Deaths of Despair
As we celebrate the holidays, it’s important to also remember those less fortunate than ourselves. I expect most of those reading this blog or listening to the podcast have a college degree or attend college at the moment. It’s a fortunate group, because the economy favors those with a college education. Indeed, college graduates do not simply make more money, but have more stable families and better health outcomes. Inequalities have become about more than a better life. It has come to mean life itself.
Angus Deaton and Anne Case were the first to recognize an increase in early mortality rates among non-hispanic whites without a college degree. They refer to this phenomenon as deaths of despair, because they involve causes such as suicide or drug overdoes brought about by a lack of hope. The reasons for this epidemic are complex. It involves sociological affects due to economic transformations. Yet at the same time, it is a peculiarly American phenomenon. Deaths of despair are not widespread in Europe or Australia.
For many readers, the term deaths of despair is no longer new. But it’s often misunderstood. For example, recessions do not exacerbate deaths of despair. The pandemic did not lead to an increase in deaths of despair either. A temporary loss of income or suffering does not lead to despair. Rather it takes a sustained loss of hope before depression or despair become overwhelming. So, the tragedy from deaths of despair involves long term economic and social transformations that leave people without any sense of hope for things to ever improve. As Deaton and Case describe it, “It is not inequality itself that is unfair but rather the process that generates it.”
Globalization has brought about many socio-economic changes in developed economies. Many working class jobs have disappeared due to automation and competition from trade. In exchange, new industries have emerged in what has been called the knowledge economy. Unfortunately, most of those jobs exist in other parts of the country and demand different skills and qualifications. The problem with economic inequality is not simply that some people make more money than others. Rather the problem is some people receive better opportunities than others. Moreover, the geographic disparities in economic opportunities have disrupted communities and created two distinct versions of America.
Perhaps it helps to realize how many Americans lack a four year college degree. Recent U.S. Census data shows just 36% of Americans over 25 years of age possessed a four year college degree in 2019. So, the challenges of the working class do not represent a disadvantaged minority, but rather the overwhelming majority of Americans.
Moreover, educational inequalities lead to social inequities. Michael Sandel writes, “Something more than material deprivation was inciting the despair, something distinctive to the plight of people struggling to make their way in a meritocratic society without the credentials it honors and rewards.” Sandel refers to a tyranny of merit where education becomes a moral justification for those inequities. Over time inequities compound until the gap between the haves and the have nots becomes insurmountable. The difference is not merely about material well-being, but respect and dignity. As Sheryl Wudunn and Nicholas Kristoff write, “Poverty is about not just income but also humiliation, social exclusion, the stress of being forever lower on the social ladder.”
Thankfully Deaton and Case believe solutions do exist to resolve this crisis. They believe “if we can get the policies right, we can ensure that what is happening today is not a prelude to another great disaster but rather a temporary setback from which we can return to rising prosperity and better health.” Indeed, they perceive the crisis as a failure of public policy. The difference between the United States and other Western nations involves differences in policies rather than differences in culture. For them the United States has exacerbated the challenges of globalization through an inadequate social safety net and a failure to provide many Americans adequate health care.
Health care dominates the narrative. On one level this makes sense, because deaths of despair involves a public health crisis. Many of the deaths involve overdoses from drugs or inadequate medical care. However, American health care policy creates even more significant challenges. For starters Americans pay more for health care than any other country despite receiving substandard health outcomes. At the same time, many Americans forego almost any medical care at all due to lack of insurance or inadequate health insurance. But it’s not just the cost of medical care for people. It also distorts the cost of labor and encourages businesses to find ways to outsource their employment wherever possible.
Because the United States ties health care to employment, it has encouraged employers to hire part-time and contract labor to avoid health care insurance and other benefits. This trend has enormous economic and social consequences for the labor force. Obviously, workers without benefits lose out on paid leave and other forms of insurance, but they also receive different treatment from their employers who view them differently than their full-time staff.
Deaton and Case have influenced conversations surrounding inequality and economic growth in the United States. However, the reforms they propose face peculiar political challenges. For starters, the demographic that faces deaths of despair has become ideologically resistant to government solutions. Arlie Russell Hochschild referred to a great paradox to explain why people in Louisiana oppose environmental regulation despite suffering the most from industrial pollution. Indeed, Barak Obama alienated many of his working class supporters through the passage of the Affordable Care Act. So, it’s difficult to imagine how reform is possible without support from the groups most affected by the policies.
Nonetheless, Deaton and Case have provided a new language to discuss the economic and social challenges America faces. Moreover, their ideas have already influenced arguments from the right and the left. The crisis faced from deaths of despair challenge the classic political divide of the right and left. It is more than an economic challenge. It is truly a matter of life and death.
Jessica Bruder (2017) Nomadland: Surviving America in the Twenty-First Century
Anne Case and Angus Deaton (2020), Deaths of Despair and the Future of Capitalism
Anne Case and Angus Deaton (2020) “The Epidemic of Despair,” Foreign Affairs
Angus Deaton and Anne Case (2021) “The Great Divide: Education, Despair and Death,” NBER Working Paper
Matthew Desmond (2016) Evicted: Poverty and Profit in the American City
Jacob Hacker and Paul Pierson (2020) Let them Eat Tweets: How the Right Rules in an Age of Extreme Inequality
Arlie Russell Hochschild (2016) Strangers in Their Own Land: Anger and Mourning on the American Right
Nancy Isenberg (2016) White Trash: The 400-Year Untold History of Class in America
Thomas Piketty (2019) Capital and Ideology
Michael Sandel (2020) The Tyranny of Merit: What’s Become of the Common Good?