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United States of Despair

Jun 15, 2020 Anne Case , Angus Deaton

America finds itself in the grips of two epidemics, each of which has exposed deep inequalities across races and levels of educational attainment. Between rising "deaths of despair" among working-class whites and higher COVID-19 mortality rates among African-Americans, the stunning secular decline in US life expectancy will continue.

PRINCETON – Well before COVID-19 struck, there was another epidemic running rampant in the United States, killing more Americans in 2018 than the coronavirus has killed so far. What we call “deaths of despair” – deaths by suicide, alcohol-related liver disease, and drug overdose – have risen rapidly since the mid-1990s, increasing from about 65,000 per year in 1995 to 158,000 in 2018.

The increase in deaths from this other epidemic is almost entirely confined to Americans without a four-year college degree. While overall mortality rates have fallen for those with a four-year degree, they have risen for less-educated Americans. Life expectancy at birth for all Americans fell between 2014 and 2017. That was the first three-year drop in life expectancy since the Spanish flu pandemic of 1918-19; with two epidemics now raging at once, life expectancy is set to fall again.

Behind these mortality figures are equally gloomy economic data. As we document in our book, real (inflation-adjusted) wages for US men without a college degree have fallen for 50 years. At the same time, college graduates’ earnings premium over those without a degree has risen to an astonishing 80%. With less-educated Americans becoming increasingly less likely to have jobs, the share of prime-age men in the labor force has trended downward for decades, as has the labor-force participation rate for women since 2000.

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Anne Case

Writing for PS since 2020
2 Commentaries

Anne Case is Professor Emeritus of Economics and Public Affairs at Princeton University. She is the co-author of Deaths of Despair and the Future of Capitalism (Princeton University Press, 2020).

Angus Deaton

Writing for PS since 2015
14 Commentaries

Angus Deaton, the 2015 Nobel laureate in economics, is Professor Emeritus of Economics and International Affairs at the Princeton School of Public and International Affairs and Presidential Professor of Economics at the University of Southern California. He is the co-author of Deaths of Despair and the Future of Capitalism (Princeton University Press, 2020).

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0 Comments on this paragraph, 28 in all 28 Comments on this article

Ian Maitland Jul 20, 2020

“There is little relationship between the opioid crisis and contemporaneous measures of labor market opportunity.”
https://www.nber.org/papers/w27544#fromrss
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Edwin Hoffman Jul 5, 2020

How many “America Is Finished” pieces before PS risks appearing prejudicial to well-informed readership?
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Curtis Carpenter Jun 22, 2020

When Nietzsche informed us all that God was dead, he neglected to mention that Economics and the profit motive had stepped in to fill the vacuum. And when Marx tried to call this to our attention, the world's capitalist responded with absolute horror and some significant bloodletting.

So here we are -- finding ourselves somewhat ironically needing Nietzsche again to inform us that what is needed is a revaluation of our values.
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Ian Maitland Jun 22, 2020

Case & Deaton tell us that "[t]he federal government has given pharmaceutical companies billions of public dollars to develop a vaccine and, thanks to lobbyists, did not attach conditions on pricing or impose public claims on patents."

Whoa there. Only thanks to lobbyists? Maybe opponents of attaching government strings to patents asked themselves a question that hasn't crossed Case & Deaton's minds. Does it make sense to start threatening patent fights with companies when we need to mobilize them to fight the greatest health care challenge we have ever known?

As Helen Branswell presciently wrote in 2018, "Every few years an alarming disease launches a furious, out-of-the-blue attack on people, triggering a high-level emergency response. SARS. The H1N1 flu pandemic. West Nile and Zika. The nightmarish West African Ebola epidemic.

In nearly each case, major vaccine producers have risen to the challenge, setting aside their day-to-day profit-making activities to try to meet a pressing societal need. With each successive crisis, they have done so despite mounting concerns that the threat will dissipate and with it the demand for the vaccine they are racing to develop.

Now, manufacturers are expressing concern about their ability to afford these costly disruptions to their profit-seeking operations. As a result, when the bat-signal next flares against the night sky, there may not be anyone to respond."
- Curtis Carpenter Jun 22, 2020
  
  Somehow I think Big Pharma will find a way to survive its mass altruism and continue to pump billions into advertising and lobbying.
  
  Push comes to shove, they can always raise the price of insulin... or any other product they can "price to value" where "value" depends on one's desire to live a while longer.
  - Ian Maitland Jun 22, 2020
    
    How many tens or hundreds of millions -- or billions? -- of lives are you prepared to sacrifice in your jihad against corporate America?
    - Curtis Carpenter Jun 22, 2020
      
      I have no problem with "corporate America" or with corporatism in general. My problem is with exploitation capitalism and the notion that every aspect of human existence can be understood and appreciated in the context of an economic, "free market" paradigm.
      
      How much are you prepared to pay to stay alive for another few weeks?
      - Ian Maitland Jun 22, 2020
        
        We are discussing a particular context -- pharmaceutical innovation -- and my question remains the same: How many lives are you prepared to sacrifice on the altar of your ideology?
        
        Curtis Carpenter Jun 22, 2020
        
        Get over yourself Ian.
        
        Whoever told you you had been appointed Grand Inquisitor was pulling your leg.
        
        If you insist though, you go first and answer my question. In U.S. dollars please.
        
        P. Kamath Jun 23, 2020
        
        He is counting using his abacus. Please be patient.
        
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Ian Maitland Jun 21, 2020

Another apparent anomaly for Case/Deaton to explain:

1. "What we call 'deaths of despair" – deaths by suicide, alcohol-related liver disease, and drug overdose – have risen rapidly since the mid-1990s...." Case & Deaton today.

2. "[R]eal (inflation-adjusted) wages for US men without a college degree have fallen for 50 years." Case & Deaton today.

3. Since 2005, "[d]eath rates have been increasing for middle-aged white women, decreasing for men" (Andrew Gelman 2015).

Doesn't it seem problematic for the "deaths of despair" hypothesis that it is less educated men who are suffering the declining wages and job loss, but it is less educated women who are doing the increased dying? Haven't women's wages actually increased over the relevant periods?
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Ian Maitland Jun 21, 2020

Please could Case & Deaton explain the following apparent discrepancy.

1. "Behind these mortality figures are equally gloomy economic data. As we document in our book, real (inflation-adjusted) wages for US men without a college degree have fallen for 50 years." Case & Deaton today.

2. "Many commentators have suggested that the poor mortality outcomes can be attributed to slowly growing, stagnant, and even declining incomes; we evaluate this possibility, but find that it cannot provide a comprehensive explanation. In particular, the income profiles for blacks and Hispanics, whose mortality has fallen, are no better than those for whites." Case & Deaton in 2017 (Mortality & Morbidity in the 21st Century).
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Ian Maitland Jun 21, 2020

I suppose that, in principle, the following two findings might both be true. But maybe you can see why I don't trust economists bearing tales of surging inequality.

1. Case & Deaton: Over the past 50 years "college graduates’ earnings premium over those without a degree has risen to an astonishing 80%."

2. Auten & Splinter: "[S]ince the early 1960s, increasing government transfers and tax progressivity resulted in little change in after-tax top income shares."
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Andrew Baldwin Jun 21, 2020

Interesting article. It is too bad that Anne Case ignores the case for Official Poverty Measure (OPM) being improved by switching from the CPI-W to the chained CPI as its escalator. I recently brought up the issue with her, but she hasn’t chosen to respond. Improving the precision of our inflation measures is an issue on which all economists should be in agreement.
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Peter Schaeffer Jun 19, 2020

One of the things I found stunning back in 2016, was how satisfied upscale liberals were with the status quo. Sort of like cliche Republicans back in the 1950s. Of course, you would expect some complacency back then, given that the Democrats had ruled the White House for two terms. However, the prevailing worldview went way beyond that. More of a "Duloc is a perfect place" kind of thing.

The unholy marriage of left-wing identity politics and right-wing neoliberalism was in full swing. The HRC crowd though that life was perfect.... And it probably was for them. Not so much for America.
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Leo Arouet Jun 18, 2020

They are right: the future cannot be so bright, without falling into the negative, due to the low commitment to climate change and the reduction of CO2 emissions. Therefore, the future may or may not be hopeful.
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Elizabeth Pula Jun 17, 2020

Cynthia Chung in these two articles:
https://www.strategic-culture.org/news/2020/06/14/enemy-within-story-purge-american-intelligence/
https://www.strategic-culture.org/news/2019/11/24/on-churchills-sinews-of-peace/

traces, with perceptive skill and a very reasonable tone, the unexpected despair of the "common man". What was initiated by Roosevelt has created radically transiting results. The included conversation as quoted from Roosevelt's son gives a probing insight to the transitions.

Churchill was a statesman with a view from a British imperialistic stance. He did deliver passionate messaging for the world at that time, just significantly not to or for all. Political legacies are lucky to establish temporary fields of focus. Roosevelt attempted to further the vision of the enlightenment movement. Chung is able to temper the passion of that era's imperfections.

Excuse does not absolve the past, and neither does blame.

Guilt and Truth are relatives.

Paths to understanding meander, correcting time.

Struggle is constant.
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j. von Hettlingen Jun 16, 2020

Anne Case and Angus Deaton say the US is engulfed by two epidemics – the “deaths of despair” from suicide, drug overdoses and alcoholic liver disease, and the Covid-19 related deaths. The two epidemics expose “deep inequalities across races and levels of educational attainment.” Before Covid-19 struck, the other epidemic has been running rampant since the mid-1990s, killing working-age white men and women at unprecedented rates. The current pandemic is seeing higher Covid-19 deaths among African-Americans. Nevertheless, both cases show “the stunning secular decline in US life expectancy.”
The authors – a team of spouses with Case being a top expert on the links between economic and health status, and Deaton a Nobel laureate known for his work on household poverty and welfare – give a disturbing account of life expectancy in the world’s wealthiest nation in their new book, Deaths of Despair and the Future of Capitalism. In 2015, life expectancy fell for the first time in decades. Then it fell again in 2016 – and for a third time in a row in 2017. Outside of wars or pandemics, life expectancy has been consistently rising across the world.
Although the “deaths of despair” in the US that predated Covid-19 have exposed the “pre-existing inequalities,” no vaccine would be able to inject optimism, help reduce anxiety, ease fears and pains. Deaths of despair, while less visible and less broadly disruptive than Covid-19, is equally devastating as the coronavirus, preying disproportionately on low-income and less-educated white working-class Americans. In 2017 alone, there were 158,000 deaths of despair. Their loss of life was preceded by a loss of jobs, community and dignity, and whose deaths are inextricably linked to the policies and politics that had transformed the US economy and increased inequalities.
The authors focus on the white working class because it is undergoing a particularly harrowing shift. However they do not believe that this demographic matters more than others, nor it is worse off in absolute terms than others. Death rates among African Americans remain persistently higher than those of their white counterparts, even considering the increased deaths of despair among white Americans. But black death rates are falling faster than white rates, which involve mainly deaths of despair among white citizens.
The main reason why death rates of blacks fell more rapidly than death rates of whites at the beginning of the twenty-first century is that blacks were not suffering the epidemic of overdoses, suicide, and alcoholism, according to the authors. They “do not believe that the post-Covid-19 economy will provoke a spike in deaths of despair. The fundamental cause of that epidemic, our analysis suggests, was not economic fluctuations, but rather the long-term loss of a way of life among white working-class Americans.”
The grim irony of this discrepancy is that the appearance of African American progress itself may be a contributing factor in the rising deaths of despair among white Americans. Case and Deaton mention a survey published in 2017 finding that more than half of white working-class Americans believe that discrimination against whites is as big a problem as discrimination against minority groups. Yet more than two-thirds of college-educated white Americans disagree. However Trump has hijacked the grievances of the whites to garner their support, vowing to fight the opiod crisis.
The authors conclude that the simultaneous erosion of work and community life, together with “at least the perception of a loss of racial privilege,” forms a potent combination, more powerful than simply income losses. They believe “the most likely post-Covid America will be the same as pre-Covid America, only with even more inequality and dysfunction. True, public anger over police violence or outrageously expensive health care could create a structural break.” Even so, real changes take time.
Popular grievances among white working class Americans fuel the rise of populism and might help Trump win again this year. But another four years of Trump will not improve their fortunes, because Republicans have no appetite to provide for the current and future generations, citing they can not afford a budget overreach. Many millennials fear being worse off than their parents, given the grim economic prospects. This despair has driven their elderly counterparts to suicide, drug and alcohol abuses. It is imperative that they do not follow in their footsteps. To start with they need to vote in November.
- nigel southway Jun 21, 2020
  
  For who? Sleepy joe?
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Peter Schaeffer Jun 15, 2020

Alas, the facts don’t support the hype. Quote from the CDC

“From 2010 through 2014, life expectancy increased 0.2 years for the total population and increased 0.3 years for males and females (Table 1). From 2014 through 2017, life expectancy decreased 0.3 years for the total population, 0.4 years for males, and 0.2 years for females (1). However, between 2017 and 2018, life expectancy increased 0.1 year for the total population, males, and females (2). Life expectancy in 2018 was at the level most recently reached in 2015 and 2016 for the total population, in 2016 for males, and in 2013 by females, which was 0.2 years below the peak in life expectancy for the total population in 2014, 0.3 years below the peak for males in 2014, and 0.1 year below the peak for females in 2014.”

Overall, life expectancy rose in the early Obama administration, fell in the late Obama administration, and then rose again under Trump. From 2010 to 2018 there was no overall change in life expectancy.
- Michael Public Jun 17, 2020
  
  You need to split your figures into those who have a 4 year degree and those who don't. Else two opposing trends are obscured by a non-moving average.
  - Peter Schaeffer Jun 17, 2020
    
    MP, I looked for some data on this subject. It turns out to be tangled and inconclusive. It is clearly true, that better educated people live longer. This is true for a long list of countries and time periods. However, finding trends is more complicated. Some studies show that the education/life expectancy gradient is actually declining over time. The bottom line on this is not clear.
    - nigel southway Jun 21, 2020
      
      Goes to show you can cherry pick any data
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Emanuel Müller Jun 15, 2020

Might the decline of the life expectancy of the working-class whites be inversely proportional to the rise of the life expectancy of robots?
- Michael Public Jun 17, 2020
  
  Absolutely. Of the 'good working class jobs' that evaporated, some went to China and Mexico but the vast majority got automated by robots. Not robots with AI, but production lines and automated welders that have been available for decades already. AI will just make it worse, because it will being automation out of the factory and into vehicles, stores and warehouses - to say nothing of certain white collar jobs too.
  - nigel southway Jun 21, 2020
    
    90% of the job loss was outsourcing not automation
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  - Peter Schaeffer Jun 19, 2020
    
    MP, You are repeating the conventional wisdom... That factory jobs were lost to automation. There is only one problem. It's not true. Take a look at FRED series MANEMP. Bush and the WTO wiped out manufacturing employment. Note the dramatic fall in jobs after 2000. Nice theory (automation), but the facts are otherwise.
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