Painting by Édouard Manet
In November 2015 two Princeton economists, Anne Case and Angus Deaton (a Nobel Prize winner), released a revealing study, “Rising morbidity and mortality in midlife among whitenon-Hispanic Americans in the 21st century.” It was published in the prestigious Proceedings of the National Academy of Sciences. The economists’ findings were scary: “Over the 15-y[ear] period, midlife all-cause mortality fell by more than 200 per 100,000 for black non-Hispanics, and by more than 60 per 100,000 for Hispanics. By contrast, white non-Hispanic mortality rose by 34 per 100,000.”
In one of their few non-technical digressions, the scholars acknowledge: “After the productivity slowdown in the early 1970s, and with widening income inequality, many of the baby-boom generation are the first to find, in midlife, that they will not be better off than were their parents. Growth in real median earnings has been slow for this group, especially those with only a high school education.”
In a 2017 follow-up, Case and Deaton published a revealing, if scarier, study, “Mortality and Morbidity in the 21st Century.” Their findings are alarming:
We find that mortality and morbidity among white non-Hispanic [WNH] Americans in midlife since the turn of the century continued to climb through 2015. Additional increases in drug overdoses, suicides, and alcohol-related liver mortality — particularly among those with a high school degree or less — are responsible for an overall increase in all-cause mortality among whites.
They persuasively argue that this developed is “triggered by progressively worsening labor market opportunities at the time of entry for whites with low levels of education.”
While most Americans are ever-fearful of cancer and heart disease, the scholars note that declines in these conditions has been offset by “increases in drug overdoses, suicides, and alcohol-related liver mortality in this period.” They identify this growing condition as “deaths of despair” and it is leading to increased mortality among middle-aged NWH men and women. Sadly, many of these people are Trump supporters.
In their rigorous study, Case and Deaton argue, “deaths of despair are a large and growing component of midlife all-cause mortality.” They repeated stress that this is very much a U.S. phenomenon and is in marked contrast to the mortality rates of “other wealthy countries” (i.e., Europe and Japan).
They show that between 1998 and 2015, the mortality rate for men age 50–54 with less than a bachelor’s degree increased by 14 percent (from 762 to 867 per 100,000) while the rate for men with a bachelor’s degree or more it fell by 30 percent (349 to 243.)
Equally significant, one of their observations challenges widely held conventions about race in the U.S. “Mortality rates of BNHs [Black Non-Hispanics] age 50–54 have been and remain higher than those of WNHs age 50–54 as a whole, but the rate for BNHs have fallen rapidly, by about 25 percent from 1999 to 2015.” They add, “as a result of this, and of the rise in white mortality, the black/white mortality gap in this (and other) age group(s) has been closing.”
Going further, they are pessimistic about the state of the nation: “Traditional structures of social and economic support slowly weakened … . Marriage was no longer the only socially acceptable way to form intimate partnerships, or to rear children.” They point out that “these changes left people with less structure when they came to choose their careers, their religion, and the nature of their family lives.”
Stepping back, they warn, “when such choices succeed, they are liberating; when they fail, the individual can only hold himself or herself responsible.” They add, “In the worst cases of failure, this is a Durkheim-like recipe for suicide.”
They also address a common assumption promoted by Joseph Stiglitz and embraced my many “progressives” – that the rise in suicides, overdoses and alcohol abuse is due to rising income inequality. “Our preliminary conclusion is that, as in previous historical episodes, the changes in mortality and morbidity are only coincidentally correlated with changes in income.” Going further they add, “We suspect that more likely causes are various slowly moving social trends — such as the declining ratio of employment to population, or the decline in marriage rates.”
Even more pessimistic, they conclude:“Ultimately, we see our story as about the collapse of the white working class after its heyday in the early 1970s, and the pathologies that accompany this decline.”
Case and Deaton are not alone in examining the growing concern of “deaths of despair.” Shortly after the 2016 election, Shannon Monnat published a revealing study, “Deaths of Despair and Support for Trump in the 2016 Presidential Election.” Her analysis is pretty straight forward: “Much of the relationship between mortality and Trump’s performance is explained by economic factors; counties with higher economic distress and larger working-class presence also have higher mortality rates and came out strongly for Trump.” She adds, “In many of the counties where Trump did the best, economic precarity has been building and social and family networks have been breaking down for several decade.”
Equally telling, she details the toll the “deaths of despair” phenomenon is taking on the American public:
Over the past decade, nearly 400,000 people in the U.S. died from accidental drug overdoses and drug-induced diseases. Nearly 400,000 more committed suicide, and over 250,000 died from alcohol-induced diseases like cirrhosis of the liver. Approximately a fifth of these drug, alcohol and suicide deaths involved opiates (prescription pain relievers or heroin), suggesting that opiates are part of a larger problem.
One needs to add the nearly half-a-million deaths over the last decade caused by cigarette smoking to the list.
Monnat details how Trump over-performed the most in counties with the highest drug, alcohol and suicide mortality rates. And that he performed best in counties with high economic distress and a large working class. She notes that “many of the counties with high mortality rates where Trump did the best have experienced significant employment losses in manufacturing over the past several decades.”
Monnat concludes on a cautionary note: “Clearly there is an association between drug, alcohol and suicide mortality and Trump’s election performance.” But she warns, “However, this relationship should not be interpreted as causal. No single factor (including race, education, income, rurality, or health) can explain this election outcome.”
That was 2016 – it’s now 2019 and the 2020 elections are beginning to heat up.
The overlapping problems of drugs, alcohol, suicide and despair kills thousands of Americans every year. Last year, the CDC reported that between 2006 and 2016 life expectancy in the U.S. rose from 77.8 to 78.6 years. However, it warned that the death rates for Americans aged 15 to 44 years rose by around 5 percent each year between 2013 and 2016.
It identified drugs, alcohol and suicide as the principle culprits and reported the following:
+ Drug overdoses killed more than 63,600 people in 2016; women saw the largest increase with those aged 45 to 54 having the most overdoses overall, but those aged 15 to 24 saw a 19 percent jump per year between 2014 and 2016.
+ Alcohol is a major public health concern with liver disease replacing HIV as the sixth-leading killer of adults ages 25 to 44 in 2016.
+ Suicide is on the rise, now the second-leading cause of death among people ages 15 to 24 between 2014 and 2016 as well as third-leading cause of death among people ages 25 to 44 killing almost 17 of every 100,000 people in 2016.
The concept of “deaths of despair” has not entered the political debate among any of the announced candidates, whether Trump or the Democrats, but the issues associated with it likely will play a critical role.
Earlier this year, Trump drew attention to the issue of drug overdoses. “Every week, 300 of our citizens are killed by heroin alone, 90 percent of which floods across from our southern border. More Americans will die from drugs this year than were killed in the entire Vietnam War,” he noted. However, his concern about drug overdoses was driven not by the humanitarian issue but by the campaign promise to build “the Wall.” “Our southern border is a pipeline for vast quantities of illegal drugs, including meth, heroin, cocaine, and fentanyl,” he said.
One can only wonder when the Democratic candidates will discover “deaths of despair” and, hopefully, begin to meaningfully speak to Trump base, thus further eroding his support and likely ending his efforts for reelection in 2020.