Why middle age can be deadly for less-educated white Americans

Printed from: https://newbostonpost.com/2015/11/11/why-middle-age-can-be-deadly-for-less-educated-white-americans/

The death rate for white, middle-aged, less-educated Americans is climbing, while the overall average mortality rate in the nation continues to fall, according to recent research. The findings have prompted speculation over the trend, which is driven by rising substance abuse and suicide rates.

Countries in Europe such as the U.K., France, and Germany show no similar trend. In those nations, the death rate for white, middle-aged, less-educated populations continues to fall, similar to other groups, as technological advances and health-care improvements increase longevity.

Since 1998, the life-expectancy for middle-aged whites continued to rise in those overseas countries even as the sudden drop began in the U.S., according to a paper by Nobel laureate Angus Deaton and his wife, Anne Case. They point to economic factors as a potential underlying cause. From 1999 to 2013, the Princeton University economists said, 480,500 Americans died who would still be alive if mortality rates had maintained their pre-1998 trends.

“Half a million people are dead who should not be dead. About 40 times the Ebola stats. You’re getting up there with HIV/AIDS,” Deaton said in an interview with The Washington Post. Deaton last month won the Nobel Prize in economics “for his analysis of consumption, poverty and welfare,” drawing more attention to the paper, which was published in September.

Suicide and substance abuse, including overdoses and chronic liver disease, account for most of the increase in death rates among less-educated whites aged 45 to 54, Deaton and Case said in their paper. But it’s not just mortality that’s on the rise – illness is also increasing for this group. Its members suffer disproportionately from chronic pain conditions, the researchers said.

Indirectly, that condition has led to increased abuse of illegal drugs like heroin, a morphine derivative, Deaton and Case said. Of all new heroin users in the past decade, 90 percent are white, independent research has shown. As authorities have tightened access to prescription painkillers such as oxycontin, which is chemically similar to morphine, some people in this demographic group substituted heroin for opioid pills, according to Deaton and Case. At the same time, heroin reaching the U.S. street trade was becoming stronger and more readily available.

Pain and depression may explain the increase in drug abuse, alcoholism and suicide, though what underlies these behavioral and psychological trends is less clear, according to Deaton and Case. They suggest that economic insecurity may be a contributing factor. They cite stagnant wage growth, a loss of manufacturing jobs and unmet expectations among those in middle age with no more than a high school education, and widening income inequality as potential reasons for the trends.

Coupled with a lack of reliable pension payments and inadequate retirement savings, life after 65 promises little more than further impoverishment for many. The prospect of a gloomy future may be contributing to what’s killing middle-aged whites in the present.

“Those currently in midlife may be a ‘lost generation’ whose future is less bright than those who preceded them,” Deaton and Case conclude in their paper, published in The Proceedings of the National Academy of Sciences.

The Deaton-Case research has prompted speculation on other causes of rising death rates for these middle-aged whites. Writing in The New York Times, Ross Douthat blames a lack of community, prompted by decreased attendance at religious institutions and a breakdown in families.

Douthat argues that these trends, alongside the financial struggles this group faces, gives them a sense of having missed out on what was promised to them. Hispanic and black populations have not experienced increased mortality because these groups’ expectations were more in line with their current reality, according to Douthat’s reasoning. He says these groups are more likely to retain strong familial and religious ties, which help give meaning to their lives.

The Case-Deaton paper has sparked headlines nationwide, which may help focus more attention on the trends it reveals. Deaton and Case compare the rising death rate among less-educated whites in middle age to the AIDS epidemic, which has taken 650,000 American lives. “However,” they said, “public awareness of the enormity of the AIDS crisis was far greater than the epidemic described here.”