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Why have middle aged, white Americans experienced a stunning rise in premature deaths due to alcoholism, suicide and drug abuse? Economists who have documented the dramatic decrease in life expectancy say an obvious place to look is the loss of work and economic status for the working class. But economics correspondent Paul Solman finds that’s not the whole story.
But first: the second of a two-part look at the declining life expectancy for some middle-aged white Americans.
Last week, economics correspondent Paul Solman examined the role prescription painkillers and alcohol may play in the trend.
Tonight, he explores how the economy and the job market may be involved.
Its part of our weekly series Making Sense, which airs Thursdays.
The Hardee's in Maysville, Kentucky, a popular hangout for the senior set.
Martin Sauer used to work for the sheriff's department, where he says he saw his share of Saturday night drunks, but nothing like the current opioid drug epidemic.
MARTIN SAUER, Kentucky:
People get hooked on it and can't get off of it, or don't want to, causing a lot of younger generation to lose their lives.
And by younger generation, Sauer means his middle-aged neighbors, who, as we reported last week, are experiencing a stunning rise in premature deaths due to alcoholism, suicide and drug abuse. But why?
ANGUS DEATON, Economist:
The health crisis here is particularly among white working-class or white people with a high school and no more. For those people, the economy's been very hard for a very long time.
Predictably, Angus Deaton and Anne Case, economists who have documented the dramatic decrease in life expectancy, say an obvious place to look for a cause is the economy.
ANNE CASE, Economist:
It used to be, with a high school degree, you could get a job, that actually could provide for your family. And the disappearance of those may lead people to feel a lot more stressed.
Indeed, in the period covered by their study, 1999-2014, inflation-adjusted income for households headed by a high school graduate fell by 19 percent.
Well away from the Ivory Tower, on the ground in Maysville, Wayne Pendleton has lived the change.
WAYNE PENDLETON, Kentucky:
Maysville, when we moved here, was a pretty well flourishing little town right here. But we have lived here, what, 17 years? And you can just name the stuff that's left here. You can't take a job away from a guy 55 years old and expect him to start all over again.
SHERMAN SAUNDERS, Kentucky:
Even at my age, it's depressing if you're not trying to do something.
Despite four heart attacks, Sherman Saunders still wants to work.
That's not someone else's responsibility to take care of the family. It's supposed to be yours. You have to go to work to do that yourself.
MARCY CONNER, Nurse:
Most of the men aren't working.
Marcy Conner, a nurse specializing in substance abuse, has a close-up view of the downward spiral.
All of a sudden, you lose your job. So, here is a male with no identity. He's not working. He's supposed to be a provider for his family. He can't even do that. So that low self-worth, along with that hopelessness feeling, we start seeing tremendous depression.
So, how do you relieve depression? You can relieve it with drug use, alcohol use, or suicide.
Conner's own husband died of alcohol poisoning.
Poured alcohol down his feeding tube until he died.
The husband of best friend Becky Manning also killed himself.
BECKY MANNING, Widow:
He blew his head off.
Joseph Manning had been a truck driver for 30 years.
And then he retired at 55, which then gave him nothing to do.
Then he started getting depressed. And then we would go to different doctors, and then they would just try different drugs. And those never worked, because they caused side effects, which made him feel worse about himself.
Right, weight gain?
Yes, he gained weight.
Absolutely, where I'm worthless. I can't be here for my wife, you know?
So when you hear about the end of work, the jobs, like truck driving jobs …
… which will be replaced by…
… self driving cars, you think?
What are these men going to do? Yes.
In this next generation, I think you're going to see the death rate continue to climb.
Local doctor Craig Denham buys into the economic hypothesis.
DR. WILLIAM CRAIG DENHAM, Family Physician:
Economics is a major component. Job availability is a major component.
So, case closed. Economics explains the epidemic of suicide and overdose deaths ravaging America's white working-class.
Not so fast, say Case and Deaton.
Because Europeans have suffered too in this — the jobs leaving the country, but we don't see them killing themselves.
Yes, you know, Spain suffered. The unemployment rate went from 5 percent to like 25 percent. And the health improved.
And what about working-class black Americans?
African-Americans' rates of death from suicide, drug overdose and alcohol have been flat. They have not risen.
DARRICK HAMILTON, Economist:
It's not as if stress is something new to the black American population. We have been dealing with stress for quite a long time.
Economist Darrick Hamilton.
The impact of stress is not new, so that's why you're probably not seeing an uptick the way it is for whites. We're used to struggle, unfortunately.
And also there's this argument on the other side that whites have been ahead for so long that, when they see their world coming apart, even though they're still doing much better than blacks, then they see equalization as oppression.
ROBERT FRANK, Economist:
The group that they studied is one that has, by almost every concrete measure, been falling behind in recent decades.
Economist Bob Frank has devoted much of his career to the study of inequality.
Life is graded on the curve. It's not how well you do in absolute terms. It's how well you do relative to your competitors.
Or relative to your own past.
And if you're in a chronic loser position, I think that's a position that just wears people down eventually.
Psychologically and physiologically, as low status is linked to decreased serotonin in the brain, which can cause dysphoria, a state of intense unease and distress.
If you're exposed to having low status in a chronic way and experiencing protracted feelings of dysphoria, it's not surprising that many people would turn to drink and drugs as a way to alleviate such feelings.
In fact, according to a recent study by economist Alan Krueger, middle-aged men who have dropped out of the labor force report notably low levels of emotional well-being, and more than half take pain medication every day.
And so, if you suffer enough, and your kids are not doing very well, and the world's going to hell in a handbasket, then suicide, either directly or through painkillers or alcohol, might seem like a not completely crazy thing to do.
There is, we should acknowledge, another take on the rise in so-called deaths of despair.
ANTHONY FLANNERY, Kentucky:
I don't buy into the everything fell apart, so now I just — I can't do nothing. I still believe in the American dream.
Anthony Flannery, who works long hours in health care, and on funding his dream of making music full-time, doesn't dispute the data. He just doesn't think they provide an excuse or even much of an explanation.
So people that lay around and give up, I don't relate to it. It's like, OK, I can understand getting knocked down, and now you, oh, I don't know what to do. I'm overwhelmed.
I get that. I have been there countless times. But you have to get focused, pick yourself up, find a direction, and make it happen in your life and for your family.
But if the problem is a decline in moral fiber, what would explain that? Too easy access to remedies that seem to cure all problems, until they become the problem themselves, or, longer term, the deteriorating economics of white working-age America, relative to any and all expectations?
For the PBS NewsHour, economics correspondent Paul Solman, reporting from Kentucky.
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