In “Mortality and morbidity in the 21st Century,” Princeton University professors Anne Case and Sir Angus Deaton, a Nobel Memorial Prize winner, follow up on their groundbreaking 2015 paper to explore patterns and causes of increased middle-aged white mortality. They find a deep divide among white non-Hispanics based on education level, with those without a college degree experiencing a surprising rise in mortality, while those with a college degree are experiencing a decrease (similar to what has occurred in other developed countries at all education levels). Mortality rates of whites with no more than a high school degree, which were around 30 percent lower than mortality rates of blacks in 1999, grew to be 30 percent higher than blacks by 2015, which is in line with recent literature pointing to lesser-educated whites losing ground to other groups in various life measures.
Case and Deaton found that both white men and white women are facing a mortality crisis with deaths of despair rising in parallel. White deaths of despair have increased in all regions of the country, at every level of urbanization. The states with the highest mortality rates from drugs, alcohol and suicide, among white non-Hispanics aged 45-54 in 2015, are geographically scattered. Many states in the Mountain Division (Nevada, New Mexico, Arizona, Utah and Wyoming), together with West Virginia, Kentucky, Oklahoma, Tennessee, and Florida, had mortality rates from deaths of despair above 100 per 100,000 people in 2015. This puts mortality from drugs, alcohol and suicide on par with heart disease mortality in these 10 states, and well ahead of deaths from transport accidents there (19 per 100,000) and assault (5 per 100,000) for this group.
Overall, the authors note that while there have been mortality advancements from improved health care treatment of cancer and heart disease, as well as improvements from fewer people smoking, those gains are slowing, especially from heart disease mortality, and have been offset by the deaths of despair. While other wealthy countries — the UK, Germany, France, Sweden, Australia and Canada — continued to make progress in mortality rates, the U.S. did not: These countries on average experienced a decline in mortality rates for men and women aged 50-54 of 1.9 percent per year between 1999 and 2014, while rates for U.S. white non-Hispanics increased by 0.5 percent a year.
Case and Deaton document an accumulation of pain, distress and social dysfunction in the lives of working class whites that took hold as the blue-collar economic heyday of the early 1970s ended, and continued through the 2008 financial crisis and the subsequent slow recovery. Each successive birth cohort of men leaving school with less than a B.A. does worse than the previous cohort, at the beginning of their careers, and worsening further as they age. They are less likely to be in the labor force at any given age, while those who work face lower real wages and lower returns to experience. Men and women in successive cohorts are less likely to be married at any given age, perhaps as a consequence of poor labor market opportunities. Each successive cohort reports more pain, more mental distress, heavier drinking, as well as lack of social connection. Each is observed to have higher mortality rates from drugs, alcohol and suicide than the preceding cohort.
The Case-Deaton analysis is pessimistic about the future, concluding that those who are currently suffering in midlife are likely to be much less healthy in old age than are the current elderly.
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