Last month in a report prepared for the Brookings Panel on Economic Activity titled “Mortality and morbidity in the 21st century,” Anne Case and Nobel Laureate Angus Deaton provided a more in-depth analysis of their groundbreaking 2015 findings of increasing midlife mortality rates among working class (high school or less education) Whites in the United States. In the context of continued declines in mortality rates for other age, education, and race/ethnicity groups, these increased mortality rates among midlife, working class Whites are particularly striking and reverse decades of progress in reducing mortality. In the 2015 paper, Case and Deaton noted that drug and alcohol overdoses, suicides, and liver disease/cirrhosis accounted for much of the increased mortality in this group. The authors have described this as “deaths of despair”.
In their recent analysis of these data, Case and Deaton find an expanding geographic pattern for the increasing rates of death from drugs, alcohol, and suicide among midlife Whites, beginning in the Southwest, then spreading to Appalachia, Florida, and the West coast, and now across the entire country. Their data show a deterioration of economic and social wellbeing in this group that increases as rates of marriage and employment decline along with overall physical and mental health. The data suggest that the drivers of this increased mortality will not be easily reversed via job training or income redistribution since this cumulative disadvantage began in the 1970s when those with high school or less education entering the labor force found increasingly fewer labor market opportunities for the skills they possessed.
The implication from these thoughtful analyses is that some of our most pressing current health problems, including the recent opioid abuse and overdose crisis that I have blogged about recently, have their roots in economic and social forces that began decades ago. The health of our Nation relies on a better understanding of how population-level factors influence health and the foresight and will to preempt, when possible, these population-level determinants to reduce later disease and death.
It is not the implication of this work that we should focus our research on working class Whites to the exclusion of other groups that experience disparities in health. In a recent interview for the Washington Post, Case and Deaton responded to some who suggested that they were ignoring Black mortality. These researchers were doing what we want all researchers to do – follow the data where it leads, putting aside any preconceived assumptions or biases. They report on the increase mortality rates of working class Whites because of the exceptional increased mortality observed over time in this group relative to other groups. They note that Black non-Hispanics, despite their mortality decline over the last few decades, still have about 200 more deaths per 100,000 than their White non-Hispanic counterparts, and economic and societal factors continue to play a significant role in this health disparity. Health disparities research is not a competition among population subgroups for research and political attention, but instead an effort to understand the factors that contribute to these disparities that will guide new approaches to reducing health disparities.