Has despair led to a stunning hike in mortality rates for some Americans?

While U.S. death rates have been declining steadily over the past few decades, a study this week found that the trend does not apply to some middle-aged white Americans. Causes behind the reversal included suicide, liver diseases and drug overdoses. Judy Woodruff learns more from Anne Case of Princeton University and Dante Chinni of the American Communities Project.

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    Death rates in the United States have declined steadily for decades. But a study out this week found a disturbing reversal in mortality rates for white Americans between the ages of 45 and 54 who do not hold a college degree.

    For that group, the rate of death has climbed since 1999, even as rates for people of different ages, races and education levels have continued to fall. The causes of death driving the reversal were suicide, alcohol-related liver diseases, and prescription opioids and heroin overdoses.

    I'm joined now by one of the study's authors, Anne Case. She is a professor of economics and public affairs at Princeton University. And by Dante Chinni. He's a data reporter and he's director of the American Communities Project, a political science and journalism program at Michigan State University that uses data to look at social, political and cultural divides.

    And welcome to you both.

    Professor Case, let me begin with you.

    You have said that when you and your husband, who is Professor Angus Deaton — he's the winner of this year's Nobel Prize, and he was the co-author of this study — that when you came across these numbers, you basically stumbled across this information, and that he said you practically fell out of your chairs. It was that surprising?

  • ANNE CASE, Princeton University:

    It is that surprising.

    After so many decades in which mortality rates fell at 2 percent a year, and the fact that in all of the sister countries that we compare ourselves to, all the wealthy countries of Europe and all the English-speaking countries, Canada, Australia, New Zealand, with their mortality rates also falling at 2 percent a year, to suddenly see this reversal was really stunning.

    And it has been stunning to all of the medical people, the epidemiologists that we have talked to as well.


    It's already — Professor Case, it's already being labeled by some as despair-related deaths. What is it particularly about this — these mortality — this mortality rate that stood out to you?


    The fact that there are several parts of this that are puzzles that we have to dig into further, the fact that it's men and women, mortality rates by suicide, by drug overdose, by alcohol-related deaths rising for all of — for both men and women, the fact that it's not happening in the African-American community, it's not happening in the Hispanic community, and it's not happening abroad.

    So, all of those things stood out to us as puzzle pieces that we have to look into further to figure out, what are the root causes of this? We know the proximate causes, drug overdose, availability of prescription opioids. But I think the next round of research will be to look at the deeper causes.


    Dante Chinni, how does this square with what you have been seeing as you have looked at the American — Americans everywhere and as you think about this cohort we're talking about, middle-aged Americans, 45-54, white? What have you seen?

  • DANTE CHINNI, American Communities Project:

    Well, the way I look at the country, the breakdown we do at the American Communities Project, is there are large segments of America that are made up of large chunks of this population.

    So, they tend to be rural, white, not high education levels, or high school, no bachelor's or even a community college degree. And the places those populations are heavily based are the Bible Belt, what we call evangelical hubs, the Appalachian America, which is what we call working-class country, and then graying America, which is kind of more based in the North and the West, but populations, again, elderly — more — I don't want to say elderly, but older people and people without a lot of college degrees, overwhelmingly white.

    What do we know about those places? Higher unemployment rates than the national average, higher unemployment rates than other kinds of communities in the country.

    The other thing that really sticks out about them is, beyond the unemployment rate, which can be a little bit deceptive, there is the work force participation rate. In these places, you're talking about all these communities I just outlined, 44 percent, 45 percent of the population not in the work force.

    Now, look, some of that is probably due to people have retired or they want to stay at home. But I think when you combine that with the higher unemployment rates in those areas, I think what you're really seeing is, in terms of the difficulty of finding a way to make a living, right?

    It's a much — it's a tougher life in these places now. I think a lot of this has to do with the decline of small manufacturing in these places. Tougher rural life.


    And you think about — Professor Case, you think about what's happened in this country to the economy over the last 15 years, we can't, of course, jump to any conclusions, but we know jobs — there's been a huge change in the job picture.

    We know American manufacturing has taken a big hit. What sorts of questions does all this raise for you?


    It's — one of the questions is why it is the case that the employment-to-population ratio has fallen so dramatically, especially among women.

    In our surveys, we were able to look at morbidity, as well as mortality, so we can actually find out how people are, what their general health is like, what their mental health is like, and there's been a doubling in this 15-year period among people aged 45-54 who report that they're unable to work.

    So, this used to be the period of time when people were at their highest earnings capacity. And to see these people, upwards of 10 percent of the white population, saying that they're not able to work is really troubling.

    It used to be the case that, with a high school degree, you could get a good job, you could get a job with benefits, you could get a job that was stable, that you had job security. And I think people's narratives of their own lives had in them having a job, and the fact that these jobs are gone and they're not coming back any time soon leads people to despair.

    And they report themselves in worse health. They report lower mental health, a lot more stress, a lot more distress. And I think these mortality rates just reflect that.


    Dante Chinni, I mean, I — you're nodding your head as she's saying all this. I mean, this does seem to dovetail with at least the circumstances that you find in your research.


    Yes, absolutely.

    I mean, I can't — I would love to get the professor's data and run a geographic analysis on it to see if we're seeing these things fall in line with what I'm expecting. But this is exactly what we're talking about.

    Look, in a lot of these places, when you lose a job, particularly if you're in your 40s, there's not a lot of places to go. There's certainly not a lot of places to go to get a job where you can earn similar to what you were earning before. Maybe the benefits go away. Maybe the health insurance goes away.

    If you go out to some of these places, not just rural America, but there's a category that we look at call the middle suburbs, and they're based — they're overwhelmingly white. They're primarily based in the Industrial Midwest, the Northeast, around Pittsburgh, Cleveland, Detroit. Milwaukee, you see some of it.

    You have large white populations. A lot of these were high school-educated people who did make a really good living. They had a good life. Their parents had a good life. They had a good life. And all of a sudden, the rules changed, right? And the idea that a high school education was good enough, it wasn't good enough anymore. It wasn't good enough to have the cabin up north anymore.

    And, suddenly, it wasn't good enough to have a job anymore. And that's a very hard thing to deal with. We will see. Again, we have got to take another couple cuts at this data, right, and see what's there. But it certainly does fit the profile.



    Well, it's clear that there is going to be more research. At least, it looks as if there is going to be more research based on what you have done.

    Professor Case, thank you very much for joining us. Professor Anne Case at Princeton and Dante Chinni here in Washington, we appreciate it.




    Thanks very much.

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