Deaths of Despair: Criticism

Buffalo, NY Amtrak Central Terminal.

When I first moved to a rust belt city, everywhere you went you felt a pang of nostalgia, even though I had not known the exact place before. I recognized the grand banking center in the old granite building. I could tell that the train station used to bustle with commuters. There is a common thread when you go to any place of seeing better days. Not only that though, there’s always talk about who can bring back the good times. That if they just had someone willing to invest in the place they could turn back the clock and get back the great old amenities. There is also a deep disappointment when one of the old industries moves out or goes bankrupt, a feeling that they were supposed to be the exception. Of course you can’t turn back the clock.

If you needed evidence that the white working class towns are getting left behind JD Vance in his memoir Hillbilly Elegy where he tells a haunting story of life in rust belt Ohio, under “Appalachian values,” which could involve watching your parents drink and beat their kids. “There is a lack of agency here — a feeling that you have little control over your life and a willingness to blame everyone but yourself. This is distinct from the larger economic landscape of modern America,” Vance writes.

Likewise you can read in the New York Times about Elizabethton, Tenn, a small, rural, majority white town who are teaching children as young as 6 how to administer Narcan to save a loved one from overdose. “We’re in the Bible Belt, and a lot of schools here don’t like to admit drugs are a problem.” said Sherry Barnett, the region’s overdose prevention specialist for the state of Tennessee.

Clearly the problem is real. The question is whether framing “deaths of despair” as a non-college Whites issue is useful and fair.

Ann Case and Angus Deaton wrote their original paper on Mortality and morbidity in the 21st century in 2015. They wrote an upcoming book of their findings, Deaths of Despair and the Future of Capitalism to be published March 2020. In it they show a disturbing rise in suicides, alcohol and drug related deaths in the non-college White population in particular compared to other minorities.

The comparison only works if you leave out college educated Whites, and include college educated minorities. Whites as a group have not seen such a stark rise in mortality. While Black and Hispanics as a group are less likely to have a college degree than Whites, 17.3% of non-Hispanic Blacks have a college degree compared to 30% of non-Hispanic Whites, it is not an apples to apples comparison. Singling out non-college is also questionable because the group is partially self-selecting. You can go to college at any point in your adult life and the reasons you might not go to college may have more to do with the events in your cohort. Maybe they delayed college to fight in a war. Maybe after leaving a job, instead of taking job retraining at a local college they had to take care of a sick relative. The circumstances that correlate with not going to college may be more important than the identity “non-college.”

All-Cause Mortality for Black Non-Hispanics and White Non-Hispanics with a High School Degree or Less, 1993–2015

Among all cohorts of non-college Whites there has been an upward trend followed by a recent uptick in all-cause mortality. The recent uptick is attributable to the opioid crisis and America’s slow and lackluster response to the epidemic. Since the spike in opioid deaths has recently caught up with the African-American population which was temporarily shielded from the medical industry’s overprescription of opioids early on by ironically racism. Doctors who believed their black patients had a higher tolerance for pain, partially due to the myth of literal “thicker skin” among medical professionals, or those who were wary of their black patients complaints about pain, may have inadvertently saved thousands of black patients from the prescription opioid crisis.

While it is clear that African Americans face discrimination in this, among many effects that make economists hyper-aware of race, it is not clear that non-college Whites are similarly singled out. The authors are careful not to draw conclusions based on race, and base most of their speculation on economic effects, lack opportunity, jobs leaving the area, lack of access to healthcare. Case and Deaton emphasize that their study is strictly observational. However just separating out non-college Whites as a group invites racial reading of the data.

Conservative media misreads much of this data as a culturally White American phenomenon. Non-college Whites are a large and diverse group that in many individual cases, like in Middletown, Ohio or Elizabethton, Tennessee are facing great hardship and disinvestment. There are also many reasons to believe that small majority white towns are better than they have been. Drug use is down among the youngest cohort of Americans. Teen pregnancies are at historic lows. There are plenty of individual cases of non-college White men who go on to found companies and earn more than their parents. There is no reason to believe that non-college Whites are being discriminated against.

Political Data Analyst. Professional experience in statistical models and surface and air microbiology.