The timing for reading the book “Deaths of Despair” (2020) by the economists Angus Deaton and Anne Case couldn’t have been more suitable, but mostly for reasons that are presently ravaging the world in many different ways: the COVID-19 pandemic, protests and killings for civil rights, and reawakened debates on structural racism in our societies.
Deaths of Despair documents the abnormal spike in mortality rates among middle-aged non-Hispanic white American men since the onset of the 2000s. Except for the rocky 1920-30s, in which the mortality rate of this group rose partly due to the devastation brought by the aftermath of the First World War, the Spanish flu of 1918-19 and the Great Depression, it had been on a steady decline since the early 1900s. The authors further add that “any decline in life expectancy is extremely uncommon”. Yet, for three recent consecutive years (2014-17), life expectancy fell for the US population as a whole and was mainly driven by white Americans across age groups. The US is the only industrialized society to record falling life expectancy.
In the past, advances in medicine and public health campaigns played a huge part of the successful story of declining mortality rates around the world. In fact, as the authors acknowledge, steady falls in mortality rates in conjunction with higher life expectancy seen across all age groups (especially among newly-born infants and the elderly) have been the hallmark of arguments that the world is overall progressing and becoming a better place to live in. While this continues to be the story of the day for large swaths of the world’s populations today, it recently became the story of the past for some.
With a focus on the social and economic forces behind the now-rising mortality rates among middle-aged white men in the US, the authors damningly describe this predicament as follows: “For the white working class, today’s America has become a land of broken families and few prospects”. And while this book predominantly looks at the US, declining mortality rates among middle-aged white men seem to also be slowly unfolding across the pond in the United Kingdom.
What has happened to this demographic group? Deaths of Despair finds that the fastest-rising deaths rates have been from three causes: suicides, drug overdose, and alcoholic liver disease, which are mostly self-inflicted. In the midst of the reinvigorated attention towards the Black Lives Matter movement, it would now surely come across as highly unpopular (and even difficult for some people) to loudly raise the plight of white working class Americans, regardless of whether the latter group are aware of their own precarious situation beneath their confident racial and cultural pride. But the authors carefully note as follows: “The story of what happened to African Americans in the seventies and eighties has been extensively researched and debated, and we have nothing to add to that literature except to note that there are some parallels with whites today.” Furthermore, it is not difficult to observe that the majority of street protesters, of those in support of President Trump or for other racially-motivated supremacist causes, have been middle-aged white men and women.
The authors center the underlying social and economic forces into four kinds. The first force is the discontents of meritocracy: the increase in mortality rates has been almost entirely driven by those without a bachelor’s degree. A growing number of social scientists have already warned that the impacts of the widening gaps in educational attainments, for example in terms of earnings, career prospects and erosion of dignity, may pave the way for social calamity (#1, #2). The second force is the twin trend of stagnant, and even negative, real wage growth in one hand, and a decline in the quality of jobs on the other hand, among the American working class starting from the late 1980s. But unlike others, the authors do not stop at low wages as the signifying reason behind rising mortality. They extend the argument with an emphasis on the erosion of meaning and dignity that comes with it:
“Jobs are not just the source of money; they are the basis for the rituals, customs, and routines of working-class life. Destroy work and, in the end, working-class life cannot survive. It is the loss of meaning, of dignity, of pride, and of self-respect that comes with the loss of marriage and community that brings despair, not just or even primarily the loss of money.”p. 8
The third force is the expensive US health care system, which the authors argue not only gets more spent on as a share of GDP in the world, but simultaneously also delivers some of the worst health outcomes of any country in the West. They even go as far as labelling the amassed market and political power of the US health care industry today as the cancer at the heart of the economy. The fourth and final force has a lot to do with the health care industry, namely the increased concentration of market power held by only a handful of corporate companies within each industry. In simple terms, with market power you have greater control of what prices you want to charge your customers, including the government. Greater market power also allows you to fend off competition and discourages innovation by smaller and new firms. This is particularly rampant in the tech industry. The concentration of market power fundamentally undermines the spirit of “free markets”, as it encourages profit-making by rent-seeking: the systematic transfer of incomes, wealth and union power from labour to a minority of capital owners. Saez & Zucman (2019) estimated that since the early 2000s, and particularly following the 2018 tax reform, labor has been much more heavily taxed than capital in the US.
Deaths of Despair is an extended continuation of similar early works done by the economist Alan Krueger, who passed away last year by suicide. Krueger was widely known for his work on the economics of happiness, as well as pain. In his paper “Where Have All the Workers Gone? An Inquiry into the Decline of the U.S. Labor Force Participation Rate” from 2017, he concluded the following:
“Nearly half of prime age men who are not in the labor force take pain medication on any given day; and in nearly two-thirds of these cases, they take prescription pain medication. Labor force participation has fallen more in U.S. counties where relatively more opioid pain medication is prescribed, causing the problem of depressed labor force participation and the opioid crisis to become intertwined.”
I don’t contend to the idea that people should be rejected for supposedly inherent traits. There are only ingrained traits. I know that acknowledging this fact requires a very painful patience. Do not mistaken it for being the point of view from a privileged position. I simply want to be as pragmatic as possible, no matter how much anger I possess. Racism and discrimination were huge scars left in me from my teenager years in Norway, so I have been perfectly drilled with pain from such experiences.
On a personal level, I have myself lately witnessed a kind of political transformation awashing the minds of my own friends, who used to be at the centre-right, perfectly civilized and factual. In the past, I am confident that they would never have imagined themselves today supporting, or even fighting, for causes that are so utterly reactionary and destructive to themselvs and to the country that they are proud of. What happened to them is an ever-recurring question.
What makes me overall optimistic, amid much sadness, nonetheless is that I know that those friends of mine are not inherently bigoted. Circumstances made them so, and they are reversible. If we are serious about fighting racism, we cannot view our opponents as being inherently racist (or “deplorable”) and just end the discussion there. They need to be part of the story and the solution. Regardless of your preference, rejection and exclusion are unaffordable, something that racists also need to understand. To raise the issue of suffering of one particular demographic group should not be seen as equivalent to diminishing such stories of other demographic groups, especially when they all portray being undermined by essentially the same social and economic forces (though to different degrees, but that’s not the point).
This book helps me to partly understand the root causes behind the political transformations of people, including the white working class in the United States and elsewhere. As I continue to read it, I want to share a quote that indicates the book’s utmost relevance for understanding the large-scale upheavals now taking place around the world. Please, do read it.
“The root cause of an epidemic of typhus in 1848, as the great pathologist Rudolf Virchow saw it, was poverty and lack of political representation.”p. 25