Are Middle-Aged White Men Dying from Despair?

Economists Anne Case and Angus Deaton have a couple of well-known papers, here and here, identifying a marked increase in death rates for middle-aged white American males without a college degree due to alcohol (both from overdose and from long-term abuse), drugs, and suicide. The upturn started around the year 2000, and the increase has been striking. Case and Deaton term the phenomenon “deaths of despair.” And, given the age of the men involved, it’s difficult not to think of Arthur Miller’s Willy Loman in association with the findings. But there is a lot to be cautious of regarding both the asserted American exceptionalism of the phenomenon, as well as in identifying the causes.

To be sure, Case and Deaton are more theoretically circumspect in the 2017 Brookings paper than they were in the 2015 PNAS paper. But before we get to the discussion of theoretical cause, the data warrant a closer look. Case and Deaton’s argument holds out the distinctive increase in alcohol, drug, and suicide mortality for this American age cohort relative to similarly aged males in Europe, and relative to similarly-aged African American and Hispanic men in the U.S. But while the magnitude of the phenomenon for this cohort of white American men is distinctive, Case and Deaton’s data don’t seem to indicate the phenomenon itself is — with apologies for a qualified superlative — quite as unique as they suggest.

First, in their Brookings study, the “Average Annual Percent Change in Mortality for Age 50–54 by Cause, 1999–2015,” Table 2 indicates an annualized increase in mortality from drugs, alcohol or suicide for U.S. white, non-Hispanic men during that period of 5.4 percent.

While that’s the largest increase among the comparison groups (national, ethnic, and racial) reported in the table, contrary to many of the narratives about their data, some of the comparison groups witness increases in these forms of mortality as well. To wit, Irish, Canadian, and Australian men in this age cohort also saw increases in mortality due to alcohol, drugs or suicide in the range of 3.0 percent, 2.5 percent, and 2.5 percent, respectively. Men in the U.K., Sweden, and Denmark also saw increases in these forms of mortality, even if the rates of increase were significantly lower.

Indeed, fully half of the fourteen nations reported on by Case and Deaton saw an increase in mortality from these causes for men in the middle-aged cohort. Again, the rate of increase is highest in the United States, but the fact that seven out of the fourteen countries reported also saw an increase in these forms of mortality take some of the shine off the claim that the phenomenon is exceptionally American.

At the very least, these other countries provide the possibility of comparative leverage for otherwise nation-specific theories for the mortality increase in the United States. This is a possibility that Case and Deaton don’t follow up on (albeit, because of data limitations, not because of their lack of desire).

Turning from comparative national to intranational comparisons, U.S. Hispanic men and U.S. black men in the age cohort have saw increases in these forms of mortality. Again, the rates of increase have been much lower than white men, but the fact of the increase itself also takes a bit of the shine off the uniqueness narrative Case and Deaton, and others, want to tell.

As I mentioned above, Case and Deaton punt their cross-national comparisons (for lack of data) as they delve into explanation. That is unfortunate because the cross-national data likely could provide substantial leverage on a number of the hypotheses they float as possible explanations for the data.

In the last half of the Brookings paper, Case and Deaton discuss various possible hypotheses, seemingly rejecting one hypothesis (income decline), but then recovering even that one by the end of the paper. They even provide a respectful nod to Charles Murray’s theory in Coming Apart.

By the end of the paper, however, they are left with positing “slow-acting social forces” as the most plausible causes, but it’s not entirely clear what that entails. While they want to endorse economic factors, they’re careful enough scholars to avoid committing to a specific cause given the significant ambiguity in the data. They even provide a nod to the isolating effects of the sexual revolution as a possible cause, even if they want to “emphasize” economic causes:

In our account here, we emphasize the labor market, globalization, and technical change as the fundamental forces, and put less focus on any loss of virtue, though we certainly accept that the latter could be a consequence of the former. Virtue is easier to maintain when it is rewarded. Yet there is surely general agreement on the roles played by changing beliefs and attitudes, particularly the acceptance of cohabitation, and of the rearing of children in unstable cohabiting unions.

A little later, however, even the “virtue” hypothesis returns with a bit more plausibility as Case and Deaton note the difficulty of disentangling causality from statistical indicators that all move in the same direction.

What our data show is that the patterns of mortality and morbidity for WNHs without a college degree move together over birth cohorts, and that they move in tandem with other social dysfunctions, including the decline of marriage, social isolation, and detachment from the labor force.

One last empirical whine, though: I do wonder about combining alcohol abuse, drug abuse and suicide in a single measure of “despair.” Despair is all about demand, yet for both drugs and alcohol, I think there are plausible supply-side theories to consider as well.

On the drug abuse front, the last couple of decades have seen a huge shift on the supply side, particularly in predominantly white communities, with the significant increase in access to and use of opioids, as well as meth and other drugs in rural communities. “Despair” in these communities could be constant while supply changes account for the variation in mortality figures. Similarly, alcohol mortality includes deaths from long-term alcohol abuse as well as alcohol overdose. Yet increased availability of alcohol in grocery stores and gas stations became widespread in the 70s and 80s, a couple of decades prior to observation of a spike in the long-term effects of alcohol abuse.

I am open to the “despair” hypothesis, but an increase in despair isn’t required, at least for the drug and alcohol mortality figures, if there is a supply side story. (And, to be sure, the story could be both a demand and a supply side story.) The comparative national data, and comparative ethnic and racial data, in the Brookings paper, however, make me uncertain the phenomenon Case and Deaton are observing is unique to white middle-aged American men. And, whether it’s uniquely American or not, I still wouldn’t take any bets yet on the identity of the culprit.

Reader Discussion

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on March 22, 2018 at 06:31:23 am

Important topic; nice essay.

Moderator: Please mark the quoted passages--block indents, perhaps? Where you find the words "we" and "our," this denotes quoted text. Oh, and feel free to delete this message.

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Image of nobody.really
on March 22, 2018 at 12:15:33 pm

Then again, how many of these deaths of "despair" are actually accidental overdoses. Recent studies have shown that an astoundingly large (greater than 2/3's) of opioid deaths are the result of multiple drug interactions; opioids, alcohol, heroin, etc. Are we to conclude that all of these deaths are (passively) intended, i.e., the despair hypothesis or are they simply the statistically likely outcome of drug cocktails.

Compare current 'despair" deaths due to drugs / alcohol with the death rate of the 1970's of drug users (heroin, etc). Is there a statistically significant difference in a) absolute number, b) percentage of users dying, c) percentage of the population using drugs (yes, it would appear so), d) percentage of users properly characterized as *addicts*.

Depending upon the numbers, one could conclude that many of these deaths are simply the result of some number of addicts living longer, into their middling years, BUT eventually succumbing to their peculiar malady. It is not at all clear that such deaths evidence an increase in the social despair index.

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Image of gabe
on March 22, 2018 at 12:44:17 pm

On the other hand, I suppose that "studies" such as these are essential in both the * manufacture* and acceptance by the public of a newly discerned crisis.

Of course, we ( our benefactors in the FAS) must never let a crisis go to waste.

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Image of gabe
on March 22, 2018 at 14:53:07 pm

For what it's worth, the segment of the population currently experiencing high rates of addiction and suicide is the precisely the population that is limited to the kind of unskilled and semiskilled work that has been off-shored for the last 50 years.

In the broad vocational terms that have been used by the Department of Labor in the "Dictionary of Occupational Titles" and the "Selected Characteristics of Occupations Defined in the Dictionary of Occupational Titles" since the 1950s, these are the people with IQs ranging from ~70-110. These are the people who are neither highly educated nor intrinsically self-actuating. They do best with the structure, discipline, direction and socialization commonly commonly associated with the work place. They amount to 2/3 of any given population.

When they are subjected enforced idleness, social isolation and overt discrimination in the work place as well as the disruption of their communities in the name of some imagined greater good, such as diversity, such people always have, and always wil,l seek oblivion in drugs or vindication in revolution.

This is not brain surgery or rocket science, it is something has been demonstrated time and time again in history.

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Image of EK
on March 22, 2018 at 16:44:21 pm

I have spent enough time and energy in litigious matters of environmental health and risk assessment to have developed a healthy suspicion of the use of statistics to prove anything controversial in the fields of social and environmental science. Statistical analyses in these disciplines are rife with material bias and prone to overlooked analytical errors. (This serious problem has been discussed extensively in the literature and, surely, is better assessed by statisticians or scientists than by a retired environmental lawyer.)

I do not say that statistics properly gathered and evaluated are unreliable and unimportant. I do say: 1) that social and environmental sciences have become politicized, 2) that some who employ statistics in those fields have been credibly suspected of lacking objectivity and 3) that statistics generally are readily manipulatable to meet the demands of ideology and to facilitate the opportunity for publication. While I make no such assertions as to the particular studies and authors discussed in Professor Rogers' commentary, for numerous reasons I do recommend further scrutiny of this analysis of US "deaths of despair." Two of my reasons are as follows:

1) The assertions that white male self-destruction is "exceptionally American" and that "U.S. black men in the age cohort saw (lesser) increases in... (self-destruction)" sound counter-intuitive. Yet, these particular concessions to "American exceptionalism" may be so politically useful that academia is unwilling to challenge them (unlike all other claims to American exceptionalism.)

2) The hypotheses raised as possible explanations for the ''deaths of despair'' seem utter speculation. These include: "the labor market, globalization, and technical change as the fundamental forces" plus “slow-acting social forces" but with "less focus on any loss of virtue, though we certainly accept that the latter could be a consequence of the former." What does ANY of that mean? Perhaps it is understandable why the authors "avoid committing to a specific cause given (they say) the significant ambiguity in the data" and (I say) the open-ended speculative quality and the inherent statistical-unverifiability of the causative forces which they nevertheless assert are "fundamental." (which raises the further point of logic: if there is "significant ambiguity in the data" (they say) and if the possible causative factors are open-ended and unverifiable (I say) how can the authors dub those particular causative forces "fundamental?"

In my opinion environmental and social sciences are facing a crisis of public credibility because of their propensity to grossly simplify complex causal relationships and confidently assert conclusions about causation based largely if not solely on statistics (particularly mere correlations and curious but meaningless associations.) In so doing, particularly through the publication of such "studies," they mislead public opinion, lawmakers and regulators and falsely incentivize grant-givers with conclusions that are likely to be false.

Journalism is not the only field in which mere publication becomes the vehicle through which false facts become canonized.

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Image of timothy
on March 24, 2018 at 15:19:54 pm

I believe you are onto something. At least from my 55+ white, non-Hispanic, unemployed (but educated), overtly discriminated-against in the workplace and slightly socially isolated seat, it would appear so, anyway.

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Image of Bill Burns
Bill Burns
on March 30, 2018 at 00:45:08 am

The same study also shows higher death rates in women in the same circumstances, but I guess that's not important.

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Image of excessivelyperky
on March 30, 2018 at 17:42:51 pm

A fair point, actually. I wonder if Mr. Rogers will chime in on why he restricted his focus to white middle-aged men and not also women, as the abstracts seem to include both in their findings. Doubly tragic if women have achieved parity here before closing whatever pay gaps actually still persist, as well.

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Image of Bill Burns
Bill Burns
on July 13, 2020 at 06:25:59 am

[…] declines in such deaths over the same period (and decreases in pain and suffering). James Rogers shows, however, that some nations, especially in the Anglosphere, have seen spikes in such deaths among […]

on July 19, 2020 at 20:07:17 pm

[…] in such deaths over the identical interval (and reduces in ache and struggling). James Rogers shows, nonetheless, that some nations, particularly within the Anglosphere, have seen spikes in such […]

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