Deaths of Despair and the Future of Capitalism

1. Rising mortality among middle-aged white Americans

"Mortality rates for white American men and women ages 45–54 in the twentieth century (deaths per 100,000)."

Unprecedented reversal. For the first time in decades, mortality rates for middle-aged white Americans have been increasing, bucking the trend of improving life expectancy seen in other developed countries and among other demographic groups in the U.S. This reversal began in the late 1990s and has continued into the 21st century.

Stark contrast. While other developed nations like France, the United Kingdom, and Sweden have seen continued declines in mortality rates for this age group, the U.S. has diverged dramatically. This trend is particularly alarming given the United States' wealth and advanced healthcare system. The increase in mortality rates represents a significant public health crisis and points to deeper societal issues affecting this demographic.

2. The trio of "deaths of despair": suicide, drug overdose, and alcoholism

"Suicide, drug overdose, and alcoholic liver disease mortality in Kentucky, by educational attainment, white non- Hispanics ages 45–54."

Three-headed monster. The rise in mortality among middle-aged white Americans is largely attributed to three causes: suicide, drug overdose, and alcohol-related liver disease. These "deaths of despair" reflect a growing sense of hopelessness and disconnection among this demographic.

Alarming acceleration. The rates of these deaths have increased dramatically since the 1990s, with drug overdose deaths showing the most rapid rise. This trend suggests a complex interplay of factors, including the opioid epidemic, economic uncertainty, and social isolation. The term "deaths of despair" encapsulates the emotional and psychological underpinnings of these mortality trends, pointing to a crisis of meaning and purpose in addition to physical health concerns.

3. Education divide: College graduates largely spared from the crisis

"Drug, alcohol, and suicide mortality, white non- Hispanics ages 45–54."

Educational protection. The crisis of rising mortality is not affecting all white Americans equally. Those with a bachelor's degree or higher education have largely been spared from the increase in deaths of despair. This education divide highlights the role of economic opportunity and social stability in health outcomes.

Widening gap. The mortality gap between those with and without a college degree has grown substantially since the 1990s. For those without a bachelor's degree, death rates from suicide, drug overdose, and alcohol-related causes have skyrocketed, while college graduates have seen much more modest increases. This disparity underscores the importance of education not just for economic prospects, but for overall health and longevity.

4. Economic factors: Wage stagnation and job insecurity

"Median earnings, white non- Hispanic men by birth cohort, with and without a bachelor's degree."

Stagnant wages. For white non-Hispanic men without a college degree, median real wages have stagnated or even declined since the 1970s. This economic pressure has contributed to a sense of lost status and diminished prospects, particularly for those in blue-collar jobs.

Job market shifts. The changing nature of the American economy, with the decline of manufacturing and the rise of the service sector, has left many middle-aged workers without the skills demanded by the new job market. This has led to:

• Increased job insecurity
• Lower labor force participation rates
• Reduced bargaining power for workers

These economic factors contribute to the stress and despair that underlie the rising mortality rates.

5. Social breakdown: Declining marriage rates and religious participation

"Fraction of white non- Hispanics who are currently married, by age, year, and education."

Fraying social fabric. Along with economic challenges, middle-aged white Americans, especially those without a college degree, have experienced a breakdown in traditional social institutions. This is evident in:

• Declining marriage rates
• Reduced religious participation
• Weakening community ties

Compounding effects. The decline in these social institutions removes important sources of support and meaning from people's lives. This social isolation can exacerbate mental health issues and contribute to the behaviors that lead to deaths of despair. The erosion of these social bonds is both a cause and effect of the broader crisis, creating a vicious cycle of despair and disconnection.

6. Geographic disparities in mortality rates across the U.S.

"Al - cause mortality rates, white non- Hispanics ages 45–54, by small area."

Regional variations. The crisis of rising mortality is not evenly distributed across the United States. Certain regions, particularly in the Appalachian states, the industrial Midwest, and parts of the Southwest, have been hit especially hard.

Local factors. These geographic disparities highlight the importance of local economic conditions, healthcare access, and cultural factors in shaping health outcomes. Areas that have experienced significant economic dislocation, such as the loss of manufacturing jobs, tend to show higher rates of deaths of despair. This geographic pattern underscores the need for targeted interventions that address the specific challenges facing different communities.

7. Racial differences: Contrasting trends between whites and blacks

"Mortality rates for blacks and whites ages 45–54, 1968–2017."

Diverging paths. While mortality rates for middle-aged white Americans have been increasing, the trend for black Americans has been quite different. Black mortality rates have continued to decline, narrowing the historical gap between black and white life expectancy.

Complex picture. This racial divergence complicates the narrative of American health trends. Possible factors contributing to this difference include:

• Different starting points in life expectancy
• Varying impacts of economic changes
• Differences in community resilience
• Disparate effects of the opioid epidemic

These contrasting trends highlight the need to consider race, class, and other demographic factors when analyzing and addressing public health challenges.

8. The role of the opioid epidemic in exacerbating deaths of despair

"Drug overdose death rates for white non- Hispanics ages 25–64 and state poverty rates for white non- Hispanics in 2017."

Deadly catalyst. The opioid epidemic has played a significant role in accelerating the rise of deaths of despair, particularly drug overdose deaths. The widespread availability of prescription opioids, followed by a shift to heroin and synthetic opioids like fentanyl, has fueled a dramatic increase in overdose fatalities.

Complex interplay. The opioid crisis intersects with broader economic and social issues:

• Areas with higher poverty rates often show higher overdose death rates
• The overprescription of opioids for physical pain may have masked underlying social and economic pain
• The epidemic has strained healthcare and social service systems, particularly in already vulnerable communities

The opioid crisis serves as both a cause and a symptom of the broader mortality crisis facing middle-aged white Americans.

9. Mental health crisis: Increasing rates of pain and distress

"Serious mental distress, white non- Hispanics, by education."

Rising distress. Alongside the increase in physical health problems, there has been a marked rise in reported mental distress among middle-aged white Americans, particularly those without a college degree. This includes higher rates of depression, anxiety, and chronic pain.

Pain epidemic. The increase in reported pain is particularly striking and may reflect both physical and emotional suffering. Factors contributing to this pain epidemic include:

• Physical strain from labor-intensive jobs
• Psychosomatic manifestations of stress and despair
• Possible over-diagnosis and over-treatment of pain, contributing to the opioid crisis

The mental health aspect of the crisis underscores the need for a holistic approach to addressing the rising mortality rates, one that considers both physical and psychological well-being.

10. Implications for the future of capitalism and American society

"The fraction of adults ages 40–59 reporting they are "not too happy.""

Systemic challenges. The crisis of rising mortality among middle-aged white Americans raises profound questions about the future of American capitalism and society. It suggests deep-seated problems that go beyond individual choices or temporary economic fluctuations.

Need for reform. Addressing this crisis likely requires significant reforms in various areas:

• Healthcare system: Improving access and addressing the opioid epidemic
• Education: Enhancing opportunities for those without college degrees
• Economic policy: Addressing wage stagnation and job insecurity
• Social policy: Strengthening community institutions and support systems

The persistence and depth of this crisis suggest that incremental changes may not be sufficient. Instead, it may call for a fundamental reevaluation of the social contract and the structure of the American economy to ensure that prosperity is more widely shared and that all segments of society have paths to meaningful, healthy lives.

Last updated: November 18, 2024