Update on deaths of despair

Christophe Dessaigne, "Hour of Despair", 2012, via Midnight-Artwork.

In 2015, two Princeton economists, Anne Case and Angus Deaton, startled the world with the information that there was a group of Americans for whom life was getting shorter, unlike any demographic more or less anywhere in decades, in their paper "Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century", which found that mortality among white Americans ages 45-54 was rising, mostly due to mental health issues and somatic pain, with drug and alcohol abuse and suicide (I touched on it here), or what they've been calling "deaths of despair".

Since then we've learned somewhat more about the situation, notably that it's especially women, not men, who are dying too early, counter to the facile stereotype according to which the whole thing is a tragic outcome of that rust belt problem of men without college degrees losing factory jobs as the economy changes from manufacturing to services, but that the places where the deaths are occurring are the same as the places where the Trump vote dominates, relatively rural, racially homogeneous regions in a state of economic decline, as if voting for Trump were just another kind of suicidal behavior, an expression of nihilistic despair—but the people who are dying aren't significantly voting for Trump, or at all; the Trump voters are people who live in the same places but are rather better off, older and the owners of small businesses, marked less by economic anxiety than animus against the black Americans and Latino immigrants who aren't even there.

Now Case and Deaton have published a followup paper, "Mortality and morbidity in the 21st century", incorporating these findings into their broad picture and also offering some important comparison between the situation in the US and that in other countries. I heard about it first on NPR last week, where the interview scuddered to a sudden end just at the moment when I was getting really interested:

GREENE: And we should say, this is - if you compare the United States to other comparable countries, wealthy countries, I mean, this is not being seen in other parts of the world.

DEATON: That's right. You see tiny traces of it. Canada thinks they have an opioid problem, for instance. We saw some of it in Scotland at some point when we looked. But there - when you put it on the same picture as the U.S., the U.S. just dwarfs it. It may be to do - Europe has a much more advanced social safety net than we have in the U.S., which of course we're in the process of taking apart, making an even further gap from what happens in Europe.

GREENE: Angus Deaton and Ann Case, thank you to you both.

DEATON: OK. Thank you.

There's now a two-part hypothesis on death by despair, to account for (a) why it's happening here and (b) why it isn't happening elsewhere, and the second part isn't getting a lot of coverage, though it doesn't always get cut off as abruptly as it did on Morning Edition.

The causes, as reported by Alana Semuels in The Atlantic, are fairly familiar:

It couldn’t be purely the economic pain they faced in the wake of globalization; after all, European countries are also affected by globalization, and their residents are getting healthier and living longer. And non-whites in the U.S. are living longer than they used to as well, and they are subject to the same economic forces as middle-age whites and are struggling, at least in economic terms, even more....

...as people get older and their fates deviate more and more from those of their parents, they struggle to keep their lives together.  The very act of doing worse than their parents’ generation—what Case and Deaton call “cumulative disadvantage”—is killing them. 

While black and Latino Americans, facing more absolute hardship than whites, aren't seeing their situation getting worse relative to the past, and are therefore much less susceptible to this kind of despair.

It's interesting to note the irrelevance of the aspects a David Brooks might want to stress, the moral difference between "conservative" rectitude and "liberal" laxness, from the NPR report:

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.

(Priceless update via Alicublog: Megan McArdle has just visited Utah and thinks it's paradise because of its churchy philanthropy making government unnecessary and ethnic homogeneity eliminating tension from the project of running around ordering people to pull their socks up.)

But the thing I can't get over is the clear evidence that social democracy as practiced in Europe provides a cushion against American-style despair:

Case and Deaton theorize that this trend is not happening in Europe because of the social safety net there. While middle-aged whites in the United States are left adrift once economic opportunities go away, those in Europe are provided with financial support and health care that make it easier to be satisfied with life, Deaton believes. What’s more, Europeans enter into more stable cohabiting relationships than Americans do, providing a stronger support network than Americans have. This may also be linked to the safety net: Single parents in Britain don’t need to seek additional partners for financial stability because they receive child allowances, for example.

I love that last bit, as an answer to Brooks: marriage is getting as rare in Europe as it is in the US, but European unmarriages last longer, because of the government's generosity!

Conservatives like to argue that a strong social democratic safety net is bad for a community, because it makes life too easy, and people won't be driven to "innovate" if they're comfortable. I don't even believe this at any level (if the American economy has been more innovative historically it's been during periods when Americans generally had more economic security than Europeans, and wider opportunity through state support, easy credit and easily available higher education, the things that began to shut down during the 1970s). But what we're seeing here is evidence not so much that the conservative theory is wrong as that it's evil; it literally kills people, in large numbers, during the inevitable bad times, and it needs to stop.