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.

Are People Waking Up to Fact GOP's "Small Government" Agenda Is Killing GOP Voters?

For years now - perhaps decades - the Republican Party has been wooing working class white voters to vote against their own economic best interests through appeals to racism, religious extremism, and other forms of hatred towards others.  It worked yet again in the 2016 presidential election.  Now, these manipulated voters who have been played for fools time and time again may be belated waking up to the fact that GOP policies are literally killing them.  The uprising of Trump voters and working class whites against the GOP plan to kill Obamacare is a case in point - especially after many receiving health care benefits woke up and discovered that the new found benefits they enjoying (and depending on to survive) derived from Obamacare.  Yes many will continue to fall for the GOP's toxic brew of racism/religious extremism/xenophobia, but perhaps the tide is finally turning, although not in time to have avoided the Trump/Pence nightmare.  A piece in New York Magazine looks at this possible awakening.  Here are excerpts:

In his inaugural address, President Trump vowed that “the forgotten men and women of our country will be forgotten no longer.” He then suggested that the government has a responsibility to provide its “righteous people” with “great schools for their children, safe neighborhoods for their families, and good jobs for themselves.”

The hedge-fund billionaire who bankrolled Trump’s campaign takes a different view. Robert Mercer reportedly believes that “human beings have no inherent value other than how much money they make,” and that “society is upside down” because “government helps the weak people get strong, and makes the strong people weak by taking their money away, through taxes.”

Thus far, Trump’s governing style has been more in keeping with his donor’s private views  . . . . The president has backed a health-care plan that finances a tax cut for millionaires by throwing millions of “forgotten” Americans off of Medicaid — while proposing a budget that would slash spending on public housing, food assistance, after-school programs, and development funds for poor rural and urban areas.

The fact that the new Republican president is serving as a loyal general in the one percent’s class war would be wholly unremarkable, had Trump not campaigned as a populist outsider. But then, if Trump hadn’t run as a populist outsider, it’s quite possible that there wouldn’t be a new Republican president.

Typically, Republicans attribute the despair of impoverished communities to the moral failings of individual poor people. But Trump never lamented the “culture of poverty.” Instead, he blamed the misery of the “forgotten” on rapacious elites who had failed to protect the “righteous” people’s economic interests. . . . This message — when liberally (or, perhaps illiberally) salted with appeals to white racial resentment — proved to be a winning one.

Trump gave the GOP the rebrand it desperately needed. But, thus far, he’s made few alterations to the actual product. And, judging by their failed attempt to pass a supply-side tax cut dressed as a health-care bill, Republicans believe that the only thing their agenda ever lacked was a racist reality star as its salesman.

But they are wrong about that: Movement conservatism is failing politically because its policies have never had less to offer the voters it relies on.

New research on the surging death rate among white, non-college-educated Americans offers a harrowing testament to this fact. In 2015, Princeton economists Anne Case and Angus Deaton discovered that an epidemic of suicides and substance abuse was driving up the mortality rate of middle-aged, working-class, white Americans — even as medical advances were pushing down that rate for college-educated whites and every other racial and ethnic group. . . . .  the great recession, black and white non-college-educated workers have seen their mortality rates rise, across every age group. And working-class African-Americans still suffer higher death rates than white ones do.

However, only the non-college-educated white population has seen a nearly continuous rise in its mortality rate over the last two decades. And that jump has been driven by a uniquely high spike in “deaths of despair.”

[N]on-college-educated white workers have seen their economic prospects drop from a higher peak — and no countervailing narrative of cultural progress has arrested their sense of decline. This foreboding can pervade whole communities, and lead their most vulnerable members to seek relief in drinking, drugs, or death. . . .  economists suggest that these breakdowns are “rooted in the labor market.” 

Movement conservatism’s other anti-poverty prescription — instilling self-reliance in the poor by kicking them out of their welfare hammocks — also withers under the paper’s scrutiny. The United States has the thinnest safety net of any major, western nation. And it is also the only such country in which non-college-educated white workers are dying much younger than they used to. . . . . the rationale behind House Republicans’ push to add work requirements to Medicaid — that providing a minimum standard of health care to the indigent unemployed breeds an unhealthy dependency — is hard to reconcile with the superior health outcomes of workers in European nanny states.

[T]he GOP has grown more radically right wing; income has grown more concentrated at the top; and Republicans have grown ever more dependent on the nonaffluent for votes.
Now, even the GOP base supports more government spending on health care and opposes tax cuts for the rich.

Republicans can continue putting the superstitions of misanthropic billionaires above the needs of their downscale voters. But in doing so, they will send more “forgotten men and women” to early graves. And, eventually, the righteous people may take the GOP down with them.

One can only hope that this growing realization accelerates and that some will learn to change the channel from Fox News.  

America’s Self-Destructive Whites

Much of the base of the Republican Party consists of working class whites, many with no college education.  I suspect that many have never traveled overseas and - except perhaps in the military, if then - and have a limited view of the world.  Especially if they are far right evangelicals who statistically have the lowest education levels of those calling themselves Christians.  Rather than attempt to adapt and accept a changing world and society, they rage and seek to impose their beliefs on all.  Anything is more acceptable than having to think and re-evaluate long held beliefs and prejudices.  In the long term, the behavior is also self-destructive.  A column in the Washington Post looks at the phenomenon.  Here are excerpts:

Why is Middle America killing itself? The fact itself is probably the most important social science finding in years. It is already reshaping American politics. The Post’s Jeff Guo notes that the people who make up this cohort are “largely responsible for Donald Trump’s lead in the race for the Republican nomination for president.” The key question is why, and exploring it provides answers that suggest that the rage dominating U.S. politics will only get worse.

For decades, people in rich countries have lived longer. But in a well-known paper, economists Angus Deaton and Anne Case found that over the past 15 years, one group — middle-age whites in the United States — constitutes an alarming trend. They are dying in increasing numbers. And things look much worse for those with just a high school diploma or less. There are concerns about the calculations, but even a leading critic of the paper has acknowledged that, however measured, “the change compared to other countries and groups is huge.” 

The only comparable spike in deaths in an industrialized country took place among Russian males after the collapse of the Soviet Union, when rates of alcoholism skyrocketed. 

A conventional explanation for this middle-class stress and anxiety is that globalization and technological change have placed increasing pressures on the average worker in industrialized nations. But the trend is absent in any other Western country — it’s an exclusively American phenomenon.  

Deaton speculated to me that perhaps Europe’s more generous welfare state might ease some of the fears associated with the rapid change. Certainly he believes that in the United States, doctors and drug companies are far too eager to deal with physical and psychological pain by prescribing drugs, including powerful and addictive opioids. The introduction of drugs such as Oxycontin, a heroin-like prescription painkiller, coincides with the rise in deaths.

While mortality rates for middle-age whites have stayed flat or risen, the rates for Hispanics and blacks have continued to decline significantly. These groups live in the same country and face greater economic pressures than whites. Why are they not in similar despair? 

The answer might lie in expectations. . . . . other groups might not expect that their income, standard of living and social status are destined to steadily improve. They don’t have the same confidence that if they work hard, they will surely get ahead.

The Hispanic and immigrant experiences in the United States are different, of course. But again, few in these groups have believed that their place in society is assured. Minorities, by definition, are on the margins. They do not assume that the system is set up for them. They try hard and hope to succeed, but they do not expect it as the norm. 

The United States is going through a great power shift. Working-class whites don’t think of themselves as an elite group. But, in a sense, they have been, certainly compared with blacks, Hispanics, Native Americans and most immigrants. They were central to America’s economy, its society, indeed its very identity. They are not anymore. 
 
Donald Trump has promised that he will change this and make them win again. But he can’t. No one can. And deep down, they know it. 

Some may think that I am unsympathetic, but having gone through the coming out process, been fired from my job for being gay, forced into bankruptcy, and having had to work hard and struggle to rebuild, I do know that giving up hope and/or merely lashing out at others who are different is not the answer - no matter whatever sound bites Donald Trump may throw to you. 

Failed Right Wing Failed Policies and White Mortality Rates

I frequently post the cartoon image above to make the point that much of the Republican Party base is being played for fools (mostly by playing on their racism and bigotry) and convinced to vote against its own best interest.  But the problem goes far beyond foolishly supporting tax cuts for the rich and the slashing on regulations that protect citizens from vulture capitalism.  It goes to cheering the dismantling of social safety net programs and the right's refusal to put America's healthcare system on a par with that of other advanced industrial nations.  The irony, however, is in the fact that many angry white voters are rallying to support Republican candidates who, if allowed to do so, would make the plight of these individuals and their families even worse.  A column in the New York Times looks at the phenomenon and the way in which right wing policies are literally killing portions of the GOP base.  Here are highlights:

A couple of weeks ago President Obama mocked Republicans who are “down on America,”  . . . .  He had a point: With job growth at rates not seen since the 1990s, with the percentage of Americans covered by health insurance hitting record highs, the doom-and-gloom predictions of his political enemies look ever more at odds with reality.

There has been a lot of comment, and rightly so, over a new paper by the economists Angus Deaton (who just won a Nobel) and Anne Case, showing that mortality among middle-aged white Americans has been rising since 1999. This deterioration took place while death rates were falling steadily both in other countries and among other groups in our own nation.

Even more striking are the proximate causes of rising mortality. Basically, white Americans are, in increasing numbers, killing themselves, directly or indirectly. Suicide is way up, and so are deaths from drug poisoning and the chronic liver disease that excessive drinking can cause. We’ve seen this kind of thing in other times and places – for example, in the plunging life expectancy that afflicted Russia after the fall of Communism. But it’s a shock to see it, even in an attenuated form, in America.

 Yet the Deaton-Case findings fit into a well-established pattern. There have been a number of studies showing that life expectancy for less-educated whites is falling across much of the nation.

But what’s causing this epidemic of self-destructive behavior?   If you believe the usual suspects on the right, it’s all the fault of liberals.. . . . But (surprise!) this view is very much at odds with the evidence.

For one thing, rising mortality is a uniquely American phenomenon – yet America has both a much weaker welfare state and a much stronger role for traditional religion and values than any other advanced country. Sweden gives its poor far more aid than we do, and a majority of Swedish children are now born out of wedlock, yet Sweden’s middle-aged mortality rate is only half of white America’s.

Life expectancy is high and rising in the Northeast and California, where social benefits are highest and traditional values weakest. Meanwhile, low and stagnant or declining life expectancy is concentrated in the Bible Belt.


Most notably, Hispanic Americans are considerably poorer than whites, but have much lower mortality. It’s probably worth noting, in this context, that international comparisons consistently find that Latin Americans have higher subjective well-being than you would expect, given their incomes.

So what is going on? In a recent interview Mr. Deaton suggested that middle-aged whites have “lost the narrative of their lives.” That is, their economic setbacks have hit hard because they expected better. Or to put it a bit differently, we’re looking at people who were raised to believe in the American Dream, and are coping badly with its failure to come true.

I’m not the only observer who sees a link between the despair reflected in those mortality numbers and the volatility of right-wing politics. Some people who feel left behind by the American story turn self-destructive; others turn on the elites they feel have betrayed them. No, deporting immigrants and wearing baseball caps bearing slogans won’t solve their problems, but neither will cutting taxes on capital gains. So you can understand why some voters have rallied around politicians who at least seem to feel their pain.

But while universal health care, higher minimum wages, aid to education, and so on would do a lot to help Americans in trouble, I’m not sure whether they’re enough to cure existential despair.

Yes, the Great Recession was brutal to many.  But cutting off your nose to spite your face as angry whites rallying to the GOP doesn't solve the overarching problems.  Like the columnist, I believe that universal health care, a higher minimum wage, improved education , etc., are not the whole answer.  Other elements are needed such as ending the embrace of ignorance, ending adherence to Bronze Age religious beliefs, and walking away for GOP dog whistle racism are also needed.  The GOP and Koch brothers may malign "Old Europe" yet Europe's nations for the most part are affording their citizens a better life style without rising mortality rates. 

Anti-Gay Prejudice Is Literally Killing Gay People

I often state that while they try to pretend otherwise anti-gay Christofascists in actuality want all of us gays dead.  A new study released by Columbia University reveals that in some countries these "godly folk" are having some degree of success in this unspoken goal: gay individuals living in countries with high levels of anti-gay bigotry, prejudice, and hate, are expected to die 12 years earlier than their peers living in more progressive nations.  The findings were based on a review of 20 years of data.  I often state that the "family values" crowd has blood on their hands and this study indicates that, yes, they do in fact have blood on their hands.  Will these people feel and ounce of remorse?  Of course not, they are too busy congratulating themselves on their piety and poisonous religiosity.  The New Civil Rights Movement looks at the study findings.  Here are highlights:

A study just released by Columbia University’s Mailman School of Public Health finds that gay people living in communities entrenched with high levels of anti-gay bigotry, prejudice, and hate, are expected to die 12 years earlier than their peers living in more progressive and accepting environments.

“Shorter life expectancy of 12 years on average for LGB individuals in communities with high vs. low stigma,” a statement on the study reads.

“Our findings indicate that sexual minorities living in communities with higher levels of prejudice die sooner than sexual minorities living in low-prejudice communities, and that these effects are independent of established risk factors for mortality, including household income, education, gender, ethnicity, and age, as well as the average income and education level of residents in the communities where the respondents lived,” the study’s lead author, Mark Hatzenbuehler, PhD, assistant professor of Sociomedical Sciences at Columbia, said in a statement. “In fact, our results for prejudice were comparable to life expectancy differences that have been observed between individuals with and without a high school education.”

Ironically, conservatives for decades have been touting faux-scientific claims that gay people die decades earlier than heterosexuals. Most recently, RNC Committeeman Dave Agema of Michigan has been criticized for pushing a website that has published preposterous lies, like the “median age of death of homosexuals is 42 (only 9% live past age 65).” It also calls gay people “filthy.” Are the anti-gay hate groups and those pushing anti-gay bigotry responsible for creating an environment that is literally killing LGB people? Possibly, since this study seems to say, “yes.”

Next time you hear Tony Perkins and others seeking to export homophobia to Africa or hear a pastor bellowing anti-gay screeds from the pulpit, know that they are literally killing people.  These folks need to be expelled from decent society and the nation's political process.

New Study: Gay Marriage Extends Life Expectancy

A new Danish study shows significant benefits and lower mortality rates for men in same sex marriages.  Naturally, this will be but one more reason for the Christofascists to ramp up opposition to same sex marriage since, truth be told, they'd prefer that all of us gays experienced early deaths.  But seriously, the study findings show very positive results in addition to increasing family and relationship stability.  Here are highlights from Huffington Post:

Is marriage the key to gay men living longer? According to a new Danish study, the answer is a definite yes. 

Published in the International Journal of Epidemiology, the study reportedly examined 6.5 million adults from 1982 to 2011. As the Los Angeles Times points out, the mortality rate for married gay men plummeted during the course of the study, now hovering slightly lower than the rate observed for unmarried or divorced heterosexual men.

"Among men in Denmark, it is more dangerous to be unmarried or divorced than to be married to another man," study researcher Martin Frisch of the Statens Serum Institute in Copenhagen and the Center for Sexology Research of Aalborg University is quoted by Live Science as saying.

In a press release, Frisch added, "It is a novel observation that being married was not always protective. Among persons living alone and persons living in same-sex cohabitation, those who were married to a member of the opposite sex had noticeably higher mortality than unmarried and same-sex married persons."

The Los Angeles Times adds these points:

The study is the first of its kind to examine mortality -- the risk of death during a specific period of time -- and relationship status for an entire nation.

"Our study expands on century-old knowledge that married people generally have lower mortality than unmarried and divorced persons," wrote the lead author, Dr. Morten Frisch, a professor of epidemiology at Aalborg University. "From a public health viewpoint it is important to try and identify those underlying factors and mechanisms."

Researchers found that marriage in and of itself did not ensure low mortality during the period studied. For instance, opposite-sex married couples who lived apart faced a two-fold increase in their mortality rate.

Also, heterosexual men and women saw a steep jump in their mortality rate during the study period if they were married two or more times. The rate increased 27% for women with each successive marriage, and it increased 16% for men.

Surprisingly, researchers found that the risk of death during the study had grown worse for lesbian couples. After dropping for many years, mortality rates had begun to rise slightly, so that they were now higher than those of married gay men and cohabiting heterosexual couples.  "Lesbians may constitute a largely unnoticed high-risk population for suicide and breast cancer," the authors wrote.

It remains unclear precisely why heterosexual married couples have the lowest risk of death during the years studied, although researchers suspect it has to do with income, health care, increased social support and other factors.