Left Behind

Drawing by Anders Nilsen
Drawing by Anders Nilsen

The United States is in the throes of a colossal health crisis. In 2015 life expectancy began falling for the first time since the height of the AIDS crisis in 1993. The causes—mainly suicides, alcohol-related deaths, and drug overdoses—claim roughly 190,000 lives each year.

The casualties are concentrated in the rusted-out factory towns and depressed rural areas left behind by globalization, automation, and downsizing, but as the economists Anne Case and Angus Deaton demonstrate in their new book, Deaths of Despair and the Future of Capitalism, they are also rampant in large cities. Those most vulnerable are distinguished not by where they live but by their race and level of education. Virtually the entire increase in mortality has been among white adults without bachelor’s degrees—some 70 percent of all whites. Blacks, Hispanics, college-educated whites, and Europeans also succumb to suicide, drug overdoses, and alcohol-related deaths, but at much lower rates that have risen little, if at all, over time.1

The disparity is most stark in middle age. Since the early 1990s, the death rate for forty-five-to-fifty-four-year-old white Americans with a BA has fallen by 40 percent, but has risen by 25 percent for those without a BA. Although middle-aged blacks are still more likely to die than middle-aged whites, their mortality has also fallen by more than 30 percent since the early 1990s. Similar declines occurred among middle-aged French, Swedish, and British people over the same period.

Case and Deaton show how this crisis worsened over generations, beginning with the Baby Boomers. College-educated whites born before World War II were slightly more vulnerable to suicide, drug overdoses, and alcohol-related deaths than non-college-educated whites, but these trends reversed among those born after the war, and then the fates of those with and without a BA continued to diverge.

Growing economic insecurity is a major cause of the problem. White manual workers once expected that the American Dream would come true for them. In Kathryn Newman’s remarkably prescient study of downsizing, Falling from Grace (1988), older people recalled that Elizabeth, New Jersey—where 18 percent of residents now live in poverty—was once a “place of grandeur, where ladies and gentlemen in fine dress promenaded down the main avenue on Sunday.” The Singer Sewing Machine company employed over 10,000 workers, roughly a tenth of the city’s population. The company awarded scholarships to children, sponsored baseball games, and hosted dances and bar mitzvahs in its recreation hall. Each sewing machine had a label, and if returned with a defect, the man who’d made it would fix it himself.

The last American Singer plant closed decades ago, along with thousands of other factories. There were 19.5 million decently paying US manufacturing jobs in 1979, compared to around 12 million today, when the population is almost 50 percent larger. Over the same period, the wages of workers with…


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