The White-Mortality Crisis Shows How Psychological Distress Can Become Physical

Every commercial business in Union Level, Virginia, is shuttered as a result of textile-mill closures and the diminished dominance of tobacco in the area. Photo: The Washington Post/The Washington Post/Getty Images

Back in November of 2015, the Princeton economists Anne Case and Angus Deaton, who are married, published an alarming paper showing that the mortality rate of middle-aged white Americans had gone up between 1999 and 2013, in contrast to just about every other subgroup in every other wealthier, economically developed country, and that this group was also dealing with rising rates of all sorts of physical symptoms and illnesses, many of them related to addiction.

While there was subsequently some debate over whether that mortality rate had gone up, as opposed to just being flat — the latter, in retrospect, is more likely — this was still a shocking finding that has spurred a lot of debate and discussion.

Yesterday, Case and Deaton released a new working paper for the Brookings Institution, “Mortality and Morbidity in the 21st Century,” that builds on their past research to offer some stark statistics about just how often middle-aged white people are dying from so-called “deaths of despair” — that is, those connected to drugs, alcohol, or suicide. The headline finding is that “Working-class white Americans are now dying in middle age at faster rates than minority groups.” As Julia Belluz noted in a comprehensive write-up for Vox yesterday, which includes six very useful charts, the only fully accurate explanation for why this is occurring is, “It’s complicated.” She adds, “There’s no single reason for this disturbing increase in the mortality rate, but a toxic cocktail of factors.”

There does seem to be a single basic “origin story” that can explain a lot of this, though, and one hint about it comes from the fact that the vast majority of this death and suffering has descended upon whites without college degrees. Those with degrees are doing way better, and in many cases have enjoyed important gains over the last several decades. As Belluz explains:

Why education is such an important health indicator is difficult to untangle, Case added. “But when you think about what happens when industries pull out of towns, the tax base implodes, schools [are] not well funded, and the death spiral continues.”

In the past, people with low levels of education could get a job in a factory and work their way up the chain of command. “You could graduate high school, work at Bethlehem Steel, get more money every year as you get more experienced,” Deaton said, “and turn yourself into one of the famed blue-collar aristocrats of the 1970s.” Now, he added, “There’s a feeling that life has gone, and remainders of that life are getting less and less for each generation.”

To be clear, the study authors don’t buy the idea that one’s income relative to what one expected is influencing mortality. Rather, “It’s the life you expected to have relative to your father or grandfather — it’s just not there anymore,” Deaton said.

That “feeling that life has gone” appears to have infected a lot of Americans, and it’s deadly. The fact that it is the one constant in this big, complicated public-health crisis should serve as a loud warning alarm about what can happen when big chunks of a country get left behind by roiling economic forces beyond their control.

Psychological Distress Led to the White-Mortality Crisis