Unhappiness in America: Despair among Rural White Males

In 2015, Princeton economists Anne Case and Angus Deaton published a paper which “documented a marked increase in the all-cause mortality [and decline in life expectancy] of middle-aged white non-Hispanic men and women in the United States between 1999 and 2013. This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround.” This is astounding. During the twentieth century the life expectancy of white males increased every decade from 47 in 1900 to 75 in 2000.  It is the experience around the world in rich countries and poor countries and has always been associated with increasing income.

Case and Deaton revisited their earlier paper in 2017 seeking to describe their results in greater detail.  Figure 1 presents the mortality data for Non-college non-Hispanic white males over 60 and for all black males over 60.

Figure 1.

For WNCNH (white non-college non-Hispanic males) the mortality rate rose by 15% between 1999 and 2015, while the mortality rate for blacks declined by 21%. What’s going on?

According to Case and Deaton, this increase in mortality is directly related to a major spike in what they call “the diseases of despair.”  These are alcoholism, suicide and opioid addiction.  Each of the colored lines in figure 2 represents a different cohort (birth year). So those born in 1950 are represented by the red line, while those born in 1980 is represented by the light blue line. The figures shows that the death rate increases as men grow older, but more importantly, that younger cohorts have higher age-specific mortality rates. For example, men born in 1960 have a mortality rate of around 40 at age 40, while for those born in 1970 the mortality rate from these causes is around 80 at age 40. Younger cohorts have higher “disease of despair” mortality rates than older cohorts at every age. Things are getting worse, much worse.

Figure 2.

Once again, the key question is why?  Why such an increase of alcoholism, opioid addiction and suicide in this demographic group?  The authors are unable to say conclusively.  However, they note that increases in deaths of despair are accompanied by a measurable deterioration in economic and social wellbeing, which has become more pronounced for each successive birth cohort. Marriage rates and labor force participation rates fall between successive birth cohorts, while reports of physical pain, and poor health and mental health rise.

Pia Malaney says that the crisis in America resembles what happened in Russia after the collapse of the Soviet Union.  She writes “In the early 1990s, in the aftermath of the collapse of the Soviet Union, life expectancy in the former Soviet Union and Eastern Europe fell dramatically. In Russia alone, it was estimated that between 1989 and 1995 there were 1.3 to 1.7 million premature deaths as life expectancy fell from 70 in 1989 to 64 in 1995. The proximate causes there too, were a significant increase in suicides and drug and alcohol abuse, leading to an increase in cardiovascular and liver diseases.  The primary victims?  Middle aged men and women. Once again, in-depth studies found that it was not direct deprivation, nor collapse of the health system that were driving these deaths.  Rather they could be traced to the psychological stress likely brought on by the shock of the severe economic transition. Unable to cope with the aptly named “shock therapy,” older (mostly) men essentially drank themselves to death.”

The shock to American white non-college males was probably related to the end of the “blue collar aristocracy” in the mid-1970s.  These men had good jobs and enjoyed strong social relationships centered around drinking and male bonding. But that world has disappeared.  Barbara Ehrenreich writes

“I grew up in an America where a man with a strong back—and better yet, a strong union—could reasonably expect to support a family on his own without a college degree. In 2015, those jobs are long gone, leaving only the kind of work once relegated to women and people of color available in areas like retail, landscaping, and delivery-truck driving. This means that those in the bottom 20% of white income distribution face material circumstances like those long familiar to poor blacks, including erratic employment and crowded, hazardous living spaces.”

The decline in good jobs, coupled with the upsurge of immigration and the relative improvement of the social and economic status of people of color, have eroded, for many older whites, the belief that things were getting better, that their lives and those of their children were going to improve. But their wages have been stagnant, their health care more expensive and their country has become more unfamiliar. They are beset with physical pain, broken marriages, declining friendships and increased anxiety.  Thus they turn more to alcohol and opioids, and ultimately choose suicide over the pain of their lives.

The response of the Body of Christ must be radical love. It is the only cure for despair. Our churches, concerned with increasing inclusiveness, must find a way to include these forgotten people who are dying from loneliness.

Isaiah, chapter 62 says Christ has been anointed to proclaim the good news to the poor, to bind up the brokenhearted, to comfort all who mourn and provide for those who grieve in Zion—to bestow on them a crown of beauty instead of ashes, the oil of joy instead of mourning, and a garment of praise instead of a spirit of despair.

The Church is called to be Jesus in the flesh and to comfort all those in despair with the oil of joy and a garment of praise.