Deaths of Despair and the Future of Capitalism

Noted Princeton economists Case and Deaton, a winner of the Nobel Prize, examine the effects of income and educational inequality on public health. As Beth Macy's Dopesick carefully chronicled, there is a disease afoot in the land, born of economic anxiety, manifested in addiction and self-destruction. Building on a Brookings Institution paper of 2017, Case and Deaton give a name to this epidemic. In 1900, they write, the leading causes of death were infectious diseases such as tuberculosis and cholera. Writing before the unexpected onset of COVID-19, the authors mark the current leading causes as heart disease and cancer. However, especially among the poor and those without a four-year college degree, "the risk of dying in midlife from suicide, accidental drug overdose, or alcoholic liver disease" is markedly higher than in better-educated and more affluent cohorts. Thus the "deaths of despair" of the title, self-inflicted and generationally bound--for, as the authors note with grimly precise data, the chance of such a person's dying at age 45 in 1960 were half again as high as in 1950, and in 1970 more than twice as high as in 1960. "The later you were born," they conclude, "the higher your risk of dying a death of despair at any given age." The epidemic of deaths of young people today to gunshot, cirrhosis, fentanyl and opioid overdosing, and such causes is sober testimonial to the authors' mathematical reasoning. Non-college educated whites born in 1980, the authors write, are four times more likely to commit suicide as their college-educated white cohorts. Interestingly, the epidemic is not affecting other ethnicities in nearly the same numbers. What has affected nearly every group, however, is another manifestation of despair: obesity, which yields pain and often self-medication, especially among "those who are not at the top." An alarm every bit as urgent as The Jungle and a book that demands immediate attention.

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April 20, 2020
Husband and wife economists Case and Deaton (The Great Escape) analyze the factors contributing to rising death rates among white, working-class Americans in this grim yet galvanizing account. Attributing much of the overall increase to suicides, drug overdoses, and alcoholic liver disease, Case and Deaton show that 158,000 people succumbed to such “deaths of despair” in 2017 (“the equivalent of three full 737s falling out of the sky every day, with no survivors”). They also note that the mortality rate among white men aged 45–54 without a bachelor’s degree has increased 25% since the early 1990s, while decreasing 40% for those with a college diploma. Looking behind the numbers, Case and Deaton examine how solid, blue-collar jobs that could support a stable family life have been replaced by low-paying service industry jobs, contributing to wage stagnation; the role of the pharmaceutical industry in the opioid epidemic; and deficiencies in American health care (“a disgrace”). In a brisk final chapter, they outline possible reforms, including universal health care, wage subsidies, the loosening of patent protections to buoy business innovation and competition, and German-style apprenticeship programs as a college alternative. Complementing their candid prose with enlightening charts and graphs, Case and Deaton make the scale and immediacy of the problem crystal clear. This is an essential portrait of America in crisis.