The term "deaths of despair" has become common in recent years. Citing the opioid epidemic and a spike in suicides, researchers and journalists alike have suggested that much of the American working class, having seen its well-paying jobs disappear, has essentially given up on life.
It's true that there's a growing gap in life expectancy between better-educated and less-educated Americans. But is despair really what's driving this divergence? A new study raises serious doubts.
A research team led by Arline Geronimus of the University of Michigan reports that, while drug overdoses are a significant contributor to untimely deaths among the working class (at least among whites), less-educated Americans also suffer higher mortality rates from cardiovascular disease and various types of cancer.
These illnesses, the researchers suggest in the Journal of Health and Social Behavior, may reflect the accumulated wear-and-tear of a lifetime of hard work and struggling to make ends meet.
"Rather than giving up in the face of hopelessness, less-educated Americans may be losing ground for exactly the opposite reason—because they work so hard, they bear the consequences of years of stress," Geronimus said in announcing the findings.
She and her colleagues gathered data on mortality rates and causes of death in 43 states and the District of Columbia from 1990 to 2015. They focused on Americans between the ages of 25 and 84, and analyzed rates for whites and blacks separately. (Hispanics were excluded from this analysis.) The researchers estimated years of life lost to various diseases among Americans of different races and genders, as well as various levels of educational attainment.
They report that, over the quarter-century beginning in 1990, the mortality rates of less-educated Americans grew significantly, even as those of their better-educated counterparts declined. As Geronimus and her team noted, this ever-growing gap was particularly large among people between the ages of 65 and 84, suggesting that these higher mortality rates are the result of long-term, cumulative effects.
Not surprisingly, the researchers found that drug overdose deaths had increased over the period, particularly for 25- to 64-year-old whites. But they argue that focusing exclusively on this tragedy distorts our view of the larger picture.
"In all demographic groups studied, especially blacks, we found the contributions of growing educational inequities in cardiovascular disease, cancer, and other internal causes of death [were more significant than those of] increases in suicide or alcoholic liver disease," they write.
This finding suggests that "the economically or socially most vulnerable" are at risk of accelerated rates of aging and disease owing to their "sustained experience with material, environmental, and psychosocial stressors."
Breaking the data down further, the researchers found that, "while less-educated blacks have the highest levels of years of life lost throughout the study period," less-educated white women "experienced the most consistent and alarming increases" in that morbid metric.
One possible reason for this is that, while smoking rates declined among less-educated white men, they stayed steady among less-educated white women.
"Even as we tackle the opioid epidemic," Geronimus and her colleagues conclude, "we should not lose sight of the widening educational mortality rate attributed to cardiovascular disease, cancers, and other internal causes." They note that "the process of persistent, high-effort coping can have adverse health repercussions."
So we are left with two narratives to consider as we debate ways to stem the untimely deaths of so many working-class Americans. One argues that less-educated Americans have higher death rates because of "hopelessness and maladaptive coping through alcohol or opioid abuse"; the other contends that these deaths are due to working-class Americans' "high-effort coping with adversity, reflecting the hopeful belief that their economic uncertainty can be overcome with effort and tenacity."