A Harvard sociologist, William Julius Wilson, countered that the true underlying problem was lost jobs, and he turned out to be right. When good jobs left white towns like Yamhill a couple of decades later because of globalization and automation, the same pathologies unfolded there. Men in particular felt the loss not only of income but also of dignity that accompanied a good job. Lonely and troubled, they self-medicated with alcohol or drugs, and they accumulated criminal records that left them less employable and less marriageable. Family structure collapsed.

It would be easy but too simplistic to blame just automation and lost jobs: The problems are also rooted in disastrous policy choices over 50 years. The United States wrested power from labor and gave it to business, and it suppressed wages and cut taxes rather than invest in human capital, as our peer countries did. As other countries embraced universal health care, we did not; several counties in the United States have life expectancies shorter than those in Cambodia or Bangladesh.

One consequence is that the bottom end of America’s labor force is not very productive, in ways that reduce our country’s competitiveness. A low-end worker may not have a high school diploma and is often barely literate or numerate while also struggling with a dependency; more than seven million Americans also have suspended driver’s licenses for failing to pay child support or court-related debt, meaning that they may not reliably show up at work.

Americans also bought into a misconceived “personal responsibility” narrative that blamed people for being poor. It’s true, of course, that personal responsibility matters: People we spoke to often acknowledged engaging in self-destructive behaviors. But when you can predict wretched outcomes based on the ZIP code where a child is born, the problem is not bad choices the infant is making. If we’re going to obsess about personal responsibility, let’s also have a conversation about social responsibility.

Why did deaths of despair claim Farlan, Zealan, Nathan, Rogena and so many others? We see three important factors.