http://www.npr.org/sections/health-shots/2017/03/23/521083335/the-forces-driving-middle-aged-white-peoples-deaths-of-despair
[images and links in on-line article]
Public Health
The Forces Driving Middle-Aged White People's 'Deaths Of Despair'
March 23, 20175:00 AM ET
Jessica Boddy
In 2015, when researchers Anne Case and Angus Deaton discovered that
death rates had been rising dramatically since 1999 among middle-aged
white Americans, they weren't sure why people were dying younger,
reversing decades of longer life expectancy.
Now the husband-and-wife economists say they have a better understanding
of what's causing these "deaths of despair" by suicide, drugs and alcohol.
In a follow-up to their groundbreaking 2015 work, they say that a lack
of steady, well-paying jobs for whites without college degrees has
caused pain, distress and social dysfunction to build up over time. The
mortality rate for that group, ages 45 to 54, increased by a half
percent each year from 1999 to 2013.
But whites with college degrees haven't suffered the same lack of
economic opportunity and haven't seen the same loss of life expectancy.
The study was published Thursday in Brookings Papers on Economic Activity.
Case and Deaton, who are both at Princeton University, spoke with NPR's
David Greene about what's driving these trends. The interview has been
edited for brevity and clarity.
Interview Highlights
On the original discovery of rising mortality rates for middle-aged whites
Angus Deaton: Mortality rates have been going down forever. There's been
a huge increase in life expectancy and reduction in mortality over 100
years or more, and then for all of this to suddenly go into reverse [for
whites ages 45 to 54], we thought it must be wrong. We spent weeks
checking out numbers because we just couldn't believe that this could
have happened, or that if it had, someone else must have already
noticed. It seems like we were right and that no one else had picked it up.
We knew the proximate causes — we know what they were dying from. We
knew suicides were going up rapidly, and that overdoses mostly from
prescription drugs were going up, and that alcoholic liver disease was
going up. The deeper questions were why those were happening — there's
obviously some underlying malaise, reasons for which we [didn't] know.
On what's driving these early deaths
Anne Case: These deaths of despair have been accompanied by reduced
labor force participation, reduced marriage rates, increases in reports
of poor health and poor mental health. So we are beginning to thread a
story in that it's possible that [the trend is] consistent with the
labor market collapsing for people with less than a college degree. In
turn, those people are being less able to form stable marriages, and in
turn that has effects on the kind of economic and social supports that
people need in order to thrive.
In general, the longer you're in the labor force, the more you earn — in
part because you understand your job better and you're more efficient at
your job, you've had on-the-job training, you belong to a union, and so
your wages go up with age. That's happened less and less the later and
later you've been born and the later you enter this labor market.
Deaton: We're thinking of this in terms of something that's been going
on for a long time, something that's emerged as the iceberg has risen
out of the water. We think of this as part of the decline of the white
working class. If you go back to the early '70s when you had the
so-called blue-collar aristocrats, those jobs have slowly crumbled away
and many more men are finding themselves in a much more hostile labor
market with lower wages, lower quality and less permanent jobs. That's
made it harder for them to get married. They don't get to know their own
kids. There's a lot of social dysfunction building up over time. There's
a sense that these people have lost this sense of status and belonging.
And these are classic preconditions for suicide.
Case: The rates of suicide are much higher among men [than women]. And
drug overdoses and alcohol-related liver death are higher among men,
too. But the [mortality] trends are identical for men and women with a
high school degree or less. So we think of this as people, either
quickly with a gun or slowly with drugs and alcohol, are killing
themselves. Under that body count there's a lot of social dysfunction
that we think ultimately we may be able to pin to poor job prospects
over the life course.
On how mortality rates differ among races
Deaton: Hispanics [have always had lower mortality rates] than whites.
It's a bit of a puzzle that's not fully resolved, to put it mildly. It's
always been true that mortality rates have been higher and life
expectancy shorter for African-Americans than for whites. What is
happening now is that gap is closing and, for some groups, it's actually
crossed. What we see in the new work is if you compare whites with a
high school degree or less, at least their mortality rates are now
higher than mortality rates for African-Americans as a whole. If you
compare whites with a high school degree or less with blacks with a high
school degree or less, their mortality rates have converged. It's as if
poorly educated whites have now taken over from blacks as the lowest
rung of society in terms of mortality rates.
On the geography of mortality rates
Case: There's not a part of the country that has not been touched by
this. We like to make the comparison between Nevada and Utah to look at
the extent to which good health behaviors lead to longer life.
Two-thirds of Utahans are Mormons. They don't drink, they don't smoke
and they don't drink tea or coffee. Two-thirds of Nevadans live in Las
Vegas paradise, where there is a little more of everything, so the heart
disease mortality rates are twice as high in Nevada as they are in Utah.
But both states are [in the] top 10 for deaths of despair. Utah has had
a terrifically hard time dealing with the opioid crisis, and suicide
rates [are] going up as well. There's a lot of surprise here in parts of
the country that we weren't really expecting to see.