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American Capitalism is Causing Deaths of Despair

Feb 25 2020
Nicole Feldman

It’s not often that a graph stuns 200 people speechless, but the numbers in Anne Case’s slideshow are staggering. Across age groups, in cities and rural areas, line after line shoots steeply upward making Case’s point impossible to ignore.

Life expectancy has fallen for Americans, particularly for white people without bachelor’s degrees.

Since the 2016 election, the plight of the white working class has crept into headlines across the U.S. and continues to pepper the news cycle. There’s a good reason for this, according to Princeton economist couple Anne Case and Angus Deaton, who found that white Americans without undergraduate degrees are dying. The cause? Despair.

At the 2019 Tanner Lectures on Human Values at Stanford, the university’s president, Marc Tessier-Lavigne, called their findings “shocking, surprising, and transformative.” Co-sponsored by Tessier-Lavigne’s office and the McCoy Family Center for Ethics in Society, the annual lectures aim to promote a better understanding of human behavior and human values.

Over three days, Case and Deaton presented and discussed the findings from their upcoming book, Deaths of Despair and the Future of Capitalism.

Drugs, alcohol and suicide

For two-thirds of people ages 25 to 64 without a college degree, “American capitalism and democracy are not working,” said Case, the Alexander Stewart 1886 Professor of Economics and Public Affairs, Emeritus.

Case and Deaton argue that American capitalism has become “grossly unfair,” causing an increasing number of working-class whites to reach levels of despair that end in their demise.

For the first time since the 1918 Spanish flu epidemic, life expectancy fell for Americans in 2014/2015 — and then again in 2015/2016 and 2016/2017.

Case and Deaton found that the most common causes of death were drug overdoses, alcoholic liver disease, and suicide, and the victims were overwhelmingly white Americans without bachelor’s degrees.

“We think of all of these as being a form of suicide,” said Case. “People are either killing themselves quickly with a gun or a rope, or people are killing themselves more slowly with drugs or with alcohol.”

Deaths of despair have been slowly and steadily creeping upward since about 1990. Opioids wielded the scythe for the largest number, but Deaton cautions that the drugs themselves are only a part of the problem.

“Underneath those counts, there’s a sea of pain and poor mental health,” said Case.

Whites without bachelor’s degrees also suffer from chronic pain, difficulty socializing and relaxing, mental distress, high BMIs and low wages. Many are not married and do not practice a religion. In 2016, they were less likely to vote because they believed elections were controlled by the rich and big corporations.

Case felt that a plea from a patient of Anna Lembke, an associate professor of psychiatry and behavioral sciences at Stanford who responded to Case and Deaton’s presentations, perfectly captured the victims’ feelings of despair: “I can’t stop drinking, I’m surrounded by bottles, and I don’t want to die.”

The health-care lobby

The duo makes the case that the unfairness of American capitalism caused those feelings of despair, largely evolving from an uptick in lobbying in the 1970s.

“One of the things we’re really concerned about is redistribution,” said Deaton, a Nobel laureate and the Dwight D. Eisenhower Professor of Economics and International Affairs, Emeritus, “a system that is actually fleecing people at the bottom in order to enrich people at the top.”

One industry’s lobby dwarfs the rest. Deaton drew a straight line between deaths of despair and the high cost and unfairness of American health care.

Though U.S. health-care costs are the highest in the world, the industry delivers the worst results, according to Deaton, who Queen Elizabeth II knighted in 2016, the year after he won the Nobel Prize in economics.

“The health-care system is really the perfect example of how rent seeking generates inequality, enriching the few at the expense of many,” he said.

The health-care lobby has made the U.S. government complicit in keeping prices high, lining industry pockets as Americans literally pay the price. At the same time, Deaton says the increase of health-care costs is one of the factors holding wages down, further increasing the actual cost to Americans.

“If this were really a free market — which it’s not — this really wouldn’t be happening,” said Deaton.

Who’s next?

Though deaths of despair are most affecting whites without bachelor’s degrees, the results of unfairness are likely to spread.

“I don’t think we think of this as just a white problem,” said Case. “I think what we’d like to do in the book is say this is one piece of a bigger problem that’s really about class rather than being about race.”

Case and Deaton found that what is happening to the white working class now is similar to what happened to the black working class in the 1970s.

“What we think is the ‘black culture’ and the ‘white working-class culture’ are both signs that if you treat people badly enough for long enough, bad things happen to them,” said Case.

The rise of populism and the anti-establishment sentiment that permeates political discussions suggest that many Americans feel the effects of unfairness. A number of studies have demonstrated the unequal distribution of wealth in America, with the top 1 percent controlling 40 percent. Working-class whites may just be the harbingers of this distribution’s more severe effects.

And the problem isn’t limited to the United States. Thus far, Western Europe’s social safety net has prevented the 50 years of falling and stagnant wages that Americans have experienced — but Deaton warns that European countries shouldn’t get too comfortable. Their working class is headed in the same direction.

“I think the Europeans should be very scared,” said Deaton.

But despair hasn’t triumphed yet. Case and Deaton believe that a distribution of wealth that is fairer to the working classes could improve outcomes, though it would likely require a change in American lobbying practices and a wider social safety net.

“We believe in a capitalist system,” said Case, “but we believe that it needs to be repaired.”


Nicole Feldman is a freelance writer who has contributed to Stanford News, Scope, and other publications across campus. 

"The Buzz" is the McCoy Family Center for Ethics in Society's media portal for ethics-related news on campus and beyond. We review events and speakers, and we feature initiatives that are of broad interest. A wide range of voices author the articles, including undergraduate students.