Jeff Guo, Washington Post, April 6, 2017

Academic research rarely goes viral, but this past year, the work of Princeton professors Anne Case and Nobel laureate Angus Deaton became the center of a national fascination over the woes of white America. It’s also landed the two in the crossfire of a debate about race and the lack of attention given to problems faced by African Americans.

In 2015, Case and Deaton pointed out that mortality rates among middle-aged white Americans have been rising, while mortality rates for other Americans and citizens of Western Europe have continued to plummet. Two weeks ago, the researchers released a deeper report probing the underlying reasons. Opioid abuse and alcoholism and a spike in suicides have been the most visible causes, but Case and Deaton say these “deaths of despair” are symptoms of a much larger problem — one that’s rooted in the economy, and how forces like technological change have battered less-educated whites in recent decades.

But the economy has been brutal lately for all Americans without a college degree, and this new report kicked off another round of controversy over how the American mainstream often ignores black experiences. Critics have complained that Case and Deaton’s focus on white mortality risks drawing attention away from equally pressing problems, like the persistently higher rates of black mortality.

Many of these objections have to less to do with the actual science and more to do with the context in which it was published. President Trump won huge swaths of voters in 2016 by promising to address the grievances of the white working class, and white nationalists endorsed his campaign. Case and Deaton’s research on white mortality seemed to speak directly to that political narrative: Not only were white Americans suffering from their own problems, but they were also literally dying out faster in middle age.

Yet African Americans have long suffered higher mortality rates and lower levels of happiness. In light of the divisive racial rhetoric surrounding the Trump campaign, some worried that the interest in Case and Deaton’s research would only heighten the sense that African Americans were being erased from the national conversation.

On Monday, Case, Deaton and I had a telephone conversation about their latest work, which explores the connection between a bad economy, bad personal choices, and these rising rates of death in middle age.

{snip}

The following is an edited and condensed transcript of our chat.

Guo: I wanted to discuss this question about whether we are neglecting African Americans with all of our focus on white mortality.

Deaton: I talked to one journalist the other day, and she said, “Ever since your first paper, people have been really upset at you for ignoring black people.”

We weren’t trying to insult anyone. We found something that we thought people didn’t know about.

Our first paper, in the PNAS, was very much just the facts. People were upset at us for not putting black mortality on one of our charts, but the reason it’s not there — which we explain — is that black mortality is so high it doesn’t fit on the graph.

Guo: I think the controversy may have less to do with your papers, and more to do with how the media seized these facts and amplified them — in a way that I’ve not seen done with science research in a long time.

Case: It’s not as much news if people’s mortality rates are falling the way you would hope they are falling. What seems like news is when mortality has stopped falling, and no one has noticed that it has stopped.

White Americans had just flatlined where the European countries continued to make progress, and where other groups in this country — African Americans and Hispanics — continued to make progress. So what the heck is going on here? We weren’t making progress anymore. That, to us seemed like the bigger story.

Deaton: Anne presented the first paper once and was told, in no uncertain terms: How dare you work on whites.

Case: I was really beaten up.

Deaton: And these were really senior people.

Case: Very senior people.

Guo: That’s incredible to me because I think one reason these questions are important is that what we learn about rising mortality among this group of white people might also help us understand health problems that are affecting other groups.

Case: Absolutely. In this one group, we might be able to isolate why this is happening, and that’s probably going to be relevant for all of us.

The other part is that if some groups are more resilient in some ways, what can we learn from that? The press often gets it wrong and will say “blacks and Hispanics have higher mortality than whites” — which is not true. Hispanics have lower mortality. What makes Hispanics resilient and can we use what we learn from that group to help all groups?

Guo: Yes! The Hispanic mortality paradox. I don’t know if we’ve gotten to the bottom of that though.

Deaton: It’s only a paradox because people are thinking about it wrong! I don’t think income solely determines health. I think lots of other things determine health. There’s this narrative, that is entrenched in some of the professions, that there’s this mysterious thing called “socioeconomic status” that is immutably correlated with health. And it isn’t.

{snip}

Guo: In your paper I kind of see the mirror image of a debate that happened in a more antiquated time. Forty, 50 years ago, when posed with the question of “What’s wrong with African Americans,” most people weren’t blaming the lack of jobs. They weren’t blaming the economy. They were blaming a lack of values. What your research shows, at least the way I interpret it, is that the underlying economic forces — not just the forces that determine your income, but that determine your career and your life trajectory — are much more powerful than we thought.

Deaton: I think there was some argument about, when working class jobs went away in black communities, that it tended to precipitate these other dysfunctions of various sorts. But yeah, there is this parallel here.

There was this terrible drug epidemic among blacks 30 years ago, and people used to say, “well that was because black culture or black society is terribly deficient.” One way to look at these figures is to see that this has nothing to do with being black. It can happen to whites too.

Case: The data are all consistent with it starting with a bad labor market. In a previous generation, you had the chance of getting a good job with only a high school degree — a job where you could move up the ladder, where there would be what we call “returns to experience”: that as you grew older, your wages would rise.

A lot of those jobs are gone — jobs with health benefits, jobs with on-the-job training. And without that kind of a job, it’s much harder. Your marriage prospects are much poorer. So you might move in with a woman or with a man, but unlike in Europe, where cohabitation is quite stable, in the U.S. cohabitation is quite fragile.

So you not only don’t have a job that gives you structure, you also don’t have a relationship that gives you structure. And this is all happening in a point in time where religions that are being chosen also don’t give you much structure.

So all those things that would be helpful in building a stable life, a middle class life, those are all turning to dust.

We think that it’s consistent then, in response to that, people take to drink, or people think “I don’t want to be a burden on people” and they kill themselves, or start taking drugs.

{snip}