A Dire Collapse of Hope

In 1995, at the height of the AIDS epidemic, there were 43,115 deaths from the disease and its complications. Twenty years later, our current opiate epidemic has passed that gruesome marker, racking up 52,404 deaths. Today, opioid-related deaths outnumber those resulting from car accidents or guns.

According to Princeton economists Anne Case and Angus Deaton, these are “deaths of despair,” and combined with deaths from alcohol and suicide they have resulted in an alarming increase in the mortality rate of white, non-Hispanic Americans in mid-life. Their report, titled “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century,” was published in PNAS (Proceedings of the National Academy of Sciences) in September 2015 to widespread headlines. Last week they issued a new paper for the Brookings Panel on Economic Activity, titled “Mortality and morbidity in the 21st century.” Jared Keller, writing for Pacific Standard, reports that:

To be more exact, Case and Deaton found that middle-aged, non-Hispanic Americans without a college degree experience a significantly higher mortality rate than those in advanced countries like the United Kingdom or Germany. While everyone else in the United States is getting healthier and living longer, it’s that segment of whites who accounted for “half a million deaths” between 1999 and 2013.

To scientists, the sudden die-off in middle-of-the-road white Americans constitutes a phenomenon “unprecedented in the annals of public health among developed nations” with the exception of the post-U.S.S.R. deaths of Russian males and, in some ways, the first shock waves of the AIDs crisis in the early 1980s.

The causes of the increase in mortality and morbidity among white, non-Hispanics (WNH) seem to be equal parts economic inequality, with its accompanying lack of economic progress among WNH, and the opiod epidemic that has spread across the nation. The increase in mortality among WNH is centered mostly among those lacking higher education and appears to have few geographical restrictions. The increase in morbidity has not only increased the number of people on Social Security, but will also impact Medicare as this cohort ages into retirement.

Joseph Stiglitz lays much of the blame for the increase in deaths from suicide, drugs, and alcoholism on our growing economic inequality, and on the high price we, as a nation, pay for medical care which, for too long, has put it out of the reach of those who need it most. Stiglitz also mentions the increase in mortality that occurred in Russia after the dissolution of the USSR.

During the early 1990s, Russia saw an alarming increase in the mortality of its men as their life expectancy fell by six years, while that of women fell by three. By 2006, Russia’s mortality rate, which had been 38 percent higher than that of Western Europe in 1980, increased to a level of 135 percent. Granted, they have been dealing with their own AIDS epidemic as well as a large jump in tuberculosis infections, many of which appear to be antibiotic resistant. But most of the increase comes from mortalities due to cardiovascular diseases (CVD) which are currently 3.8 times greater than the rate of CVD mortality in Western Europe. Deaths from external events (injuries, accidents, poisonings) increased from 2.5 times more than Western Europe in 1980 to 5.3 times greater in 2006. From a spring 2009, World Affairs Journal article by Nicholas Eberstadt:

Taken together, then, deaths from cardiovascular disease and from injuries and poisoning have evidently been the main drivers of modern Russia’s strange upsurge in premature mortality and its broad, prolonged retrogression in public health conditions. One final factor that is intimately associated with both of these causes of mortality is alcohol abuse.

The damage done by alcohol in Russia is much worse than here in the U.S. due to the popularity of home brews known as samogon. Often filled with impurities, these home brews have contributed to the death rate due to alcohol poisoning. Local studies have shown that alcohol is “a direct factor in premature death,” including one in a city in the Urals that …

indicated that over 40 percent of the younger male decedents evaluated had probably been alcohol-impaired or severely intoxicated at the time of death—including one quarter of the deaths from heart disease and over half of those from accidents or injuries.

So, when looking at a chart like the one below that was part of the original study done by Case and Denton, notice that the other nations all have decent health care available to all citizens. The Russian health care safety net is not unlike the one that exists in too many parts of the United States today—somewhere between very weak and nonexistent. It would be interesting to see how a chart that included Russia would look.

All-cause mortality, ages 45–54 for US White non-Hispanics (USW), US Hispanics (USH), and six comparison countries: France (FRA), Germany (GER), the United Kingdom (UK), Canada (CAN), Australia (AUS), and Sweden (SWE).

Michelle A. Parsons published Dying Unneeded: The Cultural Context of the Russian Mortality Crisis in 2014. A sociocultural anthropologist with a background in global health, Parsons interviewed Muscovites in an attempt to find the cultural causes of the increase in mortality. She found that after the collapse of the USSR, middle-aged Russians were faced with an economy that no longer provided stable, secure employment, and that the retirement system had collapsed, leaving the future uncertain with few prospects for improvement. They no longer felt needed, by their society or by their families. Parsons looks at the involvement of alcohol in the increased mortality rate and:

theorizes that drinking is, for what its worth, an instrument of adapting to the harsh reality and sense of worthlessness that would otherwise make one want to curl up and die.

One wonders how much of that attitude is shared by the middle-aged Americans that Case and Deaton have examined. In discussing their original paper, Paul Starr of the American Prospect wrote:

The declining health of middle-aged white Americans may also shed light on the intensity of the political reaction taking place on the right today. The role of suicide, drugs, and alcohol in the white midlife mortality reversal is a signal of heightened desperation among a population in measurable decline. We are not talking merely about “status anxiety” due to rising immigrant populations and changing racial and gender relations. Nor are we talking only about stagnation in wages as if the problem were merely one of take-home pay. The phenomenon Case and Deaton have identified suggests a dire collapse of hope, and that same collapse may be propelling support for more radical political change. Much of that support is now going to Republican candidates, notably Donald Trump. Whether Democrats can compete effectively for that support on the basis of substantive economic and social policies will crucially affect the country’s political future.


Thanks for the post by Susan Grigsby, April 2, 2017

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