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Middle-aged, white and at risk: the Americans progress forgot

Economic and social stress underlies growing mortality rate, says study

Unless you have been in blessed seclusion this week, you have heard that something horrible is happening to middle-aged white people in America – their death rates are going up, dramatically.

This defies the march of medical progress – mortality rates for every other age and ethnic group in America are declining, not increasing. And in every other wealthy country, the mortality rate for middle-aged white people is also on the way down.

The study that documents this, written by the 2015 Nobel prize winner in Economic Science, Angus Deaton, and his wife, Ann Case, was instantly headline news, and rightfully so. It is a shocking snapshot of a core of the country in trouble.

Some of that shock is because the drivers of death are not the usual suspects –cancer, diabetes and heart disease. They are mental health or psychological illnesses: suicide, alcoholic liver disease and overdoses from illegal drugs, prescription drugs and alcohol. These deaths afflict poorly educated white middle-aged Americans with special brutality.

The mortality rate for white Americans 45 to 54 years old with high school diplomas or less increased by 134 deaths per 100,000 from 1999 to 2014.

“It is difficult to find modern settings with survival losses of this magnitude,” two Dartmouth economists, Ellen Meara and Jonathan S. Skinner, wrote in a commentary to the study.

The rest of the population has plenty of cause to be scared as well. The Deaton-Case study says, “ [A]ll 5-year age groups between 30–34 and 60–64 have witnessed marked and similar increases in mortality from the sum of drug and alcohol poisoning, suicide, and chronic liver disease and cirrhosis over the period 1999–2013.”

But the 45-54 bracket of less educated whites has been walloped. Deaton and Case compare the scope of death to the AIDS epidemic that took approximately 650,000 lives. If the mortality rate for whites between 45-54 before 1998 had continued its declining path, half a million deaths would have been avoided.

Why is this happening?

Obesity is a key factor with psychological causes. But Deaton and Case stress two other related epidemics – the epidemic of pain and the epidemic of prescription opioids to treat pain, leading to addiction and a hospital full of other lethal conditions.

Underlying all this, Deaton and Case suspect, is a foundation of economic and social stress.

“After the productivity slowdown in the early 1970s, and with widening income inequality, many of the baby-boom generation are the first to find, in midlife, that they will not be better off than were their parents,” they write.

“Growth in real median earnings has been slow for this group, especially those with only a high school education. However, the productivity slowdown is common to many rich countries, some of which have seen even slower growth in median earnings than the United States, yet none have had the same mortality experience.”

I was interested in the public reaction and scoured comments on stories of all kinds of sites around the country. Two things are clear: The report scared and worried people and their responses are a fascinating Rorschach test for how people see America’s problems.

Commenting on The Dallas Morning News, “S” wrote, “It is due to institutionalized racism against Whites.”

Similarly, “jwcody” wrote on Breitbart.com, “Only black lives matter in Obamas America…”

Tony on The Dallas Morning News said, “Let’s see how long before Fox and Friends (Trump and the rest of the clowns) blame this on Obama.”

Across the country, many commenters said that maybe white middle-aged Americans now know what it feels like to be black or Hispanic, under financial stress, unprotected against the future.

“Given that the increases are due to suicide, drug overdoses and alcoholism, it seems rather evident that people are in deep pain–be it physical, emotional or mental,” “gonegirl” commented at NPR.org. “Blacks and Hispanics have perhaps been more acclimated to certain societal pressures over the decades and thus are not experiencing the same demise, though they are still less well off than whites. But now whites are feeling those same struggles.”

“When I tell my grandchildren that many Americans not so long ago with only a high school diploma were able to find full-time employment with benefits, buy a house, a car, raise children and retire, they look at me like I am reading them a story about unicorns and magic beans,” “Mrs. Choate PFFLAG Grandma” wrote on Gawker.

Having the special authority of a medical finding, this study may inspire a deeper empathy or understanding of how bad off this slice of the great white middle is and even why they are susceptible to the pessimistic, angry campaigns of outsider demagogues.

The question for politicians of all flavors, and for the leaders of large public corporations and institutions, is whether they intend to exploit the great white plague or treat it.

Deaton and Case says the problems that are killing middle-aged whites are “hard to treat… so those currently in midlife may be a ‘lost generation’ whose future is less bright than those who preceded them.”

A lost generation in middle age: a public health fluke or the start of a wider epidemic?

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