Death rates are up in U.S. for work­ing-class whites

En­ter­ing la­bor mar­ket with lit­tle ed­u­ca­tion can take its toll on health

The Denver Post - - NATION & WORLD - By Joel Achen­bach and Dan Keat­ing

Sick­ness and early death in the white work­ing class could be rooted in poor job prospects for less-ed­u­cated young peo­ple as they first en­ter the la­bor mar­ket, a sit­u­a­tion that com­pounds over time through fam­ily dys­func­tion, so­cial iso­la­tion, ad­dic­tion, obe­sity and other patholo­gies, ac­cord­ing to a study pub­lished Thurs­day by two prom­i­nent econ­o­mists.

Anne Case and An­gus Deaton gar­nered na­tional head­lines in 2015 when they re­ported that the death rate of midlife non-Latino white Amer­i­cans had risen steadily since 1999 in con­trast with the death rates of blacks, Lati­nos and Euro­peans. Their new study ex­tends the data by two years and shows that what­ever is driv­ing the mor­tal­ity spike is not eas­ing up.

The two Prince­ton pro­fes­sors say the trend af­fects whites of both gen­ders and is hap­pen­ing nearly ev­ery­where in the coun­try. Ed­u­ca­tion level is sig­nif­i­cant: Peo­ple with a col­lege de­gree re­port bet­ter health and hap­pi­ness than those with only some col­lege, who in turn are do­ing much bet­ter than those who never went.

Of­fer­ing what they call a ten­ta­tive but “plau­si­ble” ex­pla­na­tion, they write that less-ed­u­cated white Amer­i­cans who strug­gle in the job mar­ket in early adult­hood are likely to ex­pe­ri­ence a “cu­mu­la­tive dis­ad­van­tage” over time, with health and per­sonal prob­lems that of­ten lead to drug over­doses, al­co­hol-re­lated liver dis­ease and sui­cide.

“Ul­ti­mately, we see our story as about the col­lapse of the white, high-school-ed­u­cated work­ing class af­ter its hey­day in the early 1970s, and the patholo­gies that ac­com­pany that de­cline,” they con­clude.

The study comes as Congress de­bates how to dis­man­tle parts of the Af­ford­able Care Act. Case and Deaton re­port that poor health is be­com­ing more com­mon for each new gen­er­a­tion of mid­dle-age, less-ed­u­cated white Amer­i­cans. And they are go­ing down­hill faster.

In a tele­con­fer­ence with re­porters this week, Case said the new re­search found a “sea of de­spair” across Amer­ica. A strik­ing fea­ture is the rise in phys­i­cal pain. The pat­tern does not fol­low short-term eco­nomic cy­cles but re­flects a long-term dis­in­te­gra-

tion of job prospects.

“You used to be able to get a re­ally good job with a high school diploma, a job with on-the-job train­ing, a job with ben­e­fits. You could ex­pect to move up,” she said.

The na­tion’s obe­sity epi­demic may be an­other sign of stress and phys­i­cal pain, she con­tin­ued: “Peo­ple may want to soothe the beast. They may do that with al­co­hol. They may do that with drugs. They may do that with food.”

Sim­i­larly, Deaton cited sui­cide as an ac­tion that could be trig­gered not by a sin­gle event but by a cu­mu­la­tive se­ries of dis­ap­point­ments: “Your fam­ily life has fallen apart. You don’t know your kids any­more. All the things you ex­pected when you started out your life just haven’t hap­pened at all.”

The econ­o­mists say that there is no obvi- ous so­lu­tion but that a start­ing point would be lim­it­ing the overuse of opi­oids, which killed more than 30,000 Amer­i­cans in 2015.

The two will present their study Fri­day at the Brook­ings In­sti­tu­tion.

“Their pa­per doc­u­ments some facts. What is the story be­hind those facts is a mat­ter of spec­u­la­tion,” said Adri­ana Lleras-Muney, a Univer­sity of Cal­i­for­nia-Los An­ge­les eco­nom­ics pro­fes­sor, who will also speak at Brook­ings.

She noted that less-ed­u­cated white Amer­i­cans tend to be strik­ingly pes­simistic when in­ter­viewed about their prospects.

“It’s just a back­ground of con­tin­u­ous de­cline. You’re worse off than your par­ents,” Lleras-Muney said. “Whereas for His­pan­ics, or im­mi­grants like my­self” — she is from Colom­bia — “or blacks, yes, cir­cum­stances are bad, but they’ve been get­ting bet­ter.”

David Cut­ler, an eco­nom­ics pro­fes­sor at Har­vard who also will be dis­cussing the pa­per at Brook­ings, said the de­clin­ing health of white, work­ing-class Amer­i­cans sug­gests that Repub­li­can plans to re­place the Af­ford­able Care Act are akin to bleed­ing a sick pa­tient. As he put it, “Treat the fever by caus­ing an even big­ger fever.”

Whites con­tinue to have longer life ex­pectancy than African-Amer­i­cans and lower death rates, but that gap has nar­rowed since the late 1990s. The pic­ture may have shifted again around the Great Re­ces­sion, how­ever: Graphs ac­com­pa­ny­ing the new pa­per sug­gest that death rates for blacks with only a high school ed­u­ca­tion be­gan ris­ing around 2010 in many age groups, as if fol­low­ing the trend that be­gan about a decade ear­lier among whites.

White men con­tinue to die at higher rates than white women in ev­ery age group. But be­cause women started with lower death rates, the re­cent mor­tal­ity in­crease re­flects a greater change in their like­li­hood of dy­ing early. The num­bers re­ported by Case and Deaton sug­gest that white men to­day are about twice as likely as they were in 1999 to die from one of the “diseases of de­spair,” while women are about four times as likely.

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