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Washington Post Blogs
March 22, 2017 Wednesday 10:30 PM EST
New research identifies a 'sea of despair' among white, working-class
Americans;
Economists Anne Case and Angus Deaton say the early mortality spike in
this midlife group is not easing.
BYLINE: Joel Achenbach;Dan Keating
Sickness and early death in the white working class could be rooted in
poor job prospects for less-educated young people as they first enter
the labor market, a situation that compounds over time through family
dysfunction, social isolation, addiction, obesity and other pathologies,
according to a study published Thursday by two prominent economists.
Anne Case and Angus Deaton garnered national headlines in 2015 when they
reported that the death rate of midlife non-Hispanic white Americans had
risen steadily since 1999 in contrast with the death rates of blacks,
Hispanics and Europeans. Their new study extends the data by two years
and shows that whatever is driving the mortality spike is not easing up.
The two Princeton professors say the trend affects whites of both sexes
and is happening nearly everywhere in the country. Education level is
significant: People with a college degree report better health and
happiness than those with only some college, who in turn are doing much
better than those who never went.
Offering what they call a tentative but "plausible" explanation, they
write that less-educated white Americans who struggle in the job market
in early adulthood are likely to experience a "cumulative disadvantage"
over time, with health and personal problems that often lead to drug
overdoses, alcohol-related liver disease and suicide.
"Ultimately, we see our story as about the collapse of the white,
high-school-educated working class after its heyday in the early 1970s,
and the pathologies that accompany that decline," they conclude.
The study comes as Congress debates how to dismantle parts of the
Affordable Care Act. Case and Deaton report that poor health is becoming
more common for each new generation of middle-aged, less-educated white
Americans. And they are going downhill faster.
In a teleconference with reporters this week, Case said the new research
found a "sea of despair" across America. A striking feature is the rise
in physical pain. The pattern does not follow short-term economic cycles
but reflects a long-term disintegration of job prospects.
"You used to be able to get a really good job with a high school
diploma. A job with on-the-job training, a job with benefits. You could
expect to move up," she said.
The nation's obesity epidemic may be another sign of stress and physical
pain, she continued: "People may want to soothe the beast. They may do
that with alcohol, they may do that with drugs, they may do that with food."
Similarly, Deaton cited suicide as an action that could be triggered not
by a single event but by a cumulative series of disappointments: "Your
family life has fallen apart, you don't know your kids anymore, all the
things you expected when you started out your life just haven't happened
at all."
The economists say that there is no obvious solution but that a starting
point would be limiting the overuse of opioids, which killed more than
30,000 Americans in 2015.
The two will present their study on Friday at the Brookings Institution.
"Their paper documents some facts. What is the story behind those facts
is a matter of speculation," said Adriana Lleras-Muney, a University of
California at Los Angeles economics professor, who will also speak at
Brookings.
She noted that less-educated white Americans tend to be strikingly
pessimistic when interviewed about their prospects.
"It's just a background of continuous decline. You're worse off than
your parents," Lleras-Muney said. "Whereas for Hispanics, or immigrants
like myself" - she is from Colombia - "or blacks, yes, circumstances are
bad, but they've been getting better."
David Cutler, an economics professor at Harvard who also will be
discussing the paper at Brookings, said the declining health of white,
working-class Americans suggests that Republican plans to replace the
Affordable Care Act are akin to bleeding a sick patient. As he put it,
"Treat the fever by causing an even bigger fever."
Whites continue to have longer life expectancy than African Americans
and lower death rates, but that gap has narrowed since the late 1990s.
The picture may have shifted again around the Great Recession, however:
Graphs accompanying the new paper suggest that death rates for blacks
with only a high school education began rising around 2010 in many age
groups, as if following the trend that began about a decade earlier
among whites.
White men continue to die at higher rates than white women in every age
group. But because women started with lower death rates, the recent
mortality increase reflects a greater change in their likelihood of
dying early. The numbers reported by Case and Deaton suggest that white
men today are about twice as likely as they were in 1999 to die from one
of the "diseases of despair," while women are about four times as likely.
Case and Deaton play down geography as a factor in the epidemic. Yet
they note that white mortality rates fell in the biggest cities, were
constant in big-city suburbs and rose in all other areas. The Washington
Post's analysis published last year highlighted the same geographical
signature, with a break in death rates between the two most urban
classifications (big cities and big-city suburbs) and the four less
urban classifications, which The Post described as an urban-rural divide.
Last week, the Centers for Disease Control and Prevention published a
report on U.S. suicides by level of urbanization between 1999 and 2015,
a period in which 600,000 Americans took their own lives. The report
showed rising rates in each of the six urbanization classifications but
found "a geographic disparity" in which rates increased as urbanization
decreased. That urban-rural divide appears to have widened, particularly
in recent years, the CDC reported.
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