The death of the American Dream may be killing many young white Americans.

The death rates for young Americans increased substantially from 1999 to 2014, according to a recent report in The Lancet. Much of that increase was driven by the increase in mortality of white women aged 25 to 35. On average, 25-year old white women experienced an increased death rate of 3% per year from 1999 to 2014, according to the report. Twenty-five-year-old men had an increase annual mortality increase of 1.9%.

All other ethnic groups, apart from Native Americans, experienced a decline in mortality rates.

Bloomberg News has a long feature look at this disturbing trend.

The fates of the less-educated and those who graduate from universities diverge in dire ways. Middle-aged white Americans without four-year degrees are at increasing risk of dying, a well-documented trend driven not only by drug use but also by alcoholism, suicide, and slowing progress against heart disease and cancer. Outcomes may worsen further as millennials—Johnson’s generation—grow older. “America is not a great place for people with only a high school degree, and I don’t think that’s going to get better anytime soon,” said Angus Deaton, a Nobel Prize-winning Princeton University economist. It’s too soon to tell whether millennials will die at higher rates in middle age than today’s 45- to 54-year-olds, said Anne Case, a Princeton economist who identified the “deaths of despair” trend with Deaton, her spouse and co-author. But in stories like Johnson’s, there are reasons to worry.

In other words, there’s reason to suspect that this is just the beginning.

A recent survey of millennials found that white millennials are far less likely to believe in some of the basic features of the American Dream. Only 46 percent of younger whites agree with the statement that “I believe that everyone can achieve their dreams if they try hard.” For black millennials, the figure is 59%, for hispanics 56%, for asians 55%. White millennials are also more likely to agree with the statement that “the American Dream is no longer a possibility for most Americans no matter how hard they work.”

It is not surprising, then, that the increase in death rates of young white Americans is driven by suicides and accidents–which are largely deaths due to drug-overdoses.

The Lancet report points out that there are few precedents for such large increases in mortality in developed countries. “The magnitude of such increases is as large as those in two public health emergencies in the past: the substantial mortality increases in Russia during the 1990s and increases in mortality in individuals aged 20-40 years at the height of the AIDS epidemic,” the report concludes.

To paraphrase a groundbreaking article by Masha Gessen on the Russian death crisis, if this is correct–that white Americans are dying of despair, as they seem to be–then the question is: why have young white Americans been so overcome with despair in the 21st century?

Bloomberg quotes researchers Case and Deaton:

Case and Deaton have a theory for why mortality has risen for less-educated whites. For all the debate over whether college is worthwhile, high school graduates who go straight into the workforce have higher unemployment, weaker wage growth, and less chance of marrying than their predecessors and educated peers. Community supports have broken down, and as disadvantage snowballs, premature deaths rise.

This, however, only raises more questions. Why have the economic and social conditions of young whites, particularly those without a college degree, become so dire? And why isn’t more of an alarm being raised about what appears to be the greatest public health emergency in the U.S. since the AIDS crisis?

The Lancet study calls for “a rapid public health response” to avert further premature deaths. But what, if anything, can be done about people dying of broken hearts and shattered dreams?