It has been general knowledge for a while now that American longevity is not keeping up with other modernized industrial nations. A pair of researchers, Drs. Angus Deaton and Anne Case, may have found at least part of the answer. Dr. Deaton recently won the Nobel Memorial Prize for Economic Science (the not real Nobel Prize if you are among the purists). So how does an economics professor scoop the medical sciences crowd on a huge increase in mortality? Because he is an economist concerned about income inequality and his co-author (and spouse) also suffers from long term chronic back pain. And so we return to two essential differences between the US, especially over the last decade plus, and the rest of the industrialized world: lack of universal health care and lack of adequate pension/disability social programs. A third factor we share with some industrialized nations, the rise of income inequality. But the lack of social programs to support those with less income and health issues means our people die. And they die terribly.
I could not find the actual report, I don’t believe it is actually fully published on the net, but has been released to the press. I reviewed articles in the American Prospect, the New York Times and a Washington Post Blog.
http://prospect.org/...
https://www.washingtonpost.com/...
http://www.nytimes.com/...
What Angus Deaton and Anne Case discovered is that mortality rates were being negatively affected by one particular cohort of Americans between 1999-2013. Middle aged white Americans between the ages of 45 to 54 with a high school education or less were bucking the trend of increasing longevity. It is a group that still represents something close to 40% of US adults. People old enough to be suffering from increasing physical ailments coupled with being the economic losers among white Americans in the growth of income inequality over the last few decades. They are increasingly poor health but not able to afford sufficient medical treatment, or just well off enough to afford the wrong kind of treatment, improperly prescribed and abused prescriptions medications.
“The increased deaths were concentrated among those with the least education and resulted largely from drug and alcohol “poisonings,” suicide, and chronic liver diseases and cirrhosis. This midlife mortality reversal had no parallel in any other industrialized society or in other demographic groups in the United States.” American Prospect .
“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 to be published in Proceedings of the National Academy of Sciences.” New York Times
The researchers and the author of the American Prospect article, as well as the New York Times article, were quick to point out that African Americans still do much worse overall when it comes to early mortality than whites. But in the same period that this particular cohort of white Americans were losing ground, midlife African Americans were overall still gaining ground.
“As a result, the ratio of black to white mortality rates dropped from 2.09 in 1999 to 1.40 in 2013.” (American Prospect)
I am not trying to imply that white folks are worse off in general by any means, just that the research on this particular cohort of whites shows a startling and large reversal that doesn’t apply to any other population. Hispanics in fact now enjoy better life expectancy in midlife than this cohort of whites.
What is particularly notable about this reversal in mortality trends is the causes of death that contribute to it. As with other Americans, these folks are doing better at surviving heart disease and cancer and many other diseases. What is killing these folks is substance abuse: alcohol poisoning, drug overdoses and chronic diseases associated with substance abuse such as cirrhosis of the liver. Death by drug abuse for white Americans in this age group exceeds that of other Americans. In other words, one of the largest groups of victims of drugs are white middle aged people. And yet they are not the focus of the ‘war on drugs’. They are most likely to fall into other holes in our medical care system, too rich to get Medicaid, too poor to afford even subsidized Obamacare, and in many cases, too brainwashed to believe they ought to try for help from social support programs.
So how did this group go unnoticed by medical science but not the economists? From the New York Times’ Article:
“Dr. Preston of the University of Pennsylvania noted that the National Academy of Sciences had published two monographs reporting that the United States had fallen behind other rich countries in improvements in life expectancy. One was on mortality below age 50 and the other on mortality above age 50. He coedited one of those reports. But, he said, because of the age divisions, the researchers analyzing the data missed what Dr. Deaton and Dr. Case found hiding in plain sight. “We didn’t pick it up,” Dr. Preston said, referring to the increasing mortality rates among middle-aged whites.”
What is typical of this group of people is reports of significant pain. Pain that keeps them from doing everyday chores or working full time. They self report the inability to socialize, to walk a quarter mile, to adequately care for themselves because of pain. So they drink, get prescription pain pills or illegal drugs such as heroin to self-medicate, all of which ultimately makes their health worse. And then they commit suicide in increasing numbers, especially white males. So over the period of the study, half a million middle-aged white Americans have died sooner than anyone would have suspected. Unnoticed by and large, and ignored as the public health crisis it is.
And it is going to become a larger crisis. Because we now have, as noted in the Washington Post blog:
“A sicker population that has been less able to prepare for the costs associated with old age will place an increasing burden on society and federal programs, they said.”
We also have another large cohort which will face similar economic strains, our recent graduates, of all ethnicities and races, that can’t get decent jobs. People who won’t be able to participate fully in economic benefits, and who will still be deprived by politics of social programs that might make a difference to their very survival.
All the research that needs to be done hasn’t been done yet. As with all academic ‘discoveries’, it will take time to duplicate and flesh out the findings of Deaton and Case. But this isn’t their first foray into the field, this is proof of a hypothesis put forward in 2001. Themes in the Economics of Aging, U of Chicago, 2001. This earlier monograph,a chapter in the larger work that is now out of print, suggests income inequality and lack of income have a negative impact on health and mortality rates. The findings of a decade plus of additional research would seem to support that.
So, what does this mean politically? That the huge level of anger and seeming batshit crazy is based in a real world problem. Conservatives view it as a moral failing, Charles Murray is an author who makes that argument explicit. It is bought hook, line and sinker by the Republican Party and its base. The sad news is that a large group of Americans is suffering and dieing needlessly. The sadder news is they are suffering mostly from Republican policy. And the part that makes it saddest of all, is that they tend to express their suffering through support of the very political party that is killing them. But the conservative viewpoint, a moral failing in American life making these people decide not to work, doesn’t fit the facts. European nations with similar inequality and losses of relative wealth don’t have a cohort of folks dying too soon from substance abuse and suicide. European countries with more generous systems of social protection aren’t killing off their populations through neglect.
“The role of suicide, drugs, and alcohol in the white midlife mortality reversal is a signal of heightened desperation among a population in measurable decline. We are not talking merely about “status anxiety” due to rising immigrant populations and changing racial and gender relations. Nor are we talking only about stagnation in wages as if the problem were merely one of take-home pay. The phenomenon Case and Deaton have identified suggests a dire collapse of hope, and that same collapse may be propelling support for more radical political change.”
This cohort explains much of what we cannot fathom about current support for Republicans. The intensity of the desperation expressed by white people against other groups of people, always claiming they are victims. If you don’t have sufficient education, you have your most trusted new source being a bullhorn for conservative propaganda that your failure is a moral failure, you have constant pain and overindulge in mood and cognitive altering substances, you aren’t going to be rational. Facts won’t matter. And if you are already depressed and feel victimized, then is it any surprise that you turn on others around you that seem to be doing better, seem to be more capable of coping, and figure that somehow they are stealing your opportunity? You blame your neighbors and co-workers instead of the propaganda masters and the people pulling strings to make sure you can’t cope and you do fail, and worse than that, you die after suffering pain, chronic disease and depression.