Deaths of Despair, Ghosts from the Future
The shocking report on rising “deaths of despair” and what it could mean for the future
In 2015, researchers Anne Case and Angus Deaton published a study that found mortality rates for middle-aged white Americans without a college degree had increased from 1999 to 2013. Now, two years later, they have released a follow-up to their shocking 2015 report that tries to better explain those findings. The cause of these mortality rates: “deaths of despair.”
The Spread of Despair
Case and Deaton use “deaths of despair” to refer to all deaths caused by suicide, drugs and alcohol. In an interview with The Guardian, they note that “In a sense, they are all suicide — either carried out quickly (for example, with a gun) or slowly, with drugs and alcohol.” As their terminology makes clear, these are especially noteworthy because they are deaths stemming from hopelessness; it is not just that life was cut short, but that life was so painful that death (or escape) was preferable. And in the United States they have been increasing rapidly since 1999. While showing early signs in the southwest, it has quickly spread throughout the entire country:
The most afflicted demographic group is middle-aged whites with a less than a college degree, who disproportionately account for these deaths of despair compared to their educated counterparts:
These findings are shocking, but in a way, not entirely surprising. They seem to easily fit into a national narrative that is being told, one of an alienated class of white, blue-collar workers. It is telling that another study published in December found that Trump over-performed in counties with the highest rates of “deaths of despair.”
Cumulative Deprivation
Much of the initial public commentary tried to link these findings to stagnation in wages and income. That line of thought suggests a more sinister account of the impact of rising income inequality. But while that economic story coincides with changes in mortality, the researchers argue it leaves more unexplained than it explains. That is not to say that economic factors are to be acquitted entirely. Instead, the researchers find the most compelling explanations to be those that emphasize cumulative deprivation — in their words, “a long-term process of decline… rooted in the steady deterioration in job opportunities for people with low education.”
This casts a different light on despair, one that more deeply penetrates its depths. Material welfare is a condition for a decent life, but it alone is not sufficient. Its improvement does not inherently provide hope, just as its removal does not guarantee despair. The point is that this is not just a matter of improving wages for those without a college degree, but a more comprehensive vision of the impact that deteriorating life opportunities have on communities and individuals. As Case and Deaton argue, if economic factors do have an effect, it is only indirectly through their cascading “effects on family, on spiritual fulfillment, and on how people perceive meaning and satisfaction in their lives in a way that goes beyond material success.”
Solving Despair
A few immediate solutions readily come to mind. One is to take steps to address the opioid epidemic, which accounts for about one fifth of these deaths in the past decade.
Opioid abuse is especially prominent in white and rural places, and takes root in populations living with chronic pain that are already more prone to despair. The over-prescription of opioids is a messy combination of cultural attitudes toward medicine and policies that allow pharmaceutical companies to push highly addictive painkillers, but one that warrants immediate action regardless of, and in addition to, any other measures taken.
Other solutions speak to the problem of deteriorating job prospects for Americans without college degrees. Attempts to address this typically fall in two categories: those that seek to improve education attainment, and those that seek to increase blue-collar job prospects. As this study demonstrates, those with a college degree or higher do not seem to be highly susceptible to deaths of despair. So, this reasoning goes, let’s increase access to college education, and supplement with workforce development programs that teach in-demand skills to provide job opportunities that mimic those of the college-educated. Easier said than done, but this seems to be a step in the right direction.
The other approach is highlighted by messages and policies that attempt to “bring back” blue-collar jobs. This was epitomized by Trump’s campaign, and so is no surprise that he won the presidential election through the overwhelming support of low-educated, white voters. After all, the promise of easier access to college does not help the middle-aged worker who cannot feasibly return to school: she needs a job now, and preferably one made available by reopening the factory that used to sustain her community.
In office, Trump has tried to deliver on his promises on the campaign trail. Signing an executive order to roll back some of Obama’s attempts to curtail climate change, Trump declared that he was true to his word. “The miners told me about the attacks on their jobs,” Trump said. “I made them this promise. We will put our miners back to work.”
But economists are skeptical that this will help. It is true that the number of coal miners has decreased in the past decade, but economists do not think that was driven by Obama’s policies. Instead, they point to the rise of natural gas production, and, you guessed it, automation. With mines being increasingly mechanized, we could witness an increase in coal production with no accompanying increase in mining jobs.
Hope Without Jobs
This is not to say that Trump’s policy would be justified if it did result in an increase in mining jobs, but to argue that attempts of this kind are likely to fail. For all of the finger-pointing at Mexico and China, automation is the overarching driver of job displacement. At best, these policies are myopic, and can result in very short-term upticks in jobs. But ultimately, companies investing in America will be putting their money toward machines that make those jobs obsolete.
Don’t be fooled into thinking that automation is only going to affect low-skill factory jobs. One recent Oxford study claimed that about 47 percent of total U.S. employment is at risk of automation, and as soon as the next few decades. Included among those at the highest risk of automation were office jobs, administrative roles, and sales positions.
This casts doubt on our other solution of making college education more accessible, not just as a concern that this will also affect the more highly educated, but as a vision of a future where there are not enough jobs for everyone. If the driving force behind the “deaths of despair” is the long-term deterioration of job opportunities, as the researchers suspect, they may be the first signs of what is to come. If indeed that is the case, we are not just haunted by these deaths now, but also by ghosts from the future.
I do not think that this means we are doomed. These findings reveal startling and tragic cases of the meaninglessness and loss of dignity experienced by those who are unable to find respectable work. This gives credence to intuitions we might already have based on the central and unifying role jobs play in our lives. While in the short term, we do need to make efforts to help people get into skilled jobs, we must also face the reality that that is only a stopgap solution. Over the long term, we need to determine how to set up society so that people can still find meaning and purpose without requiring them to work a full-time job.
We can think of this like a game of musical chairs: each round we remove one of the chairs so there aren’t enough chairs for everyone to sit in. Automation works the same way with jobs. But if there are not enough jobs to go around, we cannot simply abandon the ones who are “left out” to a life of despair. As this study shows, that is not a life at all.
