Saturday, March 25, 2017

The Disease Killing White Americans Goes Way Deeper Than Opioids

In rich countries, death rates are supposed to decline. But in the past decade and a half, middle-aged white Americans have actually been dying faster. Princeton economists Anne Case and Angus Deaton first pointed out this disturbing trend in a 2015 study that highlighted three “diseases of despair”: drugs, drinking and suicide.

On Thursday, the pair released a deeper analysis that clears up one of the biggest misconceptions about their earlier research.

The problem of dying whites can’t only be blamed on rising rates of drug overdoses, suicides and chronic alcoholism, they say. More and more, middle-aged white Americans are dying for all kinds of reasons — and the underlying issue may have less to do with opioids and more to do with how society has left behind the working class.

“Ultimately, we see our story as about the collapse of the white, high school educated, working class after its heyday in the 1970s, and the pathologies that accompany that decline,” they write.

This is slightly different than what they said in their first paper, where they emphasized that the trend of rising white mortality was “largely accounted for by increasing death rates from drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis.” That's technically correct — but by focusing only on the increase in death rates, Case and Deaton distracted from the larger picture.

The alarming fact isn't just that middle-aged whites are dying faster, but also that mortality rates have been dramatically declining in nearly every other rich country. The United States is getting left behind.

In the last 15 years, a chasm opened up between middle aged whites in America and citizens of European countries like France, Germany and the United Kingdom. While white death rates in America rose slightly, death rates in those other countries continued to plummet. In comparison to what happened in Europe, the situation for American whites starts looks much more dire — and it's a bigger problem than opioids or suicides can explain. It's not just about what went wrong in America, but what stopped going right.

by Jeff Guo, Washington Post |  Read more:
Image: Jim Cole/AP

[ed. Finally, a more nuanced perspective on factors fueling opioid abuse in America. People are dealing with a sense of loss and purpose in their lives, and a diminished likelihood of meaningful employment in the future, so why wouldn't they embrace something that makes each day easier to take and dulls the pain? It's a completely rational coping strategy, and the same reason people turn to marijuana to make boring, repetitive tasks more acceptable. As far as I know, there's been very little research into the efficacy of  using opioids to treat depression, but I suspect many are using them for that purpose. Our current reactionary policy of rescheduling pain-killers and restricting prescriptions (and pharmaceutical controls) has had little effect other than forcing people to find alternatives in the street, thus making the situation worse than it needs to be (and more dangerous), and therefore exacerbating the problem. Give people the opportunity to live meaningful lives and the problem will correct itself. But that won't happen if income equality stays the same, which is a much larger problem to deal with (and which no one seems in a hurry to fix). Better to let the disenfranchised kill themselves than redistribute the wealth and opportunities that might make society's discarded workforce replace drugs for hope.]