Amidst America’s changing politics, deaths of despair persist

From 2014–17, average life expectancy in the US declined for the first time since 1933. What needs to change so that America’s working class is not left behind?

Interview Published 31 March 2021 Updated 7 July 2021 4 minute READ

Professor Angus Deaton

Dwight D Eisenhower Professor of Economics and International Affairs Emeritus, Princeton University

Between 2005 and 2019, an average of 70,000 Americans each year lost their lives to so-called ‘deaths of despair’ – alcoholism, suicide, and drug overdose – with deaths largely concentrated among the working class.

With average life expectancy in the US also declining for the first time since 1933, Nobel-winning economist Angus Deaton speaks to Lyndsey Jefferson about the causes and solutions, drawing on Deaths of Despair and the Future of Capitalism, which he co-authors with Anne Case.

70,000 Americans every year lost their lives to deaths of despair between 2005 and 2019.

Your book describes how ‘deaths of despair’ are mainly happening to middle-aged, white working-class people without a bachelor’s degree. What can be done to give workers without degrees the same quality of life as the college-educated middle class? Are policies such as making college tuition-free the answer?

Lower university fees would certainly help. The price of a college education in the US has gone up enormously and the state colleges, which used to be more affordable, have had severe budget pushes. But not everybody wants to go to college, and David Goodhart’s new book Head, Hand, Heart: The Struggle for Dignity and Status in the 21st Century suggests we have over-emphasized education.

The BA has become a requirement for access to a job with dignity and to social esteem. We have to somehow stop that. In Germany and the Netherlands there are lots of routes to jobs with dignity and those countries do not have ‘deaths of despair’. In Britain, the number of people getting a university degree is going up rapidly, so that may lead to the same sort of stratification.

After 2013, the mortality rate for black Americans started increasing as well, as opioids got into the inner-city communities, so deaths of despair are happening among black people without a BA too. Mortality rates for whites and blacks with or without a BA now have much more in common than mortality rates across educational groups within either the black or white communities. The extent to which class is replacing race as a stratifier is being discussed quite a lot in sociology literature.

The BA has become a requirement for access to a job with dignity and to social esteem. We have to somehow stop that.

Angus Deaton
Dee Knapp weeps as she looks over the death certificates of four of her five children as her son, Keylan Knapp, stands over her at home on 14 August 2018 in Luther, Oklahoma. Keylan was the only remaining child of Dee's five children, and he died of a drug overdose at the start of the COVID-19 pandemic in March 2020. All of Dee's five children have passed away. Photo by Lynsey Addario/Getty Images. 

Dee Knapp weeps as she looks over the death certificates of four of her five children as her son, Keylan Knapp, stands over her at home on 14 August 2018 in Luther, Oklahoma. Keylan was the only remaining child of Dee’s five children, and he died of a drug overdose at the start of the COVID-19 pandemic in March 2020. All of Dee’s five children have passed away. Photo by Lynsey Addario/Getty Images. 

What is the sociology literature saying about class replacing race as a dividing line?

A key reference is Robert Putnam’s book Our Kids: The American Dream in Crisis and his points on this subject and my recent paper with Anne Case examines life expectancy through different lenses. The idea that class (as exemplified by education) trumps race is controversial, and certainly incomplete. For example, while one-third of white Americans have a BA, only one-quarter of black Americans do. Even conditional on education, there are large differences in income, wealth and other important outcomes.

Life expectancy at 25

How does what is happening to the white working class today compare to what happened to black Americans 30-50 years ago during the earlier wave of de-industrialization? Issues of poverty, crime, and the crack-cocaine epidemic were, at the time, considered to be particular to the black community but now, white workers are blamed for their problems in a similar way. Is class the common thread more than race?

Some make those arguments but the alternative explanation at that time, led by sociologist William Julius Wilson, was that the world turned against them, not that they turned against the world. That makes a lot more sense for what has happened to the white working class, but one difference was the HIV/AIDS epidemic in the black community which does not have a parallel now.

There is a good question which people put to us from time to time: ‘All the bad things that are happening to the white working class, like the cost of health insurance, globalization, and automation, are happening to African Americans without a BA too. So why aren’t their mortality rates going up?’

Part of the answer is now they are. But my guess is that after the horrors of the 1970s, things got a lot better for black Americans. The protests last summer suggest we have a long way to go, but I think of that as actually being a sign of progress in some sense, because people are not prepared to put up with indignity anymore.

There are a number of statistics we quote in the book but the most remarkable is the Gallup poll about opinions on interracial marriage. In 1968, 80 per cent of Americans thought interracial marriage was wrong, whereas now, more than 87 per cent think it is fine. There is a much greater acceptance of black Americans being full and equal participants in American life.

 A ‘Save America’ message is displayed in Youngstown, Ohio. Photo: Getty Images.

 A ‘Save America’ message is displayed in Youngstown, Ohio. Photo: Getty Images.

Do you think the ‘white working class’ in America is demonized or caricatured in the media? If so, why?

A lot of that has to do with one of the themes we take up in Deaths of Despair about meritocracy. There is this idea that if people achieve success based on educational merit, then they tend to underplay the role of luck in their being successful and overplay the role of their own hard work, which, of course, plays a part too.

But what about people who did not go to college? It is important to remember that in America, only one-third of adults have a four-year bachelor’s degree. Those who succeed tend to feel that if you did not make it, that is your fault, which makes them smug and sometimes even contemptuous, and brings to mind Hillary Clinton’s comment about the ‘deplorables’.

The people left behind think the system is rigged against them, which is increasingly true, but there is also this horrible feeling that maybe it is their fault. The combination of those two things leads to a tremendous amount of resentment. Condescension and contempt on one side and resentment on the other is heady and dangerous.

I do not think it is the complete story of how Donald Trump got elected but it is an important part. The Democrats made a conscious decision in the early 1970s to give up on the white working class and move away from the unions. They became a sort of coalition between minorities on one hand and an educated elite on the other.

The Democrats made a conscious decision in the early 1970s to give up on the white working class and move away from the unions.

Angus Deaton
A memorial questions the existence of God in Huntington, West Virginia on 20 April 2017. The city has been portrayed as the epicentre of the opioid crisis. 'This epidemic doesn't discriminate,' Huntington Mayor Steve Williams said. 'Our youngest overdose was 12 years old. The oldest was 77.' Photo by Brendan Smialowski/AFP via Getty Images.

A memorial questions the existence of God in Huntington, West Virginia on 20 April 2017. The city has been portrayed as the epicentre of the opioid crisis. ‘This epidemic doesn’t discriminate,’ Huntington Mayor Steve Williams said. ‘Our youngest overdose was 12 years old. The oldest was 77.’ Photo by Brendan Smialowski/AFP via Getty Images.

Your book talks about how deaths of despair are happening to a lesser extent in more deprived parts of the UK, but not really happening at all in continental Europe. Why is this?

Deaths of despair are rising in the UK, more so in the north-east, and especially in Scotland where the death rate from drugs is similar to America. In the rest of the UK, the rates are rising but much lower than in the US. There are similar signs in other English-speaking countries. I do not think we have an explanation of why in Britain, but not in France or Germany.

Deaths of despair are rising in the UK, more so in the north-east, and especially in Scotland where the death rate from drugs is similar to America.

Angus Deaton

Even President Biden seems to agree that a return to business as usual will not deliver for America’s working people. What policies should be priorities for the new administration?

One of the things we identified in the book as being crucial to do is healthcare reform. I do not think there is a snowball’s chance in hell of comprehensive reform happening now. And the stock market knows that, which is one of the reasons it is doing so incredibly well. They know the rent seekers, the banks, the oil industry, the healthcare industry, and the legions of lobbyists in Washington are not going to be reined in. It would take a Roosevelt-type administration to do this.

Chefiatou Tokou chants during a Labor Day march in Boston on 4 September 2017. Local cooks and cashiers from McDonald's, Burger King and other restaurants walked off the job,  joining strikes by fast food workers in 300 cities. Photo by Craig F. Walker/The Boston Globe via Getty Images. 

Chefiatou Tokou chants during a Labor Day march in support of raising the federal minimum wage to $15 an hour on 4 September 2017. In Boston, Massachusetts, cooks and cashiers from McDonald’s, Burger King and other restaurants walked off the job,  joining strikes by fast food workers in 300 other cities. Photo by Craig F. Walker/The Boston Globe via Getty Images. 

Look at the Supreme Court. I care about abortion, but for me, the big issue around Amy Coney Barrett is that the court is now enormously pro-business. There are issues of redistribution away from workers towards capital and the enormous strengthening of tech that has happened because of the pandemic.

All of this is good for profits and bad for labour. So, I just do not think the reforms that need to take place are going to happen. Now the Democrats control the Senate, which gives opportunities that would not be there otherwise, but it is a narrow margin. Even so, they have made a very good start with the pandemic relief package.

I also do not want to minimize the benefits of being rid of Donald Trump, especially when it comes to foreign policy and America’s standing in the world. Also, Biden’s family is not going to be plundering the administration. So the ‘crony capitalism’ will take a hit to some extent, but the big issues of domestic policy will remain.