White death

Donald Trump’s base is killing itself with drugs and booze. Or so one might infer from a startling new paper by Ann Case and her husband, this year’s Nobel laureate for economics Angus Deaton, both of Princeton.

Trump, still frontrunner for the Republican presidential nomination in most polls, is doing especially well among likely primary voters with a high school education or less and incomes below $40 000 a year (the median US household income is currently just under $54 000).

Fully a third of this demographic said the Donald (so dubbed by an ex-wife who spoke imperfect English) was the guy for them in a late September survey by the Pew Research Centre. His closest rival for their affection was Dr. Ben Carson, the pediatric neurosurgeon who has said he would rather see a bullet-riddled body than any impairment of Second Amendment gun rights. He mustered just 14 per cent. No one else in the herd made it into double digits.

Case and Deaton call their paper “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century”. In it, they report a statistically significant surge in the rate at which middle aged white Americans are dying. The increase is particularly marked among those with no more than the equivalent of matric.

The mortality rate for men and women in their late forties and early fifties has been falling by an average of 2 per cent a year in industrialised countries since 1978, say the authors. That continues to be the case in all except the US where in 1999 the trend suddenly reversed itself. But only for whites. For African- and Hispanic-Americans it continued in the right direction, albeit, in the African-American case, from a substantially higher base.

In 1999, for every 100 000 living Americans, 381 whites aged between 45 and 54 died from all causes. By 2013, that had risen steadily to 415, an increase of 34, or 9 per cent. But here’s the really striking thing. Of those additional deaths, the vast majority entailed drug overdoses and alcohol poisoning (22), suicide (9) and chronic liver cirrhosis (5) – markers all of despair — only slightly offset by falls in deaths from other causes such as heart attack and traffic accidents.

Here’s what happens when you crunch the numbers by education level. For whites with at least some college, the mortality rate actually fell by 70 between 1999 and 2013. But for those whose education stopped at or before high school graduation, it exploded by 134 to 736 (compared with 582 for all African-Americans and 270 for Hispanics). Of the increase, drugs, alcohol and cirrhosis accounted for 56, suicide for 17.

Case and Deaton calculate that if white middle-aged mortality had stayed on its 1979-1998 trajectory – falling by 1,8 per cent a year – nearly half a million deaths would between 1999 and 2013, would have been avoided, 54 000 of them, equivalent to the number of Americans killed in Viet Nam, in 2013 alone.

Not only are more midlife whites dying early, they are also, as one might expect from the mortality data, feeling sicker, both in body and mind. They are less likely to report that they are in excellent health than they were in 1999, more likely to say they are in pain. Blood tests show an increased incidence of heavy drinking. Relatively more respondents to a standardized questionnaire known as the Kessler 6 are turning in scores that indicate serious mental illness.

What’s happening? Chickens and eggs still have to be sorted. Is there, for example, a real epidemic of pain for which addictive opioids like Oxycontin are being overprescribed and then substituted for with opiates like heroin, contributing to overdose deaths. Certainly there does seem to be a major heroin problem, especially in rural areas and communities suffering from the loss of manufacturing employment. But what’s behind that?

“Although the epidemic of pain, suicide and drug overdoses preceded the financial crisis, ties to economic insecurity are possible,” Case and Deaton conclude carefully. That sounds right. To be middle-aged without a degree in America’s Darwin-world is to confront the reality that you are not going to be better off than your parents and that before you lies the prospect of some seriously ungolden years with little in the way of safety net, Obamacare notwithstanding.

“The phenomenon Case and Deaton have identified suggests a dire collapse of hope,” writes their Princeton colleague Paul Starr in The American Prospect. “That same collapse may be propelling support for more radical political change.” In the shape, God help us, of Donald Trump?

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