White women and men in small cities and rural areas are dying at much higher rates than in 1990, while whites in the largest cities and their suburbs have steady or declining death rates.

White women and men in small cities and rural areas are dying at much higher rates than in 1990, while whites in the largest cities and their suburbs have steady or declining death rates.

White women and men in small cities and rural areas are dying at much higher rates than in 1990, while whites in the largest cities and their suburbs have steady or declining death rates.

The Norman Rockwell vision of America was always heavily idealized, but the country has changed in fundamental ways over the past half-century. We are now an urban society. Left behind are small towns and small cities where the kids leave after high school graduation, the churches struggle to stay open and the biggest business in town is often the local hospital.

In Bakersfield, Calif., a city in heavily agricultural Kern County, Samantha Burton, 42, was addicted to painkillers for a decade but has been clean for more than two years. She said her problem started with a prescription for Percocet after she got a bad case of food poisoning.

“This can be a very stifling place. It’s culturally barren,” she said of Bakersfield. “There is no place where children can go and see what it’s like to be somewhere else, to be someone else. At first, the drugs are an escape from your problems, from this place, and then you’re trapped.”

One theory about what is causing rising mortality among whites is the “dashed expectations” hypothesis. According to Johns Hopkins University sociologist Andrew Cherlin, whites today are more pessimistic than their forebears about their opportunities to advance in life. They are also more pessimistic than their black and Hispanic contemporaries.

“The idea that today’s generations will do better than their parents’ generation is part of the American Dream. It has always been true until now,” Cherlin said. “It may still be true for college-educated Americans, but not for the high-school-educated people we used to call the working class.”

Cherlin said whites benefited from discriminatory hiring when the working class was built over much of the past century. Union jobs tended to go to whites, he said, and labor contracts protected them until the unions lost power and jobs went overseas.

“Whites had a privileged place in the blue-collar economy,” he said. And as the middle of the labor market disappeared, so did that historic white privilege.

Predominantly white, working-class areas with high death rates have proved to be fertile ground for Trump. Political observers speculate that the voter anger driving his campaign emerges from the many distresses felt in these economically challenged — and increasingly morbid — places.

The wave of lethal agents rolling across the country is broad in its effects, but it appears to be cresting in places that are particularly vulnerable — such as a town where the trains no longer stop, or a small city that saw its biggest manufacturer move overseas, or in a household broken by divorce or substance abuse or tragedy.

Or in the mind and body of someone who is doing poorly, and just barely hanging on.

Lenny Bernstein, Anne Hull and Kimberly Kindy contributed to this report.