NOV. 9, 2015
Paul Krugman, nytimes.com
A couple of weeks ago President Obama mocked Republicans who are “down
on America,” and reinforced his message by doing a pretty good Grumpy Cat
impression. He had a point: With job growth at rates not seen since the 1990s,
with the percentage of Americans covered by health insurance hitting record
highs, the doom-and-gloom predictions of his political enemies look ever more
at odds with reality.
Yet there is a darkness spreading over part of our society. And we don’t
really understand why.
There has been a lot of comment, and rightly so, over a new paper by the
economists Angus Deaton (who just won a Nobel) and Anne Case, showing
that mortality among middle-aged white Americans has been rising since
1999. This deterioration took place while death rates were falling steadily both
in other countries and among other groups in our own nation.
Even more striking are the proximate causes of rising mortality. Basically,
white Americans are, in increasing numbers, killing themselves, directly or
indirectly. Suicide is way up, and so are deaths from drug poisoning and the
chronic liver disease that excessive drinking can cause. We’ve seen this kind of
thing in other times and places – for example, in the plunging life expectancy
that afflicted Russia after the fall of Communism. But it’s a shock to see it,
even in an attenuated form, in America.
Yet the Deaton Case findings fit into a well-established pattern. There
have been a number of studies showing that life expectancy for less-educated
whites is falling across much of the nation. Rising suicides and overuse of
opioids are known problems. And while popular culture may focus more on
meth than on prescription painkillers or good old alcohol, it’s not really news
that there’s a drug problem in the heartland.
But what’s causing this epidemic of self-destructive behavior?
If you believe the usual suspects on the right, it’s all the fault of liberals.
Generous social programs, they insist, have created a culture of dependency
and despair, while secular humanists have undermined traditional values. But
(surprise!) this view is very much at odds with the evidence.
For one thing, rising mortality is a uniquely American phenomenon – yet
America has both a much weaker welfare state and a much stronger role for
traditional religion and values than any other advanced country. Sweden gives
its poor far more aid than we do, and a majority of Swedish children are now
born out of wedlock, yet Sweden’s middle-aged mortality rate is only half of
You see a somewhat similar pattern across regions within the United
States. Life expectancy is high and rising in the Northeast and California,
where social benefits are highest and traditional values weakest. Meanwhile,
low and stagnant or declining life expectancy is concentrated in the Bible Belt.
What about a materialist explanation? Is rising mortality a consequence
of rising inequality and the hollowing out of the middle class?
Well, it’s not that simple. We are, after all, talking about the consequences
of behavior, and culture clearly matters a great deal. Most notably, Hispanic
Americans are considerably poorer than whites, but have much lower
mortality. It’s probably worth noting, in this context, that international
comparisons consistently find that Latin Americans have higher subjective
well-being than you would expect, given their incomes.
So what is going on? In a recent interview Mr. Deaton suggested that
middle-aged whites have “lost the narrative of their lives.” That is, their
economic setbacks have hit hard because they expected better. Or to put it a
bit differently, we’re looking at people who were raised to believe in the
American Dream, and are coping badly with its failure to come true.
That sounds like a plausible hypothesis to me, but the truth is that we
don’t really know why despair appears to be spreading across Middle America.
But it clearly is, with troubling consequences for our society as a whole.
In particular, I know I’m not the only observer who sees a link between
the despair reflected in those mortality numbers and the volatility of right-wing
politics. Some people who feel left behind by the American story turn
self-destructive; others turn on the elites they feel have betrayed them. No,
deporting immigrants and wearing baseball caps bearing slogans won’t solve
their problems, but neither will cutting taxes on capital gains. So you can
understand why some voters have rallied around politicians who at least seem
to feel their pain.
At this point you probably expect me to offer a solution. But while
universal health care, higher minimum wages, aid to education, and so on
would do a lot to help Americans in trouble, I’m not sure whether they’re
enough to cure existential despair.
A version of this oped appears in print on November 9, 2015, on page A23 of the New York edition
with the headline: Despair, American Style.