had become a hub for heroin users and dealers, but the community had never been able to invest in a methadone clinic. In addition, Ann said that the waiting lists for doctors who prescribed Suboxone, an opioid dependence medication, were several months long. Narcotics officers patrolled the streets and convinced Ann to become an informant, but law enforcement alone did little to stem the tide of addiction.

With the advent of the Affordable Care Act, lawmakers are increasingly aware that substance abuse is a public health issue, not solely a criminal justice issue. However, there is much work to be done to ensure that mothers get the treatment they need. The time is now to "empower women and daughters," Hillary reminded us, for one woman's recovery can change the course of her entire family for generations to come.