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To put these numbers in context, this reversal is contrary to the trend in France, Germany, Canada, the United Kingdom, Australia and Sweden. Indeed, it goes against the trend in every wealthy, industrialized democracy we know of. The aforementioned list is simply the other countries used as reference cases in the study. Within the US, this reversal is unique among racial and ethnic groups. Hispanics, African Americans, Asians. Historically, health outcomes and lifespans in the US have been heavily race and wealth dependent. So when it comes to lifespans and various disease statistics, African-Americans start off in a worse position. But they share the trend toward improving numbers which is the norm across groups in the US and wealthy countries abroad. Middle aged white people - men and women - are alone in reversing this trend and going backwards. Nor is the trend undifferentiated within this group. It is a most severe among middle-aged whites with the lowest education levels.
Now, there are many possible explanations for why this is happening - we'll get to those in a moment. But we might assume that a middle aged population group, under some mix of economic and societal stress, would be hit by the classic diseases of life stress: heart disease, cancer, diabetes, etc. But that's not it. These people are quite simply killing themselves - either directly or indirectly. According to Case and Deaton's study, the reversal in the overall mortality trend is driven by three causes: drug and alcohol poisonings, suicide and chronic liver disease. In other words, either literal suicide or the slow motion suicide of chronic substance abuse.
The authors assemble the data to show the real world effect in this way. For middle-aged whites, if mortality had simply held constant at 1998 levels until today, 96,000 deaths would have been avoided through 2014. Had the annual rate of decrease in mortality rates continued at the pre-1998 levels, fully 488,050 deaths would have been avoided through 2014.
Step back for a moment and absorb that number. Whatever this phenomenon is, since 1998 it has accounted for almost half a million premature deaths. Half a million! As the authors note, the only comparable instance in recent US history is the AIDS epidemic which took the lives of 650,000 Americans from 1981 to 2015. These two epidemic are profoundly different in numerous ways. The point is not to stand them up against each other in equal terms. But the sheer numbers tell a sobering tale. And unlike the AIDS epidemic, no one seems to know this is even happening.
So why is this happening?
On the one hand, the correlation with lower education levels points us to a phenomenon we've known about for years: the declining economic and life prospects of less educated, less affluent Americans who are taking the brunt of the great divergence between the ten percent or so of the population that is getting ahead in today's economy and everyone else who is just struggling to hold their own or falling behind. But race stands out. White people are certainly not the only ones affected by these economic trends. And yet, this phenomenon is affecting whites and no other US ethnic group. As an additional data point, the authors note that the rise in these three causes of death (alcohol and drug poisoning, suicide and chronic liver disease) show a clear rise for white Americans in each five year age group between 30 and 64. The difference is that it is only in the 45-54 group that the increase is great enough to push "all cause" mortality higher. Focusing solely on the middle aged group is partly deceiving because they're not the only ones affected.
The authors of the study note that with the exception of a pause in the 1960s due to rising rates of smoking, this reversal is unprecedented in the United States going back to at least 1950. When I first read about this study, the one thing that came to mind was the example of post-Soviet Russia and other post-Soviet successor states where lifespans dropped precipitously after the collapse of the Soviet Union. Different studies have found different absolute numbers - presumably because the quality or consistency of record-keeping isn't up to the standards of Western Europe and the United States. For instance, this study reports that life expectancy in Russia fell by 5 years between 1991 and 1994. Today life expectancy for Russian men is less than 60 years compared to 67 years in 1985. Another study from The Lancet provides numbers that are not quite as bleak. But the overall pattern is the same.
Some point to post-Soviet privatization or "shock therapy" as one cause of the collapse, with declining investment in public health service provision driving the fall off. But this explanation is belied by data from post-Communist states in Eastern Europe which underwent similar and often more radical market transitions but showed no comparable drop in lifespans. In Russia, the key drivers appeared to be increases in alcohol and tobacco use, especially homemade alcohol, aftershave, cologne and other alcoholic drinks that are close to being poisons. There is even some evidence of an increase is simple accidents as a driver of declining lifespans.
In Russia, the post-Soviet lifespan collapse does not appear to be tied to the arrival of particular diseases, acute economic stress as such or a dramatic decline in the quality or availability of healthcare. The evidence suggests a broad societal collapse coinciding with or coming in the wake of state collapse, one played out through the mechanisms of chronic substance abuse, but stemming from a broad loss of hope in the future or even commitment to living. Though the scale differs greatly, the phenomenon revealed by the Case-Deaton study suggests something similar. The causes of death - suicide and chronic substance abuse - are similar. In the US case, economic factors clearly plays a role. But the clear role of race confounds any simple economic explanation.
So what is happening?
I put this forward as no more than an educated hypothesis. But the most logical culprit is the social transformation that people across the ideological spectrum agree on but talk about in dramatically different ways. The relative decline of American whites (or as social scientists refer to them, "non-Hispanic whites") versus other ethnic and racial groups - principally African-Americans and Hispanics.
It is always important to understand what 'relative decline' means. It doesn't mean that that group in 'relative decline' is falling. It simply means that others are rising. And while we can quibble over how rapid the rise is, how we measure it and whether it's happening fast enough, there's little question that non-whites are rising in affluence, cultural influence, political power and on almost every other front. The simple fact, something we are all supposed to be happy about (and I hope we are) is that while being white still has numerous built-in and ingrained advantages, it is not as big an advantage as it once was. And there is every reason to think the advantage will continue to decline, as indeed the percentage of whites in the population continues to decline.
Let's put this clearly: the stressor at work here is the perceived and real loss of the social and economic advantages of being white.
With this predicate in place, the role of education seems clear. As noted with 'relative decline', all things are indeed relative. We are also living in an era of stagnant or declining incomes for most Americans. That hits those with the lowest education levels the hardest. The declining importance of being white is simply not as big a thing if you're a professional with an advanced and a solid income than if you're someone with a high school education who was laid off from what you thought would be your career for life in your mid-forties.
This gets to why I think this study is such a critical contribution to our understanding of contemporary American politics. Several weeks ago I had lunch with a prominent US journalist who I'd been acquainted with for some time via email and social media but never met in person. In our conversation, this colleague spoke about the irreducible role of anger in the GOP presidential primaries and in the GOP Congress. As many have discussed, we're now at the point where overthrowing leaders or shutting down the government isn't simply a tool ready (perhaps too ready) at hand to achieve this or that policy goal. Rather it's the desire to shut the government down and overthrow leaders that now appears to be the real goal and drive. Deciding whether it's over the budget or Obamacare or Planned Parenthood or Syrian refugees is a secondary matter. Beneath the often febrile and sometimes race-tinged Republican talk about Obama "radically tranforming" America, or being a socialist whose erasing American 'exceptionalism' or various other regular themes on Fox News, one fairly straightforward, clear message is almost always discernible: The country people know, their country, is being taken away from them. We have grown accustomed to seeing a large segment of the body politic ready, indeed almost relishing the opportunity to break the state if it cannot control it.
So where does that anger, that combination of anger and loss come from? I'd say right here in the statistics we're talking about.
This is a complex story. And to be clear, I do not think this rise in mortality among middle aged whites is driving the mix of anger and nihilism among US conservatives. Rather, I think both of emanating from a common cause, albeit one I can identify in the broadest possible terms. We inevitably live in the world of the politics of the moment. If not necessarily in the chaos of daily soundbites, we live, navigate, advocate and think in terms of political realities that are themselves epiphenomena of or at least rooted in deeper societal trends of which we are often only dimly aware. As I've discussed, the crime wave of the late 20th century is one of the most politically consequential events of the last century in the United States. You cannot understand the politics of the 60s, 70s, 80s or 90s without placing it at or near the center of the picture. Indeed, the current (very needed) debate about 'mass incarceration' is simply a reevaluation of one of the key policy responses to the late 20th century crime wave in which the draconian response looks very hard to justify - even among many of its longtime supporters - now that the crime wave has been over for going on 20 years.
Reductive explanations almost always fall short. And I anticipate some will say I'm advancing such an argument today. I would only counter that I'm not suggesting a causal relationship. I'm suggesting that these two facts are closely associated and stem from a common cause. What sets these statistics apart is their apparently hard, numerical nature. We can make arguments about political dysfunction, unrealistic fears about political change, historically anomalous refusals to abide within constitutional norms, etc. But every theory about politics and political change is inherently subjective and compromised by our individual place on today's partisan political spectrum. Numbers aren't magic. Perhaps these numbers have some flaw or another interpretation. But that seems unlikely. White people and just white people - particularly at the ages and life statuses where the advantage of race has been most needed - have broken from a trend that is basically universal in wealthy countries for a century. That is real. And I don't think we can understand the contemporary crisis of politics without it.
Late Update: I've now followed up with another post which looks at a methodological controversy tied to the numbers. The big picture remains the same but revised data suggests this trend may be affecting white women more than white men, though both are affected.