Deaths of Despair Afflict More Cohorts Than Case-Deaton Originally Found

At the risk of over-hoisting from an important piece of analysis, below are some of the key sections from Anusar Farooqui, who writes as Policy Tensor, on the extent of the “death of despair” catastrophe. His piece, Yes, High-School Graduates Are Dying of Despair, is important because he demonstrates that the rising death rates over time extend even into those with some college education.

Farooqu got in an argument with Matt Yglesias on Twitter over the body of work by Ann Case and Angus Deaton on so-called deaths of despair, in which they found what they called an AIDS-level surge of mortality among less-educated whites in middle age. Not only have Case and Deaton refined their analysis, but other studies have identified an increase in early deaths from suicide and addiction in other groups.

For background, from our first post in 2015 on Case-Deaton findings:

The authors found that from 1999 to 2013, the death rate among non-Hispanic whites aged 45 to 54 with a high school education or less rose, while it fell in other age and ethnic groups. This is an HIV-level silent epidemic: AIDS killed an estimated 650,000 from the mid-1980s to present, while an estimated close to half-million died in half that time period who would have lived had their mortality rates fallen in line with the rest of the population. It is hard to overstate the significance of these findings. From the New York Times:

“It is difficult to find modern settings with survival losses of this magnitude,” wrote two Dartmouth economists, Ellen Meara and Jonathan S. Skinner, in a commentary to the Deaton-Case analysis that was published in Proceedings of the National Academy of Sciences.

This cross-country comparison from the study shows how extreme an outlier these middle aged whites are:

Screen shot 2015-11-03 at 6.01.10 AM

The big culprits are linked to despair, namely “poisoning” which is opioid abuse first and alcoholism second, and suicides. Case and Deaton dug into the underlying statistics, and found distressingly high levels of pain and impaired health in this age group, so pain and physical impairment may well be bigger culprits than economic distress:

Screen shot 2015-11-03 at 6.08.18 AM

And the rise in death rates took place among men and women, in all of the four major regions of the country the authors examined, and obesity rates were not a driving factor.

These pathologies have been showing up in other demographics. For instance, the Wall Street Journal reported in May 2023 that death rates in the 1 to 19 year old age group had risen at an unprecedented rate from 2019 to 2021 due to guns, suicides, car accidents, and drugs.

Now to the immediate discussion. Farooqui took issue with a claim by Matt Yglesias, bolstered by Eric Levitz, that the Case-Deaton data was less significant that it might seem because it lumped together those with no high school degrees with high school diplomas. Yglesias and Levitz argued that the “deaths of despair” were only taking place among high school dropouts and so the white working class was not in as terrible shape as it might seem.

Farooqui pointed out that Case and Deanton had shown that death rates among the middle aged were rising, albeit relatively modestly, even among those with some college education. But then he turns to the crux of the disagreement:

However, they [Case and Deaton] do not distinguish between [less than] HS and HS, and therefore do not address the specific issue highlighted by Levitz: “… it is actually an acute crisis of mortality of the bottom 10%.”

This is an empirical question. We attack this problem using CDC data collated by Wharton. They have age-specific mortality rates by educational attainment. The ordinal categories are

In order to obtain a more representative graph, we use age-specific population weights to combine age-specific hazard ratios. The next graph displays the population-weighted average of hazard ratios for our age-specific cohorts. By construction, this weighted average of hazard ratios is not confounded by any increase in average age within discrete age brackets. And, as explained above, because we’re looking at hazard ratios, it is also not confounded by the common component. This is as kosher as it gets in this business.

We can see that the upward trend in hazard ratios is not confined to high-school dropouts. It is true that the trend is most pronounced for them. But the upward trend is also significant for high-school graduates and those with some college under their belt. The all-cause hazard ratio has increased by 3.28 for high-school dropouts, 2.08 for high school graduates, and 1.27 for those with some college. The upshot is that, on the wrong side of the diploma divide, despair goes very far up indeed.

And then he drives the point home (I’ve omitted the charts in this section, but Farooqui showed he has the goods):

All-cause mortality has a very strong signal. But the evidence for American working class despair is not confined to mortality. Prime-age labor force participation contains the same signal of despair: four out of every nine Americans with only a high-school diploma are not even looking for a job. It’s not like high-school graduates can survive on one pay-check! These are obviously discouraged workers in despair.

Take family reproduction—perhaps the most important factor in human well-being. Following the Sixties revolution in behavioral norms, the rate of family reproduction stabilized for college graduates by the 1990s. But it has continued to fall for high school graduates. See my note from three years ago. And if you’re interested a deeper dive, see Andrew Cherlin’s work.

Or, take divorce rates. For college graduates, 29.7 percent of first marriages end in divorce by age 46. For high-school graduates, 48.2 percent of first marriages end in divorce. (The table’s from here.)

We can keep going. The truth is that American working-class despair is such a robust, large-scale pattern that one can recover the signal from practically anything we care to measure—mortality, morbidity, BMI, labor force participation, marriage rates, child-out-of-wedlock rates, you name it. So, I stand by my challenge to Matthew Yglesias.

Well-off Americans are so removed from these cohorts, usually encountering them in various service, as in servile, positions where they have to put on a good face as a condition of getting paid, that they can pretend that the lesser orders aren’t suffering in financial and emotional terms. One proof is despite Case’s and Deaton’s landmark work, there’s no interest in what to do to alleviate this personal and collective disaster. Our version of “Let them eat cake” has gone from “let them learn to code” to “Deprogram them all”.

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  1. James E Keenan

    However, they [Case and Deaton] do not distinguish between

    This sentence quoting from Farooqui seems incomplete.

    1. Yves Smith Post author

      Actually it is complete but for some reason WP will not tolerate the original sentence. In the backstage, I see where it cut off, at (w/o the brackets) [<]HS. So I had to insert words.

  2. Jessica

    “Well-off Americans are so removed from these cohorts, usually encountering them in various service, as in servile, positions where they have to put on a good face as a condition of getting paid, that they can pretend that the lesser orders aren’t suffering in financial and emotional terms.”
    I had never noticed this servility until I lived for a time in Edmonton, Alberta, Canada. The high-paying oil field jobs farther north greatly affected the labor market in Edmonton too and it showed. (Also, in the way that spring brought not only greenery but also a blossoming of new motorcycles.)
    The absence of servility there made me aware of it in most places in the US. This greater equality could at times be a little inconvenient, but it felt much healthier.

    1. BeliTsari

      As an alumnus of a real famous Gas/ Oil Inspection Agency, once in Edmonton (it’s difficult to describe working conditions, without setting-off some algorithm) their “absence of servility” is earned? But, little different from our coworkers in Mexico, the US & elsewhere? That, we’re perpetuately in debt or indentured as contractors (one step ahead of process servers, skip-tracers, PO, deputies, ex-spouses & repo-men) seems to instigate then reenforce his attitude as much as substance abuse, lethal exposures, CTE, unresolved early childhood trauma, junk food & brain spirochetes? Im guessing in-breeding & rPGH engorged amygdala fits in there, somewhere?

    2. BeliTsari

      As an alumnus of a real famous Gas/ Oil Inspection Agency, in Edmonton (it’s difficult to describe working conditions, without setting-off some algorithm) their “absence of servility” is earned? But, little different from our coworkers in Mexico, the US & elsewhere? That, we’re perpetuately in debt or indentured as contractors (one step ahead of process servers, skip-tracers, PO, deputies, ex-spouses & repo-men) seems to instigate then reenforce his attitude as much as substance abuse, lethal exposures, CTE, unresolved early childhood trauma, junk food & brain spirochetes? Im guessing in-breeding & pST engorged amygdala fits in there, somewhere?

  3. Michael Fiorillo

    Many #McResistance liberals take a vicious pleasure in seeing the statistical congruence between deaths of despair and (at least in their eyes) Deplorable density. If it’s Red, they’re happy to see it dead; recall those gleeful Jimmy Kimmel routines where he yukked it up over rural Covid deaths…

  4. Vicky Cookies

    The Case-Deaton book is an interesting study in cognitive dissonance. In the introduction, they write:
    “In the last half century, America (like Britain and other rich countries) has built a meritocracy that we rightly see as a great achievement.”
    They follow this with several hundred pages of contradicting this statement with data (unless you’re a social darwinist)
    Then, in their conclusion:
    “We believe that capitalism is an immensely powerful force for progress and for good, but it needs to serve people and not have people serve it.”
    They seem to fundamentally misunderstand what capitalism is – these are economists from Princeton. Marx said somewhere that capitalism is a system of relations wherein the producer, rather than employing the means of production, is employed by them (or something to that effect). That the trend they describe gets exposure is fine and good; that it is beginning to be wrestled from ivy-stained economists is even better news.

    1. hk

      Anne Case was also one of the authors who wrote about the same phenomenon in former USSR during Yeltsin’s rule.

      Many or even most (good) economists don’t care about semantics of “capitalism.” Case and Deaton certainly don’t: they are primarily data and “policy” people with little interest in “grand ideological philosophizing.”. I tend to think it’s better that way: even economists engage in “grand ideological philosophizing,” they are playing politicians and ideologues and no expert who is also a political ideologue deserves any trust, IMHO.

      1. Vicky Cookies

        I wonder if their ideologizing, if that’s a word, in the book-ending of the study then has more to do with something like the editorial concerns of the publisher – Princeton’s press, if I recall correctly.

    2. digi_owl

      Capitalism is the kind of exploitation Robin Hood decried, only because there is a wage involved the “lord” is excused.

      1. Kilgore Trout

        “Capitalism is the extraordinary belief that the nastiest of men, for the nastiest of reasons, will somehow work for the benefit of us all.”–JM Keynes

    3. Susan the other

      I don’t know about the producer being employed (captured?) by the means of production, but there’s no doubt that producers are controlled by consumers. A more mindless mass of hungry protoplasm never existed – bringing the spat about who controls the means of production to a whole new level. Demand rules the world. Especially so in the capitalist world of material abundance. I am amused at the word “meritocracy” because nobody is ever so introspective as to question what kind of meritocracy and to what end. It is all reduced to categories of human wealth, how much money are you worth. It’s such an oxymoron we really deserve our confusion. I’d even be so glib as to suggest that our confusion about our goals is one big cause for our despair. And because it is such a mess to disentangle our dear leaders leave it to the free market – let the market decide. That approach could eventually work if we just had all the time and resources in the known universe, but clearly we do not. It is long since time we admitted the seriousness of our inequalities. Our primary and immediate goal must be security and well being for everyone. The whole idea of meritocracy is in direct conflict with well being for all. Just the catch-word “meritocracy” makes me sick.

      1. jobs

        It also implies that the people on top deserve their exalted positions and wealth, making people’s failures to get by a personal rather than a systemic issue.

      2. Vicky Cookies

        You said “demand rules the world”. As a thought experiment, let’s construct a hypothetical market, wherein an individual capitalist secures for himself a controlling share in, say, blueberries. What then does he do? He fertilizes the market for blueberries by spending some If his resources in media: paying for ‘list-icles’, funding research into the health benefits of blueberries, and having them placed where the general public would be exposed to it.
        Supply creates demand. There is, for example great popular demand for nationalized, free health-care here in the U.S. Why don’t we have it?
        I believe that it is an elitist attitude to consider the current wasteland of ‘culture ‘ and consumer society the fault of people in general (‘demand’), who are largely working class and not in control of the information which gets out.

        1. Susan the other

          I commented but it got lost in the ether. My internet connection is screwy today. Basically, I agree with you.

  5. Lefty Godot

    A large part of what makes life bearable in Western nations is the idea that the future will be better. We know what awaits us individually at some point: old age, decrepitude, illness, and death. So we need a social counter-narrative in the background keeping our spirits up, telling us that before we get to that bad end, there will still be a time when “the best is yet to be”. After World War II the bright future was recast from something that might have a balance of materialistic and more spiritual satisfactions (the Maslow pyramid) to one of full-tilt consumption. The trouble is, without unlimited money you’re just consuming throwaway crap in a repetitive fashion that becomes more and more unsatisfying. But we were able to bull along that away for two generations (between three and four decades), until Nixon broke the Bretton Woods system and the OPEC oil shocks of 1973 and 1979 (and the presidencies of Ford, Carter, and Reagan). The re-election of Reagan marked a real inflection point in American society: when the New Deal ethos died, three decades of attempted “counterculture” came to a definite end, and former ethnics all became just “whites”, among other things.

    Since the mid-1970s, all the inflation-adjusted, “real” wage gains made by workers have been women’s pay being leveled up to a higher percentage of what men earn, but still nowhere near parity (one study). So the future has been stuck in a rut, where the appearance of different new, shiny consumer toys has not mitigated the economic stagnation most families feel (outside the PMC, that is). It’s no coincidence that we have seen the rise of ersatz spiritual movements trying to offer compensation for this, including the several decades of “New Age” trendiness and the steady gains for fundamentalist, evangelical Protestantism. And the steady rise in personal indebtedness and reliance on credit. But the neoliberal economic model can’t tolerate any slowdown in mass consumption and profit-taking by the owning class, so ever larger segments of the working population are seeing the future as, not only more of the same, but worse outcomes arriving sooner. The need for college degrees now is just the most obvious credentialist filter cutting people out of the workforce, since for many of the jobs requiring a degree it’s unnecessary and often unrelated to anything you’ll do on the job. It’s another way for the owning class to kick people off the bottom rungs and pull the ladder up out of reach.

  6. adam1

    It’s amazing how tangentially related this problem is to so many other noted social concerns but it gets ignored or snubbed as just a problem for fly-over-county.

    We’ve on again off again talked about school bus drivers or the now chronic lack of them, but holy direct results. The split shift scheduling needs to be a school bus driver means most of your worker pool are middle aged plus workers who don’t have young child needs/constraints. Yet this data says we’ve lost half a million who would otherwise likely fit into this worker pool to this excess death do to despair. And given a key driver is substance abuse god only knows how many millions more have become ineligible to be a bus driver because of abuse that just hasn’t yet killed them yet (and I’m not even including the chunk Covid took away either). And we wonder why we can’t find enough bus drivers. I guess we just need to find a bigger carpet to sweep THAT elephant under.

    More on the despair side, but I enjoy genealogy as a hobby and when you look at census records from 100+ years ago, when large chunks of society were working poor, it’s amazing the percentage of people who’s occupation (if not farming) is listed as Day Laborer. These are people who work when the work volume is there, typically non-skilled, physical work. You could even work every workday for months for the same company, but then one day if the volume falls far enough find yourself without pay for that day. It makes me chuckle a little sadly but we glorifying call them gig workers today! Yes, some gig workers make very good living wages, but I would suspect most are not especially if all of their work expenses were correctly factored in (i.e. the uber driver whose PERSONAL car is depreciating at an accelerating rate). I’d suspect a big chunk or “gig” workers are desperate and on the verge of despair if not already early stage victims of it.

  7. Wukchumni

    One thing i’ve noticed with deaths of despair is that if a celebrity of somebody in the public eye commits suicide, it is almost always mentioned in the mainstream media, and yet a regular Joe or Jane offing themselves is almost never ever in an obit.

  8. Dick Burkhart

    Bravo for this to-the-point update to the Deaton-Case research. It is a direct and predictable consequence of what many call “neoliberal globalization”. The “meritocracy” is simply another name for the “ruling class”. It is already hitting its “limits-to-growth” but like past empires and civilizations, the ruling class is just too addicted to its success (read Peter Turchin). Only some form of collapse will bring it down, with very ugly events. Trump, war in Ukraine, and now Gaza, – the collapse is just getting going.

  9. LAS

    I applaud Case and Deaton for being among those who communicate about declining life expectancy in the USA. One does have to choose analytic groups in demonstrating effects statistically on a population but that is not to invalidate other analytic groupings that others work on for the reveal of additional information. It shouldn’t be an either/or discussion.

    Meritocracy is a stupid concept and I think Case and Deaton were trying to suggest as much without insulting the elite policy makers.

    Meritocracy as an ideology is mostly just another control fraud. We should have always known that in our hearts. Everyone has a role to play. We would be in a bad way if there were not a variety of occupations. So why punish people for taking one or another role? They are also filling a need.

  10. Isla White

    Could this also be mapped as combinations of teenage itch; 25 year itch and mid-life itch; a luxury in better off countries – that do not offer just choices of herding the rich neighbours sheep or – if showing promise, promoted to herding their goats?

    As a teenager stress and confusion over gender; substance abuse, falling out with school friends and in with local gangs; home life problems etc then in mid 20’s … where am I going in life? Was my higher study, if done at all – worth it and is working in that business sector for the rest of my lifetime …. meaningful?

    Then – in mid life the full awareness that we have been sold a fantasy. Bogged down with debt. Fully aware that the good guys do not or rarely win and then only temporarily; that bad guys get further faster and that the legal system in ‘country x’ is not impartial or effective.

    Time and again studies in the southern EU conclude that ‘4 out of 5 citizens in country x’ have no trust in their legal system. That going to law is a waste of time and money and – if the aggrieved party or fighting officialdom – we must swallow our loss. And move on …

  11. Freethinker

    A problem today is that in the supposedly rich countries, even poor people have (via the internet) relatively affordable access to the most knowledge the world has ever had available. So, if willing & able to think for themselves, they can easily find proof of how rigged the system is against them & this causes them to lose hope. The proof confirms the obstacles they can often see in their daily lives that those in power are gaslighting them from birth, don’t exist. They no longer believe the victim-blaming propaganda of their rulers who tell them they can have anything they want if they just would put in the effort; but it just isn’t possible to retain that level of naivete into adulthood now.

    Following on from this, they also don’t see a way to bring about the changes that would give them hope for the future, with even Europe today largely only pseudo-democracies & each generation clearly having worse lives than the previous one, with little reason to think things will change in their lifetimes. As for forcing change, even peaceful demonstrations are increasingly banned & ever more intrusive surveillance multiplies whatever you vote for. The only real choice that leaves is to opt out, but even that is not an option because euthanasia is nearly impossible to access ……almost as if our masters keep us suffering on standby in case they need our ever cheaper labour.

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