Vance makes specific reference to the ways in which his societal norms resulted in negative health outcomes. He states, "Our eating and exercise habits seem designed to send us to an early grave, and it’s working: in certain parts of Kentucky, local life expectancy is sixty seven, a full decade and a half below what it is in nearby Virginia . . . We eat Pillsbury cinnamon rolls for breakfast, Taco Bell for lunch, and McDonald's for dinner."(p.148) Beyond these baseline health problems, addiction and substance abuse also entrapped his family. His accounts provide a personal narrative of the experience associated with the increasing rates of opioid abuse seen across the U.S.. In reflecting on the role addiction played within his society, Vance provides the following particularly harrowing passage:
"Pattie had apparently drawn herself a bath, taken a few prescription painkillers, and passed out. The top floor of her home and many of her family's possessions were ruined. This is the reality of our community. It is about a naked druggie destroying what little of value exists in her life. It is about children who lose their toys and clothes to a mother's addiction."(p.145)
Passages expressing this sentiment continue throughout his book. Though in many ways it seems as though the realities of the growing opioid epidemic are hidden from mainstream exposure, J.D. Vance's memoir provides a highly detailed and intimately personal record of what it means to experience addiction, humanizing the problem.
The increasing rate of illicit drug use has arguably been one of the most pressing health topics this year. Just this past week, the U.S. Surgeon General published his first report on this topic stating, "Substance use disorders represent one of the most pressing public health crises of our time." Their work estimates that the economic cost of illicit drug use related problems has skyrocketed to 198 billion dollars annually. The CDC estimates that total opioid related deaths have quadrupled since 1999, and that specifically heroin related deaths more than tripled in the short span from 2010 to 2014. Destination HealthEU has been following this mounting issue, featuring research by Emory professors and tracking new information as it evolves.
Though Hillbilly Elegy has received criticism for portrayal of 'Hillbilly Culture,' the book has also received overwhelming praise and attention, especially throughout the recent election cycle. While this book only provides one family's account, it undoubtedly serves to expose some of the confusing and devastating health issues confronting Americans across the county. The New York Times eloquently expressed this sentiment stating, "Whether you agree with Mr. Vance or not, you must admire him for his head-on confrontation with a taboo subject . . . Mr. Vance doesn’t have all the answers. But he’s advancing the conversation."
After reading the book myself, I would agree that the best way to approach this work is to appreciate it as one man’s story that serves as an example of a mounting problem. J.D. Vance does a beautiful job at discussing very personal challenges and provides a compelling narrative on coping with complex health challenges.
Click here to find a copy of Hillbilly Elegy by J.D. Vance
1. U.S. Department of Health and Human Services (HHS), O ce of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016.