Reprinted with permission from AlterNet.

First came deindustrialization and mass unemployment, then the opioid crisis. Now a new report from HealthAffairs reveals that infant mortality rates in Appalachia dwarf those in the rest of the country. Life expectancies are considerably shorter as well.

Looking at an array of data, the study finds that infant mortality was as much 16 percent higher in Appalachia, while life expectancies had dropped by as much as 2.4 years between 1990 and 2013. Poor black men from the region are expected to live 13 years less than white women from low-poverty areas elsewhere in the United States.

“What was surprising was that in the early 1990s, there wasn’t a great deal of difference in infant mortality and life expectancy,” a co-author of the study told the Washington Post. But while these trends have stabilized across the country, “the improvements have not been as rapid in Appalachia.”

The study underscores a broader American crisis, as comparatively lower life expectancy and higher infant mortality rates are not contained to Appalachia. The United States still ranks well below other developed nations, according to a study by the Commonwealth Fund.

The Appalachian region stretches across 13 states, from Mississippi to New York. Over the past 30 years, it has been decimated by the demise of the coal industry, a trend Donald Trump vowed to reverse if he were elected president. Instead, he has put forth a budget proposal that would eliminate programs that support unemployed coal miners and people from other struggling industries in Appalachia.