David Leonhardt: How working-class life is killing Americans

In this Jan. 27, 2016 photo, 39.6-grams of black tar heroin, with a street value of about $12,000, is among many other heroin-related items in Post Falls Police Department's evidence room in Post Falls, Idaho. In California, San Diego County Health and Human Services Agency said, seven people have died in the last two months from the bacterial infection myonecrosis, which is associated with black tar heroin use. (Shawn Gust/Coeur D'Alene Press via AP, File)

When economists Anne Case and Angus Deaton first published their research on “deaths of despair” five years ago, they focused on middle-aged whites. So many white working-class Americans in their 40s and 50s were dying of suicide, alcoholism and drug abuse that the overall mortality rate for the age group was no longer falling — a rare and shocking pattern in a modern society.

But as Case and Deaton continued digging into the data, it became clear that the grim trends didn’t apply only to middle-aged whites. Up and down the age spectrum, deaths of despair have been surging for people without a four-year college degree.

In the early 1990s, the number of white adults without a college education who died from drug overdoses, alcoholism or suicide was fairly low — and the death rates for younger adults were lower than for older adults.

But over the past three decades, deaths of despair among whites without a college degree — especially those under age 50 — have soared.

The death rate for whites with a college degree, by contrast, has risen only modestly across all age groups and remains lower for the young than the old.

Case and Deaton — a married couple who are both economists at Princeton — try to explain the causes in a new book, “Deaths of Despair and the Future of Capitalism.” Their basic answer is that working-class life in the United States is more difficult than it is in any other high-income country. “European countries have faced the same kind of technological change we have, and they’re not seeing the people killing themselves with guns or drugs or alcohol,” Case said. “There is something unique about the way the U.S. is handling this.”

Inequality has risen more in the United States — and middle-class incomes have stagnated more severely — than in France, Germany, Japan or elsewhere. Large corporations have increased their market share, and labor unions have shriveled, leaving workers with little bargaining power. Outsourcing has become the norm, which means that executives often see low-wage workers not as colleagues but as expenses.

And the United States suffers from by far the world’s most expensive health care system. It acts as a tax on workers and drains resources that could otherwise be spent on schools, day care, roads, public transit and more. Despite the unparalleled spending, the U.S. medical system also fails to keep many people healthy.

Many of the problems afflicting the working class span racial groups, and Case and Deaton emphasize that these problems aren’t merely financial. Life for many middle- and low-income Americans can lack structure, status and meaning. People don’t always know what days or hours they will be working from week to week. They often don’t officially work for the company where they spend their days, which robs them of the pride that comes from being part of a shared enterprise.

“Many people used to associate the meaning of their life with what their corporation or institution was doing,” said Deaton, a Nobel laureate in economics. Miners and factory workers identified themselves as such. Warehouse workers, especially those whose paycheck is signed by a staffing company, rarely feel the same connection.

The result of these trends has been a “coming apart,” as Case and Deaton put it, of day-to-day life for whites without a college degree versus those with a college degree.

Marriage rates have diverged as well. People without college degrees are also less likely to attend church. Surveys show that a growing number of working-class Americans find it difficult to do basic things, like climb a flight of stairs or socialize, partly because of chronic problems with their mental or physical health. Many people are also drinking more. And they are unhappier.

Given all of these alarming social indicators, it’s not surprising that some other causes of death — in addition to suicide, alcoholism and drug overdoses — have also started rising for Americans without a college degree. Heart disease is the most significant, exacerbated by obesity, drinking and drug use.

The combined result is a divergence in the life expectancy of white college graduates and nongraduates. Overall mortality for whites between the ages of 45 and 54 has held roughly steady in the last 25 years. But that average hides a big increase in death rates for nongraduates and a big decline for graduates.

What can be done about all of this? Many of the solutions are obvious, if difficult to accomplish. The medical system should be overhauled to put a higher priority on health than on wealth for people who work in the industry, Case and Deaton argue. (And that doesn’t necessarily mean a mandatory version of Medicare, they add.)

The federal government should do a better job of keeping big business from maximizing profits at the expense of its workers, by enforcing antitrust laws and encouraging new kinds of labor unions. Governments at all levels should help more people earn college degrees, both four-year degrees (like BAs) and meaningful vocational degrees.

Other economic research has found that a college degree isn’t simply a marker. Students who attend and graduate from college do better in life than otherwise similar students who didn’t get the same opportunities. Graduates are more likely to be employed, earn more, marry and stay married, be satisfied with their lives, be healthy and live longer. These findings suggest that college itself — both the classroom learning and the experience of successfully navigating college — brings long-term benefits.

The focus of Case and Deaton’s book isn’t education, but it lingers as the backdrop to all of their findings. “This BA/non-BA divide,” Deaton said, “just comes up again and again and again.”

David Leonhardt

David Leonhardt is an Op-Ed columnist for The New York Times.