Thursday, April 06, 2017

Why Are So Many White Americans Dying?

In the wake of the 2016 presidential election, we have heard much about the supposed economic angst of white working class Americans.  In addition, a study last year found that mortality rates for working class whites was falling.  America is the only advanced industrial country to see this phenomenon.  It's not happening in "Old Europe" and other modern nations.  I have my own thoughts on the matter and causation: (i) America still has the worse (and most expensive) health care system of any industrialized nation where even with health care coverage, high deductibles force many to not seek medical treatment, (ii) America has the worse social safety net of any advanced nation, (iii) Europeans have far greater job security, and (iv) despite talk of vocational training for the non-college bound, our high school fail in far too many instances to provide real, marketable vocational skills.  The results in a globalized economy are deadly.  To address these problems takes money - something Republicans refuse to spend on American citizens and, indeed, the current crop of congressional Republicans seek to cut funding for all of the above cited needs, making the prospects going forward even worse.  To them, average Americans are disposable trash.  A piece in Politico looks at the problem.  Here are highlights:
It’s a mystery with profound implications for American politics, not to mention public health: Why are so many white people dying?
When economists Anne Case and Angus Deaton released their first bombshell study in 2015, showing that mortality rates were rising for middle-aged white Americans after years of decline, the finding stunned the research world. This wasn’t a global trend—it was a distinctly American phenomenon, Case and Deaton had discovered. Among other races and age groups in Europe, mortality rates had continued to fall. But in the U.S. white people aged 45 to 54 without a college degree were dying sooner, and not from the usual suspects like heart disease and diabetes.
[W]hen Donald Trump won an upset victory in the presidential victory with a message that resonated with those same voters, many turned to Case and Deaton’s research as one possible explanation for his ascendance.
Now Deaton, who won the Nobel Prize in 2015, and Case, his wife and coauthor, are back with a new paper that aims to refine their original findings, digging into the group that’s seeing the largest increases in mortality rates: white people without college degrees, accelerated by what they call deaths of despair, or suicide, alcohol- and drug-related deaths. “Ultimately,” they write, “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.”
[J]ournalists and scholars have voiced concern about the spotlight on white people’s economic problems, which are still, relatively speaking, far smaller than those of, say, African-Americans.
[N]obody is disputing that the United States has a real problem as it struggles to understand the despair in communities left behind by globalization and automation. And, Case argues, the reversal of decades of progress on health among the least educated should be setting a fire under political leaders and policy wonks in both parties as they try to craft real solutions:
[W]hite non-Hispanics stopped making progress on heart disease, which is a big killer in middle age. First progress slowed, then it flatlined, and now it looks like it’s turned in the opposite direction.
[A] [high school] degree seems to be a marker for a lot of dysfunction that we’re seeing. But this new paper shows that the body count is only the tip of the iceberg. People with less than a college degree are reporting a lot more pain, much poorer health, poorer mental health. They’re less likely to be married, they’re less likely to be attached to the labor market, their wages don’t increase with age as quickly as they had in previous generations. So part two is being able to document that these things are happening in sync with each other.
And the third part is the fact that things appear to be getting worse and worse with every successive birth cohort, so that the cohort born in 1980 is having a much harder time on all those dimensions than the cohort born in 1970, who is in turn having a much harder time than the cohort born in 1960.
It used to be the case that with a high school degree, you could get a good job, with potential for on-the-job training and you could expect to have a middle-class life. You could get married, you could have a family. And the kinds of jobs a person can get now with a high school degree are not jobs where there is any up to move to.
[I]n Europe, mortality rates are falling, but they’re falling even more for people on the low end of their education distribution. Their mortality is falling faster than people on the high end of their education distribution. So what are they doing right that we’re not? That’s sort of the question right now. And again, education might just be a marker of something else, but I think it would be wise to look at how the Europeans have actually shouldered the kind of changes in the labor market. You know, they’ve lost a lot of manufacturing jobs to the far East, they’ve weathered the recession, but they haven’t seen the same kind of dysfunction and mortality increases that we’ve seen in the U.S.—so why?
Education is not necessarily what’s driving this, but it is highly correlated with all these bad outcomes that are happening to people. And I think part of that is that your high school degree gets you less far than what it used to, and when that happens, a lot of other bad things follow on.
[W]e see the prescription opioid epidemic as being an accelerant, as making this worse, but we don’t think it’s a root cause. It was happening before the heavy-duty prescription opioids hit the market. It starts at least as far back as 1990—that death rates from deaths of despair start rising—and then you throw prescription opioids into the mix, and it makes things a heck of a lot worse. But it was happening already.
There seem to be two Americas now: one for people who went to college and one for people who didn’t, and that’s going to be truer and truer, regardless of the color of your skin. Whether or not there’s enough political force to bring us back together, I’m really not sure about that.

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