Deaths Of Despair, And The Service Project That Could Save American Lives

Anne Case & Angus Deaton (credit: Princeton.edu)

In 2015, Princeton University economists Anne Case and Angus Deaton (winner of the Nobel Prize in Economics) published a paper that made waves nationally. Case and Deaton reviewed mortality figures and causes of death, amongst Americans of various ages and genders as well as ethnic, racial, educational and income backgrounds. What they found was rather shocking.

Between 1970 to 2013, mortality rates for Americans aged 45 to 54 dropped by 44%. Similar decreases were found in other wealthy nations, such as the UK, Canada, France and Germany, thanks to improved medical treatment, disease prevention and behavioral change. More narrowly, from 1978 to 1998, mortality rates amongst white Americans aged 45 to 54 decreased at an average rate of 2% per year, which matched the average rate of decline across other developed nations.

From 1999 to 2013, other affluent nations saw their mortality rates continue to decline by 2% per year. The same was true for African-Americans and Latinos aged 45 to 54, whose mortality rates decreased by 2.6% per year and 1.8% per year respectively.

Yet, something very strange happened. During that same time period, mortality rates for whites of this age group rose by an average of 0.5% per year. Such a reversal in mortality rates is unprecedented amongst developed nations. Case and Deaton broke down the numbers by educational level, and found that for whites aged 45 to 54, with at least some college education, mortality rates continued to decline. However, for individuals with a high school education or less, mortality rates increased precipitously, which lead to a spike in overall death rates amongst whites of this age as a whole.

What caused this trend? Primarily, a precipitous rise in “deaths of despair” or drug and alcohol overdoses, poisoning and disease, and suicide. The self-assessed health of this group has also declined, with fewer people reporting excellent physical health, and more indicating challenges. Reports of chronic pain have increased rapidly, while indicators of poor mental health have spiked.

A large number of those Case & Deaton surveyed within this demographic, report increased difficulties in simple activities like walking and climbing, while an ever-larger portion indicate that they are consuming heavy amounts of alcohol. The author’s looked to obesity as a major cause of increased mortality rates, but found that life expectancy had deteriorated for both obese and non-obese whites aged 45–54.

Digging deeper into the data, Case and Deaton suggest that the opioid epidemic, which first began in the late 1990’s, when opioids gained increasing popularity as a pain treatment, and is linked with eventual heroin addiction, might be a partial cause of increased mortality rates. However, Case and Deaton are uncertain as to whether increased levels of pain came first, or opioid usage spiked prior to a pain epidemic (a sort of “chicken and egg” problem).

The authors also look to economic insecurity, in the form of minimal growth in wages, and the reality that Americans are increasingly unlikely to outearn their parents, particularly without a college education. Combined with the economic shocks of the 2008–09 Great Recession, this could play a role in increasing physical pain, suicide, and drug abuse. Yet, Case and Deaton note that other rich nations have seen similar or even worse slowdowns in wage growth, without accompanying increases in mortality.

Case and Deaton compare the reversal in mortality rates discussed here, to the AIDS epidemic, which costed around 650,000 American lives.* Increased death rates amongst middle aged whites were a major contributor to a drop in American life expectancy, first observed in 2015.

Case & Deaton published a 2017 followup, seeking to better understand this problem. They express skepticism towards the theory that stagnant incomes are the sole cause of the trends observed, noting that for middle-aged African Americans and Latinos, income growth wasn’t much better than for whites, yet mortality rate continued to drop.

Case & Deaton instead gravitate towards a hypothesis of “cumulative deprivation”, whereby employment opportunities for those with less education have steadily deteriorated, driven in part by globalization, technical change, and de-industrialization. As noted, whites with a high school education or less, are economically worse off than their parents. At the same time, marriage rates amongst those with lower incomes have declined (with more children being born out of wedlock), and fewer nuclear families.

This often leads to loneliness, particularly amongst men. Participation in traditional religious institutions has weakened, and with it, the social ties offered by these these organizations. As Deaton put it in an interview with NPR: “There’s a lot of social dysfunction building up over time. There’s a sense that people have lost this sense of status and belonging.”

As with any complex problem, there isn’t one simple solution. Improved educational outcomes, particularly vocational training, and teaching workers new skills (something Case has advocated), could have a positive impact. Education, unemployment, and income are, after all, closely linked. In recent years, programs have focused on teaching former coal miners to code, or become wind farm technicians; another proposal argues for training displaced workers in the solar industry.

Increased rates of economic growth, over an extended period of time, leading to decreased unemployment, and a broad-based rise in wages, would help. After all, economic insecurity is associated with greater physical pain, anxiety and depression, while unemployment is linked to opioid abuses, and other pathologies.

Yet, the gains from economic growth are unevenly distributed. Since 1980, GDP in the United States has grown by 154%. During that time, the median income of the American worker rose by just 16%, while the average income of someone in the top 1% of earners increased by 190%. Even with strong growth, it is unclear how much those with less education and skills would benefit. Also, there are serious questions as to how a mature economy, such as the United States, can grow more quickly.

As Case & Deaton’ suggest, along with commentators from the left and right, what we are seeing is not a purely economic phenomenon. For that reason, we must look deeper, and address issues of alienation, dispossession, and a lack of meaning, amongst Case & Deaton’s target group.

Social isolation is closely associated with a range of health risks, and is linked with increased risk of mortality, often being as large of a risk factor as obesity or smoking. Alienation can be similar to social isolation, although some people who are not completely isolated might be alienated, in that they feel disconnected from the world around them, from social or cultural norms, or suffer from a feeling that life lacks meaning or purpose. Alienation also carries serious consequences, in terms of mental and physical health. Much of what Case & Deaton observed seems to fall into the categories of social isolation or alienation, with dire consequences.

By contrast, volunteering, and being of service to others, has a tremendous positive impact on our lives. Individuals who volunteer enjoy a greater sense of self esteem and overall well being, including physical health, and feel more empowered, while lowering their stress levels. Brain research has found that giving helps trigger parts of our brain associated with pleasure and rewards. Older adults who offer social support to others, enjoy lower rates of mortality than those who don’t, even after controlling for socioeconomic and marital status, age, gender and ethnicity. Volunteering provides a sense of purpose, particularly amongst adults who (due to age), lost their roles as wage earners, or active parents. Volunteering also helps foster a greater sense of belonging and social inclusion, in part because it “focuses on what people have to offer, as opposed to what they may need.” It’s clear that volunteering can be very good for us.

For these reasons, I advocate creating a series of privately funded volunteer projects, where those who have are most vulnerable to the trends Case & Deaton studied, use their abilities to make a positive difference. What might this involve? For those who enjoy interacting with young people, this could mean mentoring interested youths in their communities, or other areas of need, on a monthly basis, in some sort of supervised setting. Volunteers and mentees could engage in team-building activities, sharing advice and guidance, based on life experiences, or assisting with schoolwork and teaching, where they feel sufficiently competent (or are interested in developing such a skill set). The iMentor program offers an interesting template for how such an initiative might be structured.

For other folks, who enjoy working with their hands, they might help to build and rebuild homes and infrastructure, in their own communities, and perhaps even throughout the country and the world. Habitat For Humanity offers an excellent model of the sort of program that could deliver great results. Expenses like transportation and lodging, would be covered by those who fund these projects.

These programs ought to be funded on a private basis, just like so many other wonderful nonprofits across the world. Given the range of philanthropic activity in the nation today, I believe it will be possible to pay for these projects, independent of any governmental support. Relying on the government to fund such initiatives, make it vulnerable to budget cuts and political rancor, which if at all possible, ought to be avoided.

When we look at the work done by the Gates Foundation, Project Literacy, Disabled Veterans (DAV), and so many other organizations large and small, we are reminded of the power of every individual, to make a positive difference in the lives of others. While doing so, if a volunteer experiences a sense of happiness and upliftment, and greater self worth, the effects of those new beliefs can carry over, into other areas of life. This individual might be more motivated to improve his or her economic, educational family or health situations, or simply to persevere through challenging times, and avoid destructive behaviors like excessive drinking or drugs. Volunteering may well be what Charles Duhigg, author of The Power Of Habit, described as a “keystone habit”, which leads to positive changes in many areas of life.

To be clear, I am not suggesting that volunteer programs take the place of public policy efforts, such as improving worker skills, or helping create jobs for those who face the sorts of risks Case & Deaton studied. Those approaches will be crucial to facilitating long-term change, at a large scale.

However, what ails so many of Americans today, seems to be a deeper crisis of self-worth and confidence, which has led to devaluation of their lives, and a range of destructive behavior. Changing those underlying beliefs is crucial to long-term upliftment. Volunteering is a highly effective way of ensuring this happens.

*It is worth noting that Case & Deaton’s findings have been contested by statistician Andrew Gelman of Columbia University, who argues that white death rates remained flat, rather than increasing, though Gelman acknowledges this is still an important finding.