‘White working-class deaths to be elevated for a generation’
Outcomes are poised to worsen as the middle-aged fare badly
Deaton and Case expand on earlier findings about mortality
Researchers who sounded the alarm on increasing white working-class mortality blamed the trend Thursday on economic upheaval that created a web of social issues so tightly interwoven that even successful policies would take years to unsnarl them.
Mortality and morbidity, which measure chances of death or illness within an age group, began climbing in the late 1990s for less-educated whites between 45 and 54. That came as progress against heart disease and cancer slowed and drug overdoses, suicide and alcoholism — so-called “deaths of despair” — became pervasive.
Distress born of globalization and technological change probably drove the deadly outcome, new research by Princeton University’s Anne Case and Nobel Prize winner Angus Deaton shows. Their findings point to a cycle of despair that’s deepening: Middle-aged whites today are more likely to report pain and mental-health problems than their predecessors and are experiencing symptoms of alcoholism at a younger age.
“Policies, even ones that successfully improve earnings and jobs, or redistribute income, will take many years to reverse the mortality and morbidity increase,” Case and Deaton write in their paper. “Those in midlife now are likely to do much worse in old age than those currently older than 65.”
Less-educated whites are unique in their plight. Mortality has continued its long-run decline for whites with bachelor’s degrees, Hispanics and blacks. In 1999, the rate for whites between 50 and 54 with only high-school degrees was 30 percent lower than the mortality rate of blacks that age. By 2015, it was 30 percent higher, a cross-over echoed across age groups.
The problem bucks a global trend: Middle-aged mortality has been falling globally, even in other advanced economies like the U.K. Adult mortality improvements have been most striking in developing countries, according to United Nations data.
While high school-only Americans earn far less than peers with a bachelor’s degree — about 60 cents on the dollar — income inequality itself doesn’t seem to be the driver of white woe. Blacks and Hispanic Americans fare even worse economically, yet they’ve made consistent gains in combating mortality and morbidity. And in Europe and the U.K., where income divides have also widened, mortality has been declining across demographics.
In the eyes of Case and Deaton, a 2015 economics laureate for his analysis of consumption, poverty and welfare, the decline is a story of cumulative disadvantage. While minorities have a long history of economic struggle, white Americans could once expect a secure job, family life and future with only a high-school degree. But unions, factories and mines began to decline in the 1970s, taking with them high-paying jobs.
In response, college attendance increased. Those who didn’t go found themselves in lower-paying jobs or left the labor market entirely, pushing down participation for those with less than a bachelor’s degree.
As opportunities eroded, so did institutions that composed the backbone of middle-class existence. Traditional churches ceded ground to creeds that emphasize individualism — as a result, people feel increased responsibility for their own successes or failures. Marriage became less common as men became less likely to work, leaving both genders with less stability.
“The story is rooted in the labor market, but involves many aspects of life, including health in childhood, marriage, child rearing, and religion,” the authors wrote.
Without their traditional moorings, whites increasingly turned to chemical crutches. Alcoholism worsened. Suicide climbed. And when doctors began to hand out opioid prescriptions more freely during the 1990s, addiction took root.
These days, more Americans die from drug overdoses than car accidents — the former killed about 47,000 people in 2015, while the latter fewer than 38,000. Opioids specifically killed 33,000 people in 2015, and the vast majority overdosing are white.
“Although we do not see the supply of opioids as a fundamental factor, the prescription of opioids for chronic pain added fuel to the flames,” Deaton and Case wrote. “Controlling opioids is an obvious priority, as is trying to counter the negative effects of a poor labor market on marriage, perhaps through better safety nets for mothers with children.”
Case and Deaton’s story chimes with America’s recent politics. President Donald Trump did far better than Mitt Romney, the 2012 Republican candidate, in counties with higher drug, alcohol and suicide mortality, according to research by Pennsylvania State University assistant professor Shannon Monnat.
“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,” Monnat wrote. “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 decades.”