From the archive: ‘Death by despair’ – The US public health crisis coming to the UK?
Re-posted this week in the light of Donald Trump’s election victory.
From the New York Times this week (but widely reported elsewhere):
“Something startling is happening to middle-aged white Americans. Unlike every other age group, unlike every other racial and ethnic group, unlike their counterparts in other rich countries, death rates in this group have been rising, not falling.”
The Times was reporting on the latest research from two Princeton economists, Angus Deaton and Anne Case (last month Deaton was awarded the Nobel Prize in Economics).
Case and Deaton analysed health and mortality data from the US Centers for Disease Control and Prevention and other sources (though they apparently stumbled across the findings almost by accident). Among their startling conclusions are that:
- The mortality rate for whites 45 to 54 years old with no more than a high school education increased by 134 deaths per 100,000 people from 1999 to 2014.
- This is a big increase – so big that it is having an impact on the death rate for all middle-aged white Americans. According to the research, if instead of this increase the previous decline in death rates had continued, half a million deaths would have been avoided in the period 1999-2013.
- This increase is in contrast to every other group, which is to say every other ethnicity and age (middle-aged blacks still have a higher mortality rate than whites but the gap is closing).
- The rising annual death rates among this group are being driven not by the ‘usual suspects’ such as heart disease and diabetes, but by an epidemic of suicides and substance abuse (alcoholism and addiction to heroin and prescription opioids). The former had already been observed; the latter was the shocking new finding.
In short, the white middle-aged less educated ‘middle class’ (in the British context, we would say working class) are killing themselves.
Even other researchers in the field were stunned by the results. Deaton himself could offer only one parallel: “Only H.I.V./AIDS in contemporary times has done anything like this.”
Clearly, something has gone very, very wrong. What the research doesn’t prove is why.
Examining the indicators of poor health, Anne Case discovered that middle-aged people, unlike the young and unlike the elderly, were reporting more pain, for example chronic joint pain. They were also experiencing the most financial distress (in the period covered by the data, the inflation-adjusted income for these households fell by 19 percent), more mental illness, and inability to work.
Commentary has predictably reflected the political persuasions of writers, and the causes of substance abuse, addiction and illness are obviously complex, but Deaton has offered his own thoughts on the cause:
“[I]f what is happening is an epidemic of despair, that people on the bottom of the economic heap are being increasingly left out as inequality expands, then what we are seeing is just one more terrible consequence of slow growth and growing inequality.”
Case and Deaton suggest that no other rich country has seen a similar trend. However, given similar economic conditions (increasing inequality and lack of security) it would be surprising if we didn’t see many of the same consequences here – and indeed we are seeing them:
- Over the past 30 years, inequalities in life expectancy related to socio-economic status have widened, with improvements in life expectancy being greater for the most advantaged.
- People who live in the richest regions of the UK survive for 10 to 20 years or more following a cancer diagnosis, and have better survival rates, than people in poorer areas.
- The rate of suicides has increased, with the level among males its highest since 2001 and with middle-aged men most at risk (the North East has the highest rate in England, while London has the lowest, again reflecting inequality and differences in economic opportunity).
Our changing economy (a result of deregulation, globalisation and technology) is telling people that they don’t matter – that they are redundant. With austerity and cuts to social security, government is reinforcing that message. No wonder people feel sick.
In the US, it seems likely that this sense of despair is driving the support for extreme Presidential candidates such as Donald Trump, who are at least talking for (or exploiting, depending on your point of view) the sense of disenfranchisement among white middle-aged working class men in particular. We can regard the rise of UKIP as being in the same vein.
Mainstream politicians should take note. They should at least sound like they recognise there’s a crisis going on. At the moment they don’t.
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