A report released today on state health-care systems from the Commonwealth Fund concludes that so-called “deaths of despair”—deaths caused by suicide, alcohol, and drug use—reached an all-time high in the United States in 2016. That year, rates of death from these three causes increased in every state in the country, with particularly dramatic increases observed in Delaware, Ohio, New Hampshire, New York, and West Virginia.
The chart below, from the report, shows the increase:
The “deaths of despair” phenomenon, which has driven an unprecedented recent decline in life expectancy in the U.S., has evoked alarm in recent years. It was the economists Anne Case and Angus Deaton who most famously first documented a troubling trend in mortality in a paper published in 2015. The chart below, from Case and Deaton’s paper, depicts midlife (ages 45 to 54) mortality for white, non-Hispanics in the U.S. and other developed countries:
As the chart illustrates, this trend was not reported in any other developed countries. “From 1978 to 1998, the mortality rate for U.S. whites aged 45–54 fell by 2% per year on average, which matched the average rate of decline in the six countries shown, and the average over all other industrialized countries,” Case and Deaton wrote. “After 1998, other rich countries’ mortality rates continued to decline by 2% a year. In contrast, white non-Hispanic mortality rose by half a percent a year. No other rich country saw a similar turnaround.”
The economists calculated that this increase in midlife mortality resulted in an additional 96,000 deaths between 1999 and 2013.
While the 2015 paper didn’t identify a cause for the observed increase in mortality, Case and Deaton returned to the question in research published in 2017. In that research, published shortly after Donald Trump assumed the presidency, the economists identified an increase in rates of drug overdose, suicide, and alcohol-related liver mortality among white Americans with a high school degree or less as the drivers of the higher midlife mortality rates in the U.S.
The researchers hypothesized that worsening prospects for Americans without college degrees were triggering a cascade of “cumulative disadvantages” across a variety of outcomes—labor market outcomes, marriage and family outcomes, and health outcomes. “Ultimately, we see our story as about the collapse of the white working class after its heyday in the early 1970s, and the pathologies that accompany this decline,” Case and Deaton concluded.
The Commonwealth Fund report also includes state-by-state performance on a variety of other metrics: premature death rates, obesity rates, access to both mental health care and other medical care, tobacco use, quality of nursing and home health care, and hospital mortality. Not all the news in the report is bad: The researchers also found improvements in access to health care (although geographic differences persist), declines in tobacco use, and improvements in measures of nursing home and home health-care quality.
The report, however, suggests that the damaging pathologies identified by Case and Deaton are continuing to wreak havoc in communities across the country.
