Why Deaths of Despair Are Rising

Deaths of Despair, a new book by Princeton economics professors Anne Case and Angus Deaton, begins with some sunny facts. For a little more than a hundred years in the United States, beginning in 1900, mortality declined. Life expectancy at birth went from 49 to 77 years, increasing by nine years between 1970 and 2000 alone. At the start of this period, the main causes of death were infectious diseases: tuberculosis, pneumonia, and gastrointestinal infections. The influenza epidemic of 1918 and two world wars briefly reduced life expectancy, but in general, advances in science meant that more people in the U.S. lived, and they lived longer. People survived the vulnerable years of infancy to the more resilient years of adulthood, and coasted through the once-again vulnerable years of old age. It’s a story we love to tell: Progress. Science. Triumph over diarrhea.

Death in midlife is especially uncommon. In 1900, for white men and women aged 45–54, there were 1,500 deaths per 100,000. By 2000, there were about 400. If trends continued, it would have been somewhere around 250 today. But after the year 2000, something happened. The mortality rates for middle-age white, non-Hispanic people without a college degree stopped declining. And then they went up. These people weren’t dying of an infectious disease or a violent global war; they were dying of suicide, drug overdoses, and alcoholic liver disease and cirrhosis, or what Case and Deaton call “deaths of despair.” The authors note that in 2017 alone, 158,000 Americans died these “deaths of despair.” “That is,” they write, “the equivalent of three full 737 MAXs falling out of the sky every day, with no survivors.” In another comparison, the number of people in the U.S. who would still be alive if declining mortality trends had continued after 2000 is around 600,000, compared to the 675,000 people who died in the HIV/AIDS crisis beginning in the 1980s. Simply put, the white working class is dying at an unprecedented rate. Read Full Article »