What you once may have sensed has now been documented: Something has gone dramatically and tragically amiss with white working-class America.
Among middle-aged white Americans with a high school degree or less, the death rate from drug and alcohol overdoses quadrupled in the 14-year period between 1999 and 2013. The suicide rate in that group rose by a heartbreaking 81 percent. Death by diseases associated with alcohol abuse rose by 50 percent. That’s an awful lot of pain and tragedy.
And in an era when the overall death rate for every other demographic group fell significantly, the death rate among working-class, middle-aged white Americans reversed itself and instead jumped by a magnitude seldom seen in modern times. Anne Case and Angus Deaton, the authors of a newly published study in the Proceedings of the National Academies of Science, estimate that almost half a million additional people in that group have died as a consequence.
Half a million additional dead over a 14-year period — that is an epidemic. According to Case and Deaton, in scale it is “comparable to lives lost in the U.S. AIDS epidemic through mid-2015,” which is a much longer time frame.¹
But the impact is not measured in death rates alone, because Americans in this demographic group have suffered a significant decline in mental and physical well-being as well. According to the Case-Deaton study, white middle-aged Americans report suffering much more physical pain and psychological distress than earlier generations, and the percentage who report that health problems prevent them from working doubled between 1999 and 2013, which suggests why enrollment in the Social Security disability program has jumped.
So let’s move from the hard science to an exploration of possible causes, where by necessity we are on less stable ground. Given the nature of this epidemic, we can’t go looking for the equivalent of the virus that we now know causes AIDS. We have to ask: What has happened to white working-class Americans in the time frame at issue that might account for such an extraordinary change not just in their lifespans but in the quality of life as well?
That question bring us inevitably into economics, and from there into politics. During the time frame in question, earnings for those with a high school diploma or less have fallen significantly thanks to a combination of technology and overseas competition. Manufacturing jobs have been replaced by lower-paying service jobs. Jobs that require no more than a high school degree and that also pay a decent wage and provide health insurance have all but vanished, as have the pensions that once gave working-class Americans cause to hope for easier days to come.
In short, it is hard not to see a historic leap in drug abuse, alcoholism and suicide as an epidemic born of hopelessness.
In our political debate, we are wrangling over the basic question of how to respond to an economy that both major parties now acknowledge has changed in fundamental ways. Some argue that in the face of such change, it is a fiscal and moral imperative to reduce spending on programs such as Medicare, Medicaid, Social Security, food stamps, housing, job training, day care and tuition assistance. They believe that social programs designed to alleviate economic stress have instead undercut our national work ethic, producing a “culture of dependency”. And I suppose you could try to argue that this alleged growth in government dependency is somehow responsible for the despair behind a fourfold increase in death by drug and alcohol overdose, or an 81 percent increase in suicide.
But there’s a fatal flaw in that theory. As Case and Deaton point out, this epidemic is a purely American phenomenon. Similar populations in other Western industrialized countries have suffered similar or even greater economic setbacks, “yet none have had the same mortality experience.” (Russia — neither Western nor industrialized — would be the exception regarding mortality, and again unmitigated economic distress may be the common factor.) In all of those other Western countries, the social safety net is considerably more substantial than it is here in the United States. That would seem to argue that programs that enhance a sense of economic security and opportunity are useful in avoiding the desperation that is the root problem here.
More specifically, in the face of this epidemic, do we continue to raise the Social Security retirement age, putting that reward even further out of reach as some now advocate? What effect is that likely to have? And do we address this health crisis by repealing programs that offer health insurance to working-class Americans of all ages, people who would otherwise have no financial means of attaining it? Is that really the direction that logic dictates?
And overall, do we continue to pretend that this once-hidden despair is a product of individual shortcomings, or something reassuringly confined to a particular demographic group, rather than something born of a despair shared by many?
¹ As a result of these changes, the mortality rate for middle-aged white Americans with a high school degree or less (736 deaths annually per 100,000) is now four times that for white Americans with a college degree (178 deaths per 100,000). It is also significantly higher than for black (582 per 100,000) and Hispanic Americans (270 per 100,000) in the same age group. I can’t yet find breakdowns for those last two groups by education.