The Age of Despair

This article first appeared in Wellesley's Calderwood Seminar: Economic Journalism.

A new study identifies alcohol abuse, the opioid crisis and suicides as driving forces for rising mortality rates among adults between 25 to 64 year olds.

By Sarah Chu

As the life expectancy of Americans has fallen for the third year in a row – an event that has not happened since the flu epidemic of 1918 – policymakers are struggling to improve outcomes from those dying from drug overdose, suicide, and alcoholism – known as deaths of despair. For working-class families, America is no longer the land of the free, but the land of the fallen.

Princeton economists Ann Case and Angus Deaton recognized not only the surge in deaths of despair, but also the widening inequalities for working-class people. American capitalism is no longer working for everyone, particularly among the white, working-class Americans without college degrees, Case told the American Economic Association at her January lecture on “Deaths of Despair” in San Diego.

Using an array of graphics in her lecture, Case convincingly highlights the stark divide of death rates from substance abuse and suicide between varied education levels. Despite having the most expensive healthcare system in the world, mortality rates for working-class white adults went up significantly in the last several years. Meanwhile, mortality rates for college-educated white adults are significantly lower than adults without college degrees. “Those with a college degree are living in a completely different universe,” Case acknowledges.

What is even more profound is that mortality rates are different across racial groups. Hispanics and blacks are less affected by deaths of despair compared to uneducated whites. This upward trajectory in death rates is largely driven by premature deaths from working-class white people. As the college-educated become wealthier and live longer, those without university degrees are left with stagnant wages and less meaningful job prospects. It is not that inequality in general is causing rising mortality rates among middle-class white families. In fact, Case believes the rise in automation, lack of meaningful work, and deterioration in mental health are to blame. Over the last few decades, the United States steel and coal-mining industries have declined and automation has eliminated some manufacturing jobs. The economic woes may stem from a collapse in blue-collar jobs, real wages being held down, or a shift in hiring more college-educated people. Minimum-wage workers are left with the scraps of working menial tasks as Uber drivers, Amazon suppliers, or DoorDash deliverers. This lack of job satisfaction trickles into home life as working-class families struggle to make ends meet. Marriage rates and religious practice has shown significant declines, signaling a lack of social interaction in their lives.

With a lack of job and home stability, working-class Americans seek help from healthcare providers for their deteriorating mental health. In their efforts to improve their well-being, they find themselves being exploited by pharmaceutical companies who encouraged doctors to overprescribe opioids in return for personal gain. Pharmaceutical companies like Purdue Pharma and Johnson & Johnson reap the benefits of the opioid epidemic while long-term users are dying from fentanyl overdose. “Today, more than 17 percent of Americans have had at least one opioid prescription filled, with an average of more than 3 opioid prescriptions dispensed per patient in 2018,” according to the CDC.

Falling life expectancy and inequality are byproducts of a broken system for people without college degrees. However, broken does not mean unfixable. To reverse this downward spiral, Congress must address the blue-collared workers displaced by robots, along with addressing their healthcare needs.

Some solutions proposed include reining in healthcare costs, investing in education, and policies that redistribute wealth to the working-class. For instance, instead of allowing pharmaceutical companies to enrich themselves by pumping out massive quantities of methanol, Congress needs to push for more consumer protection policies if they want to reverse the future of this nation.

In addition to corrupt pharmaceutical companies, an inadequate public healthcare system is affecting the livelihoods of American families. In 2019, the average spending on healthcare for every American is $11,559, nearly twice as other rich countries. Families affected by substance abuse need greater accessibility to healthcare and mental health resources if they expect to improve their outcomes. Until the government controls the rising costs of healthcare, these problems may spill over for the next generation to solve.

Lastly, an investment in education will improve health outcomes. Encouraging young people to earn a bachelor’s degree would boost earning potential and may shield them from the opioid epidemic. For the working-class people already struggling with opioid misuse and addiction, improving addiction care in the criminal justice system, may also help prevent abusers from relapsing.

The cumulative threats to the working-class is a national cry for help – and politicians are not listening. Moving toward a more equitable democracy requires measures beyond GDP. Instead of measuring the wealth of our country, we must strengthen consumer protection policies to combat pharmaceutical companies from exploiting the most vulnerable. We must provide affordable healthcare to lift countless people out of poverty. We must push for greater accessibility for higher education to achieve social mobility for the working-class. Whether the country turns the land of the fallen to the land of hope remains to be seen.