The mortality rate for middle-aged whites without a college
degree has shot upward in the last decade, even as death rates
for blacks and Hispanics continued to fall.
Posted on March 23, 2017, 21:32 GMT
Spencer Platt / Getty Images
Middle-aged white Americans without college degrees are dying
at higher and higher rates, with drugs, alcohol, and suicide
driving a dramatic increase in mortality.
The increase is happening even as mortality decreases for
similar age groups across the developed world — and for black
and Latino Americans, and whites with college degrees.
The data, outlined in a new paper by economists Anne Case and
Nobel Prize winner Angus Deaton, shows death patterns for
American whites sharply diverging from peers in Western
Europe — particularly in what they dub “deaths of despair,”
involving drugs and suicide.
“In 1999, the mortality rate of white non-Hispanics aged
50-54 with only a high school degree was 30 percent lower
than the mortality rate of blacks in the same age group,”
Case and Deaton wrote. “In 2015, it was 30 percent higher.”
The rising mortality affects a wide swath of the country.
There are 90 million white Americans aged 25 or older who
have no bachelor’s degree — more than all black, Asian and
Hispanic adults over 25 combined.
For college-educated white America, the US is a typical
Western industrialized country, with falling mortality rates
across demographics. The same goes for minority groups:
Hispanics have experienced a decline in mortality comparable
to rich European countries (although the overall level is
still higher), while African Americans have experienced
large, sustained drops.
The trend goes against a broad, global improvement in public
health through most of the 20th Century. In the US, mortality
fell from the late 1930s through to the late 1990s, pausing
only in the early 1960s after smoking became a national
pastime. If the mortality rate simply stopped falling and
flatlined, it’d be a crisis. The fact that it’s increasing is
The numbers behind such trend lines are stunning: if
mortality for whites aged 45-54 had fallen between 1999 and
2013 at the same rate as it had between 1979 and 1998, half a
million fewer people would have died, Case and Deaton have
previously noted — a number comparable to all the lives lost
in the US AIDS epidemic.
In many European countries, “mortality rates are falling for
all education groups, and are falling most rapidly among the
least educated,” Case and Deaton wrote. “The fact that the US
has pulled away from comparison countries throughout middle
age is cause for concern.”
The massive increases in mortality among non-college-educated
white population has led to the overall white life expectancy at
birth to fall in 2014 and for the overall life expectancy to fall in 2015.
The usual suspects did not cause this turnaround. Deaths from
heart disease and cancer — the two largest killers of the
middle aged— have fallen. Instead, increases in drug
overdoses, suicide, and liver diseases caused by alcohol have
been able to more than offset these vast improvements in
Money also doesn’t explain the divergences. The incomes of
black and white Americans have moved in a similar pattern,
and non-college educated blacks suffered bigger income falls
since 1999 — and yet their mortality rates declined.
For whites in middle age, however, “there is a strong
correlation between median real household income per person
and mortality from 1980 and 2015,” Case and Deaton write.
What’s really happening, they suggest, is not so much short
run changes in income, but that “long-run stagnation in wages
and in incomes has bred a sense of hopelessness.”
Case and Deaton’s work follows their blockbuster research in 2015 which
showed that there had been 96,000 “excess deaths” between
1998 and 2013 thanks to the increase in mortality rates among
whites between 45 and 54.
Other economists have shown that middle aged white men are
leaving the workforce at higher rates due to increases in
pain and disability, and that employment, earnings, and
marriage rates for men had
fallen in areas where jobs disappeared to increased competition
from foreign manufacturers.
Many media accounts of the declining prospects of the white
working class discuss the rise of opioid addiction. Case and
Deaton are more cautious, saying that “we do not see the
supply of opioids as the fundamental factor,” but that
“prescription of opioids for chronic pain added fuel to the
flames, making the epidemic much worse than it otherwise
would have been.”
African Americans are also considerably less likely to be prescribed
opioid painkillers, which is the first step for many future
addicts to full-blown dependency.
The underlying story, Case and Deaton suggest, is economic.
Since the early 1970s, people without a college degree have
had fewer good career opportunities, stagnant wages,
shrinking unions, declines in church membership and fewer
marriages. “These changes left people with less structure
when they came to choose their careers, their religion, and
the nature of their family lives. When such choices succeed,
they are liberating; when they fail, the individual can only
hold him or herself responsible.”
“Cumulative distress, and the failure of life to turn out as
expected is consistent with people compensating through other
risky behaviors such as abuse of alcohol, overeating, or drug
use,” they wrote.
“Ultimately, we see our story as about the collapse of the
white, high school educated, working class after its heyday
in the early 1970s, and the pathologies that accompany that
Matthew Zeitlin is a business reporter for BuzzFeed News
and is based in New York. Zeitlin reports on Wall Street
and big banks.
Contact Matthew Zeitlin at email@example.com.
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