Rise in mortality rates among white working class in the US

This morning several newspapers reported on a study by two economists from Princeton University into rising mortality rates among non-hispanic white men and women in the US since 1998. (Or to be more exact, the mortality rates have been decreasing everywhere, but the rate of that decrease has slowed to the point of stopping among this group).

The Guardian’s coverage, for instance, presents the study this way:

A sharp rise in death rates among white middle-aged Americans has claimed nearly as many lives in the past 15 years as the spread of Aids in the US, researchers have said.

The alarming trend, overlooked until now, has hit less-educated 45- to 54-year-olds the hardest, with no other groups in the US as affected and no similar declines seen in other rich countries.

Though not fully understood, the increased deaths are largely thought to be a result of more suicides and the misuse of drugs and alcohol, driven by easier access to powerful prescription painkillers, cheaper high quality heroin and greater financial stresses.

The full article, authored by Anne Case and Angus Deaton, is titled “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century” and you can download it here.

I have to admit I was pretty surprised when I first read the news reports, simply because of the focus on white people’s mortality rates which are usually lower than those of people of color. The lack of any mention in the news articles about how the trends being reported compared with those of people of color in the US struck me as rather odd.

The full article does address this comparison quite explicitly, however, as you would hope. (Although Table 1 seems to be lacking data on Black US mortality rates, which seems from the discussion in the paragraph below like it might be a mistake.) The authors acknowledge what is already well known: in the US people of color die younger than white people. But it argues that, while the mortality rates of people of color are improving in the US (and are improving for white people in other North American and European countries), the improvement has slowed dramatically for white people since 1998. Moreover, these deaths are the result of what I think of as diseases of despair: suicide, alcohol, and drugs.

I have a couple of thoughts on this. First, I’m interested in why this is so pronounced in the US in comparison to other countries. Obviously the trend is related to the economy, as the authors point out. But the economic prospects of working class people in, for instance, the UK have been just as badly hit as the US. So why the difference? It seems like it might be the case that health care is an important factor here. The UK has (arguably) the best healthcare system in the world and is available to everyone no matter what their race or class. In the US vast numbers of people don’t have access to healthcare: and specifically those who are poor have barely any options at all.

Second: this study is a perfect example of how it is, apparently, impossible to acknowledge class in the US. The paper and the news articles describing it go out of their way to avoid using the word “class”: at some points tying themselves in linguistic knots and qualifies in order to do so. If you look at what they are arguing, this is not just a study about race, as the headlines suggest. It is very specifically a study about the intersection of race and class. Poor white people are dying, not rich white people. This is a really important point that gets lost in the befuddling qualifying terms of college v. high-school education and so on.

Why is this so important? Well, because to talk only about race and not about class not only leaves out what are (duh) obviously very important and real sociological phenomena. (I mean, honestly–just look at this study!) But it also makes it much more difficult to talk about the problems of racism to poor white people who, quite justifiably, are alienated by talk of white privilege when they are experiencing extreme poverty and hardship themselves.

At the same time there are more abstract problems with avoiding the discussion of class by focusing on education. Class is more than (just) education. Conflating the two plays into the now quite dangerous idea that if only more people went to a four year college, they would be able to escape the kind of problems this mortality article is referring to. Given the astronomical costs of higher education these days, plus the fact that a majority of people who start college are unable to finish (thus accruing crippling debt without even getting a qualification), plus the reality that a degree is no longer the guarantee of a job, using education as a lazy stand-in for class is an obscurification that perpetuates the myth that college can solve all of the US’s class-based inequalities. It can’t. Although a longer discussion of why is perhaps best saved for another blog post.

As a final thought, this report reminded me of Chris Walley’s evocative ethnography Exit Zero: Family and Class in Postindustrial Chicago and specifically her detailed description of the ‘social devastation’ caused by the closure of the Wisconsin Steel Mill in the Calmut region, just south of Chicago. She writes that:

…in less than ten years since Wisconsin had been shut down, nearly 800 out of 3,400 [former] workers had died, mostly from alcohol and stress related illnesses, compounded by the lack of healthcare and high suicide rate.

As a detailed ethnographic and historical study, her Exit Zero project goes a long way towards contextualizing and historicizing the issues behind today’s headlines.

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