美国国家公共电台 NPR The Forces Driving Middle-Aged White People's 'Deaths Of Despair'

DAVID GREENE, HOST:

For years, it was almost a given - the annual mortality rate in the United States would generally decline. So it was a pretty big shock when a report came out more than a year ago showing death rates were actually going up for middle-aged 1, white Americans. At the time, the numbers did not explain why, but the authors now believe they better understand these deaths. They are calling them deaths of despair. The authors, Ann Case and Angus Deaton, are economists 2 at Princeton University.

Welcome to you both.

ANGUS DEATON: Thank you.

ANN CASE: Hi, it's good to be with you.

GREENE: Professor Deaton, let me start with you. If you could just take us back to when you originally discovered this trend that middle-aged, whites in the United States, the death rate was increasing. Why did this surprise you? Why was it so significant?

DEATON: Mortality rates have been going down over a hundred years or more. And then for all of this to suddenly go into reverse, we thought it just must be wrong. And in fact, we spent weeks checking our numbers because we just couldn't believe, A, that this had happened or, B, that (laughter) if it had happened, someone else must already had noticed.

GREENE: Well, Professor Case, let me bring you in here. In what way have you solved the mystery now? What might be causing this?

CASE: Well, what we've been able to document is that what we see with these deaths of despair has been accompanied by reduced labor 3 force participation 4, reduced marriage rates, increases in reports of poor health, of poor mental health. So we are beginning to thread a story in which it's possible it's consistent with the labor market collapsing 5 for people with less than a college degree, and then in turn, that having effects on the kind of economic and social supports that we usually think people need in order to thrive.

GREENE: I guess we should stress that, you know, we are just talking about people who are white who are seen as doing better economically than minorities in this country. So what is the comparison when we look at the death rates, you know, that you're seeing among white Americans versus 6 African-Americans?

DEATON: Well, it's always been true that mortality rates have been higher and life expectancy 7 shorter for African-Americans than for whites. What is happening now is that that gap is closing. If you compare whites without a B.A., their mortality rates are now higher than mortality rates for African-Americans as a whole. It's as if poorly educated whites have now taken over from blacks as the lowest rung in society in terms of mortality rate.

GREENE: And does it matter where you live? I mean, I was sort of astonished that some of the worst death rates you're seeing might be, say, in the city of Baltimore or might be in a rural community in West Virginia.

CASE: Yeah. We were surprised by that as well. There's a stereotype 8 when people think about drug overdose or they think about these deaths of despair, their minds might turn to Appalachia. And it certainly is a problem in West Virginia, in Kentucky, in Tennessee, but it's also a problem in Baltimore City, for example. There's not a part of the country that has not been touched by this.

GREENE: Well, take this all together and tell me what story this tells about our country at this moment.

DEATON: Well, we're thinking of this in terms of something that's really been going on for a long time. And we think of this as part of the decline of the white working class. You know, if you go back to the early '70s when you had the so-called blue-collar aristocrats 9, those jobs have slowly crumbled 10 away. And many, many more men are finding themselves in a much more hostile labor market with lower wages and lower quality jobs. You know, there's a sense in which these people have lost the sense of status, the sense of belonging. And, you know, these are classic preconditions for suicide.

GREENE: And we should say, this is - if you compare the United States to other comparable countries, wealthy countries, I mean, this is not being seen in other parts of the world.

DEATON: That's right. You see tiny traces of it. Canada thinks they have an opioid problem, for instance. We saw some of it in Scotland at some point when we looked. But there - when you put it on the same picture as the U.S., the U.S. just dwarfs 11 it. It may be to do - Europe has a much more advanced social safety net than we have in the U.S., which of course we're in the process of taking apart, making an even further gap from what happens in Europe.

GREENE: Angus Deaton and Ann Case, thank you to you both.

DEATON: OK. Thank you.

CASE: Good to be with you.

GREENE: They are Princeton University economists, and their study on mortality rates of white, middle-age Americans was released today.