What's Gone Wrong in White America?

            The The New York Times published a blockbuster social science story last Monday about a study completed by Nobel laureate Angus Deaton and Anne Case.  Drs. Deaton and Case found that mortality rates had spiked for whites who are between 45 and 54 years old.  That spike was largely confined to people without any college education and bucked mortality trends for all other races and age groups, both in the United States and in other developed countries. 

            Tragically, the increased death rate was the result of suicides, drug overdoses and chronic liver disease, which is generally associated with alcohol abuse.  By contrast, death from lung cancer has trended down for this group while deaths from diabetes associated with obesity have remained flat.

            I was prepared to write an article like the one Harold Meyerson of the Washington Post wrote on Thursday.  He tied this spike in white middle age death to a narrative about the job loss and economic impotence of people who thought that they would be able to maintain a middle class life style by parlaying their high school diplomas into secure jobs in manufacturing and construction, just like their mothers and fathers had.

            In Meyerson’s narrative, the deaths are a natural result of the angst people experience when they lose their jobs and realize that, for them, the American Dream is a chimera.  They realize that they are not going to do better than their parents and that they can expect to finish their lives on the brink of poverty.  They numb their existential pain with drugs and alcohol, or they end them with suicide.

            For good measure, Meyerson points out the Republican presidential candidate Donald Trump draws much of his political support from non-hispanic whites who have high school degrees or less.  Support for Trump and the high death toll for this group, he says, share common roots: “a sense of abandonment, betrayal and misdirected rage.”

             As I started to write, though, it occurred to me that Meyerson’s narrative left too many questions unanswered.  First of all, as the Times points out, while the trend for middle aged is going in an unfortunate direction, middle aged blacks still have a much higher death rate than do whites.  The death rate for middle-aged African-Americans is 581 per 100,000, 166 per 100,000 higher than the 415 per 100,000 applicable for middle-aged whites.   

            The Meyerson narrative doesn’t even mention this fact, nor does he ask why there is a difference between white middle-class mortality and black middle-class mortality.  I suppose it’s newsworthy when a mortality trend reverses itself, but it’s downright embarrassing when a story about middle-aged whites receives vast media attention and the story about abbreviated African-American longevity never even got written.  Middle-aged black mortality doesn’t appear relevant to the larger political narrative.  Do their lives not matter?

            What’s also missing, though, is any analysis of where these deaths are coming from.  Deaton and Case provide one tantalizing graph, which I reproduce here, that sheds some light on this.

            Each point on the graph represents a year and one of the country’s four census regions: blue for the Northeast, red for the Midwest, black for the South and green for the West.

            While all regions show increases in mortality due to suicide and drug overdoses, the death rates in the Northeast and the Midwest seem to lag those in the South and the Midwest.  The worst year for these kinds of deaths in the Northeast and the Midwest was 2013.  But the South and the West had already reached this level of death for these causes in 2007 and 2005 respectively.

            Why did life get harder for middle-aged whites living in the South and the West sooner than it did for middle-aged whites living in the Northeast and the Midwest? Why do things get much worse in the South after 2005 and the West after 2007?  Is there something going on at the state or local level that is either making mortality rates from drug abuse and suicide worse in the South and in the West or is there something happening in the Northeast and the Midwest that is putting a lid on the problem there?

            And finally, why have the mortality trends reversed themselves only for middle-aged whites with no college experience? It’s easy to jump to the conclusion, as the Meyerson narrative does, that folks who haven’t been to college are more likely to experience joblessness or economic dislocation leading to poverty and hopelessness than their better-educated peers. But, is that really the whole answer?

            How can we explain the fact that, according to the study, people who have taken some college coursework but didn’t graduate from college are doing much better than middle-aged whites with no college experience?  Why should a college dropout, someone who has obviously failed at something big, be less likely to die in middle-age by suicide or drug overdose than his or her peer with only a high school diploma?  Are his or her life prospects really that much better?  Is there something about an abbreviated college experience than helps to immunize a person against suicide and death by drug addiction at middle-age, or is it the willingness to try to get a college education that does the trick?

            Good science is all about generating good questions. Deaton and Case have just contributed more than their share.  Questions such as the ones I’ve just asked should keep social scientists busy for a good long time.

            Their answers are clearly matters of life and death.