‘Deaths of de­spair’

Many of the Amer­i­cans who elected Mr. Trump are suf­fer­ing. Is there any­thing he can do to help them?

The Washington Post Sunday - - SUNDAY OPINION -

IT IS a po­lit­i­cal cliche that Pres­i­dent Trump owes his elec­toral vic­tory to the ex­tra­or­di­nary sup­port he re­ceived from white vot­ers with­out a col­lege de­gree, two-thirds of whom voted for the Repub­li­can. Much less set­tled is the ques­tion of why th­ese largely low-in­come vot­ers, once re­li­able Democrats, cast their lot with a brash bil­lion­aire from New York.

The pre­cise source of the dis­con­tent that pro­duced this out­burst of re­ac­tionary pop­ulism is hotly de­bated; some of Mr. Trump’s sup­port re­flects mo­tives, such as xeno­pho­bia or racism, that can be nei­ther com­pre­hended nor re­spected. Yet there is an ob­jec­tive as­pect to “white work­ing-class” griev­ance. Any­one who doubts it need only read “Mor­tal­ity and mor­bid­ity in the 21st cen­tury,” the new re­port by No­bel Prize-win­ning econ­o­mist An­gus Deaton of Prince­ton Uni­ver­sity and his col­league Anne Case, pre­sented to a Brook­ings In­sti­tu­tion con­fer­ence Thurs­day. The gist is that death rates for nonHis­panic white men and women aged 25 to 64 rose steadily be­tween 1999 and 2015, while death rates for the com­pa­ra­ble age co­horts of all other de­mo­graphic groups ei­ther held their own or con­tin­ued to im­prove. The cu­mu­la­tive im­pact of th­ese trends, the au­thors note, ac­count for the stun­ning fact that over­all life ex­pectancy in the United States de­creased slightly be­tween 2014 and 2015, the first such de­cline since 1993, dur­ing the AIDS epi­demic.

Even more trou­bling are the spe­cific causes of ris­ing mor­tal­ity among non-col­lege-ed­u­cated white Amer­i­cans: drug over­doses, sui­cides and al­co­hol­re­lated liver dis­ease, or, as Mr. Deaton and Ms. Case aptly call them, “deaths of de­spair.” If the de­spair could be cured by bring­ing back high-pay­ing jobs that built the erst­while “blue col­lar aris­toc­racy,” as Mr. Trump promised dur­ing his cam­paign, then there might be cause for hope. How­ever, the au­thors demon­strate that “deaths of de­spair” do not seem con­nected to fall­ing in­come; oth­er­wise, mor­tal­ity would also have risen, not fallen, for His­pan­ics and African Amer­i­cans, whose in­comes fared no bet­ter than those for whites.

Mr. Deaton and Ms. Case blame “cu­mu­la­tive dis­ad­van­tage,” whose com­po­nents in­clude not only job loss but also the break­down of com­mu­ni­ties and the de­cline of mar­riage. That seems plau­si­ble. But it isn’t im­me­di­ately clear how gov­ern­ment could re­verse those long-term trends, although it is clear that Mr. Trump’s pol­icy agenda won’t do much for the peo­ple who gave him their votes, and might hurt them.

The study’s au­thors do em­pha­size one rel­a­tively con­trol­lable fac­tor: mass pre­scrip­tion of opi­oids for chronic pain, which made the epi­demic of de­spaird­eaths “much worse than it oth­er­wise would have been.” The rate of death from pre­scrip­tion opi­oid over­doses more than quadru­pled be­tween 1999 and 2015, ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Preven­tion (CDC), killing a to­tal of 183,000 peo­ple dur­ing that pe­riod. Pre­scrip­tions, though not yet over­dose deaths, have started to ebb in re­cent years, a trend fos­tered by pol­icy shifts at the CDC in the lat­ter years of the Obama ad­min­is­tra­tion.

If he does noth­ing else to keep faith with the peo­ple who elected him, Mr. Trump must at least con­tinue the more ra­tio­nal pol­icy on opi­oid pre­scrib­ing that be­gan, be­lat­edly, un­der his pre­de­ces­sor.

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