Many of them were also dying from cancer, heart disease, or respiratory diseases like chronic obstructive pulmonary disease and lung cancer, a 2022 study found-even as these conditions became less deadly for the rest of the population. They weren’t just dying from so-called deaths of despair-from drugs or suicide. From 2014 to 2017, the decline in life expectancy in the U.S., driven largely by the drop among the least-educated Americans, was the longest and most sustained in 100 years. Their white male counterparts were dying three years younger. In 2012, a team of population-health experts at the University of Illinois at Chicago found that white women who did not graduate from high school were dying about five years younger than such women had a generation before-at about 73 years instead of 78. One of the most alarming trends emerged about a decade ago. By the time I was a journalist writing about rural poverty in my mid-30s, I’d seen studies and data that helped me put the stories from home in context. I heard worse stories, about who was on drugs, who’d been arrested and sent to prison, who was in rehab, who was in rehab again. While I was gone, I heard updates: who was getting married, having children, getting divorced.

Almost everyone goes to an evangelical church, and in the halls of the town’s only high school, everyone knows everything about everyone else, or seems to: whom you dated, where you bought your clothes, how you acted on weekends, and even your destiny, inherited from the generations that came before you. The county’s median household income in 2021 was $40,763. It’s on the southern edge of the Ozarks, the hills we generously called mountains, situated in a valley where two big creeks come together in a Y. Clinton is the county seat of Van Buren County, Arkansas, and, with slightly more than 2,500 people, the biggest town in the area.

Ann rule and never let her go