U.S. mortality by poisoning, suicide, chronic liver disease, and cirrhosis, for white non-Hispanics by 5-year age group. Graphic: Case and Deaton, 2015 / PNAS

By David F. Ruccio
5 November 2015 (Real-World Economics Review) – We already knew that the number of Americans who are on disability has skyrocketed over the past three decades. But the usual response was that they are gaming the system, claiming disabilities that “lend themselves to subjective manipulation” and being encouraged to do so by overly generous government payouts. Therefore, the conclusion was, “taxpayers are paying able-bodied Americans to drop out of the work force, increasing the burden on those who are still working.” That was the existing common sense—the widely shared view that society had the responsibility (in the name of all “those who are still working”) to identify the truly disabled, weed out the others who were falsely claiming disability, and force them to get back to work. Now we know, thanks to a recently published study by Anne Case and Angus Deaton [pdf], that something else has been going on: American workers are suffering from an “epidemic of pain, suicide, and drug overdoses.” Specifically, Case and Deaton show that, after 1998, there was a marked increase in the morbidity and mortality of middle-aged white non-Hispanic men and women in the United States, especially for workers with less education. The changes are dramatic. As we can see in the chart at the top of this post, even while mortality rates in other rich countries were declining (as were the rates for Hispanic and black Americans), U.S. white non-Hispanic mortality rose by half a percent per year. As they observed, “No other rich country saw a similar turnaround.” That turnaround in mortality was driven primarily by increasing death rates for those with a high-school degree or less. And, while their focus is on middle-age, they also make clear that all 5-year groups between 30 and 64 have also suffered increases in mortality. […] What they don’t mention are the role of jobs. The fact is, most Americans are forced to have the freedom to sell their ability to work to someone else—and they suffer both when they have a job and when they don’t. When they’re fortunate enough to have a job, they’re working in Walmart stores, Amazon warehouses, and fast-food restaurants and suffering the physical and mental pains and indignities imposed by their employers. And when they don’t have a job—when they’ve been discarded by their employers—they’re suffering from the jobs they once held and from the struggle to find another job. As a consequence of both having jobs and joblessness, an increasing number of middle-age Americans are dying, committing suicide, and are the victims of pain, poor health, and psychological distress. And, unless we do something about it, the middle-age Americans who do survive the current epidemic, will carry their pain and ill health into old age. As for the political consequences, Paul Starr suggests we may be witnessing a “dire collapse of hope.” [more]

Epidemic of pain, suicide, and drug overdoses (3 graphs)

By Paul Starr
2 November 2015 (The American Prospect) – In a reversal of earlier trends, death rates among white non-Hispanic Americans in midlife increased sharply between 1999 and 2013, according to a new study by economists Anne Case and Angus Deaton, winner last month of the Nobel Prize for economics. The increased deaths were concentrated among those with the least education and resulted largely from drug and alcohol “poisonings,” suicide, and chronic liver diseases and cirrhosis. This midlife mortality reversal had no parallel in any other industrialized society or in other demographic groups in the United States. Case and Deaton’s analysis, published today in the Proceedings of the National Academy of Sciences, also shows increased rates of illness, chronic pain, and disability among middle-aged whites. The findings have important implications for American politics and public policy, particularly for debates about economic inequality, public health, drug policy, disability insurance, and retirement income. The data also suggest why much of American politics may be taking on an increasingly harsh and desperate quality. The recent divergence in death rates between the United States and other rich countries is striking. Between 1979 and 1999, Case and Deaton show, mortality for white Americans ages 45 to 54 had declined at nearly 2 percent per year. That was about the same as the average rate of decline in mortality for all people the same age in such countries as France, Germany, the United Kingdom, and Sweden. (See figure below.) After 1999, the 2 percent annual decline continued in other industrialized countries and for Hispanics in the United States, but the death rate for middle-aged white non-Hispanic Americans turned around and began rising half a percent a year. The consequences of this divergence have been staggering. If the white midlife mortality “had continued to decline at its previous (1979‒1998) rate,” Case and Deaton estimate, “half a million deaths would have been avoided in the period 1999‒2013, comparable to lives lost in the U.S. AIDS epidemic through mid-2015.” Case and Deaton’s data indicate that the white midlife mortality reversal was due almost entirely to increased deaths among those with a high school degree or less. Mortality rates in that group rose by 134 per 100,000 between 1999 and 2013, while there was little change among those with some college, and death rates fell by 57 per 100,000 for those with a college degree or more. Death rates from suicide and poisonings such as drug overdoses increased among middle-aged whites at all socioeconomic levels (as measured by education). But the increases were largest among those with the least education and more than sufficient in that group to wipe out progress in reducing other causes of death. Deaths from diabetes rose slightly but did not account for a significant part of the white midlife mortality reversal. [more]

A Shocking Rise in White Death Rates in Midlife — and What It Says About American Society

ABSTRACT: This paper documents a marked increase in the all-cause mortality of middle-aged white non-Hispanic men and women in the United States between 1999 and 2013. This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround. The midlife mortality reversal was confined to white non-Hispanics; black non-Hispanics and Hispanics at midlife, and those aged 65 and above in every racial and ethnic group, continued to see mortality rates fall. This increase for whites was largely accounted for by increasing death rates from drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis. Although all education groups saw increases in mortality from suicide and poisonings, and an overall increase in external cause mortality, those with less education saw the most marked increases. Rising midlife mortality rates of white non-Hispanics were paralleled by increases in midlife morbidity. Self-reported declines in health, mental health, and ability to conduct activities of daily living, and increases in chronic pain and inability to work, as well as clinically measured deteriorations in liver function, all point to growing distress in this population. We comment on potential economic causes and consequences of this deterioration.

Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century