The White Working Class: Dying from Drugs–and Poor Nutrition

In 2015, life expectancy in the United States declined for the first time in over 20 years. The decline was driven mostly by the continued increase since the late 1990s in the death rate among working class, non-hispanic whites–the largest group in the country, comprising over 40 percent of the population. The disturbing increase in the death rate among this group was first revealed in a landmark study by Nobel laureate Angus Deaton and Anne Case in 2015. Now Deaton and Case are back with a new study that provides additional evidence.

Deaton and Case attribute the rising death rate among working class whites to ‘deaths of despair’–drugs, alcohol, and suicide. And as the cause of the despair, Deaton and Case focus on worsening social and economic conditions.

The authors suggest that the increases in deaths of despair are accompanied by a measurable deterioration in economic and social wellbeing, which has become more pronounced for each successive birth cohort. Marriage rates and labor force participation rates fall between successive birth cohorts, while reports of physical pain, and poor health and mental health rise.

Case and Deaton document an accumulation of pain, distress, and social dysfunction in the lives of working class whites that took hold as the blue-collar economic heyday of the early 1970s ended, and continued through the 2008 financial crisis and the subsequent slow recovery.

I suppose it’s natural for economists to focus on economic and social causes, like labor force participation and marriage rates. I’m sure these play a role in the despair of working class whites, but I don’t think they tell the whole story because ‘deaths of despair’ are only a fraction of the overall rise in deaths. In their Power Point presentation, Deaton and Case offer the following graph of the rate of ‘despair’ deaths for those aged 50-54.

As can be seen in the graph, ‘despair’ deaths–basically suicide and slow-motion suicide using drugs and alcohol–increased for both men and women by 70 or 80 per 100,000. All deaths, however, increased by a lot more than that.

For the same group of people, the death rate overall increased by about 200. Despair deaths therefore account for maybe 40 percent of the total increase. That’s a lot, but it raises the question, what accounts for the other 60 percent? My guess would be deaths from diabetes and other afflictions caused by obesity. Deaton and Case are skeptical of this explanation because among blacks, unlike whites, greater obesity has not increased the death rate. But other factors might be keeping down the black death rate despite high and rising obesity.

Deaton and Case are willing to concede (p.14) that the “contribution of obesity and diabetes to the mortality increases documented here clearly merits additional attention.” Then they proceed to pay it no additional attention, and focus throughout the rest of the paper on their social science hypotheses.

The words ‘food’, ‘diet’, ‘nutrition’ and related words appear nowhere in their 58-page paper, with the exception of a single reference on page 34 to “overeating.”

Deaton and Case are to be commended for calling attention to the deteriorating social and economic state of working-class whites. But the effect of very poor nutrition and eating habits also should not be ignored.

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