When the economists Anne Case and Angus Deaton first published their research on “deaths of despair” five years ago, they focused on middle-aged whites. So many white working-class Americans in their 40s and 50s were dying of suicide, alcoholism and drug abuse that the overall mortality rate for the age group was no longer falling – a rare and shocking pattern in a modern society.

But as Case and Deaton continued digging into the data, it became clear that the grim trends didn’t apply only to middle-aged whites. Up and down the age spectrum, deaths of despair have been surging for people without a four-year college degree:

Deaths from alcohol, drugs and suicide 5 per 100K 147 per 100K





In the early 1990s, the number of white adults without a college education who were dying from a drug overdose, alcoholism or suicide was fairly low — and the death rates for younger adults were lower than for older adults. But over the past three decades, deaths of despair among whites without a college degree — especially those under age 50 — have soared. The death rate for whites with a college degree, by contrast, has risen only modestly across all age groups and remains lower for the young than the old.

Case and Deaton — a married couple who are both economists at Princeton — try to explain the causes in a new book, “Deaths of Despair and the Future of Capitalism.” Their basic answer is that working-class life in the United States is more difficult than it is in any other high-income country. “European countries have faced the same kind of technological change we have, and they’re not seeing the people killing themselves with guns or drugs or alcohol,” Case says. “There is something unique about the way the U.S. is handling this.”

More people are dying Number of “deaths of despair” per 100,000 non-Hispanic whites aged 45-54 Non- college 100 50 College grads 0 1992 1996 2000 2004 2008 2012 2016 Non- college 100 50 College grads 0 1992 ‘96 ‘00 ‘04 ‘08 ‘12 ‘16

Inequality has risen more in the United States — and middle-class incomes have stagnated more severely — than in France, Germany, Japan or elsewhere. Large corporations have increased their market share, and labor unions have shriveled, leaving workers with little bargaining power. Outsourcing has become the norm, which means that executives often see low-wage workers not as colleagues but as expenses.

And the United States suffers from by far the world’s most expensive health-care system. It acts as a tax on workers and drains resources that could otherwise be spent on schools, day care, roads, public transit and more. Despite its unparalleled spending, the American medical system also fails to keep many people healthy.

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The two economists initially focused on non-Hispanic whites because the mortality trends were worst for them. Deaths rates from suicide, alcoholism and drug abuse among whites surpassed the rates for blacks shortly after 2000, for example. But the black working class is hardly thriving -- and deaths of despair have surged among them in the last few years. Overall life expectancy remains significantly higher for whites than blacks. So, of course, do incomes and wealth.

Many of the problems afflicting the working class span racial groups, and Case and Deaton emphasize that these problems aren’t merely financial. Life for many middle- and low-income Americans can lack structure, status and meaning. People don’t always know what days or hours they will be working the following week. They often don’t officially work for the company where they spend their days, which robs them of the pride that comes from being part of a shared enterprise.

“Many people used to associate the meaning of their life with what their corporation or institution was doing,” says Deaton, a Nobel laureate in economics. Miners and factory workers identified themselves as such. Warehouse workers, especially those whose paycheck is signed by a staffing company, rarely feel the same connection.

The result of these trends has been a “coming apart,” as Case and Deaton put it, of day-to-day life for whites without a college degree versus those with a college degree:

Marriage rates have diverged Share of non-Hispanic whites aged 45-54 currently married 80% College grads 70 Non- college 60 50 1980 1985 1990 1995 2000 2005 2010 2015 80% College grads 70 Non- college 60 50 1980 ‘90 ‘00 ‘10

People without college degrees are also less likely to attend church Share of non-Hispanic whites aged 45-54 attending church weekly 30% College grads 25 Non- college 20 15 1975 1980 1985 1990 1995 2000 2005 2010 2015 30% College grads 25 Non- college 20 15 1975 ‘85 ‘95 ‘05 ‘15

Surveys show that a growing number of working-class Americans find it difficult to do basic things, like climb a flight of stairs or socialize, partly because of chronic problems with their mental or physical health:

Chronic pain is more widespread Share of non-Hispanic whites aged 45-54 experiencing neck, back or joint pain 60% Non- college 50 College grads 40 30 20 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 60% Non- college 50 College grads 40 30 20 1998 2002 2006 2010 2014

Many people are also drinking more Average number of drinks (on days when drinking) among non-Hispanic whites aged 45-54 Non- college 2.5 2.0 College grads 1.5 1.0 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 Non- college 2.5 2.0 College grads 1.5 1.0 1994 ‘98 ‘02 ‘06 ‘10 ‘14

And they are unhappier Share of non-Hispanic whites aged 45-54 who say they are “not too happy these days” Non- college 15% 10 College grads 5 0 1975 1980 1985 1990 1995 2000 2005 2010 2015 Non- college 15% 10 College grads 5 0 1975 ‘85 ‘95 ‘05 ‘15

Given all of these alarming social indicators, it’s not surprising that some other causes of death — in addition to suicide, alcoholism and drug overdose — have also started rising for Americans without a college degree. Heart disease is the most significant, exacerbated by obesity, drinking and drug use.

The combined result is a divergence in the life expectancy of white college graduates and non-graduates. Overall mortality for whites between the ages of 45 and 54 has held roughly steady in the last 25 years. But that average hides a big increase in death rates for non-graduates and a big decline for graduates.

What can be done about all of this? Many of the solutions are obvious, if difficult to accomplish. The medical system should be overhauled to put a higher priority on health than on wealth for people who work in the industry, Case and Deaton argue. (And that doesn’t necessarily mean a mandatory version of Medicare, they add.)

The federal government should do a better job of keeping big business from maximizing profits at the expense of their workers, by enforcing antitrust laws and encouraging new kinds of labor unions. Governments at all levels should help more people earn college degrees, both four-year degrees (like B.A.’s) and meaningful vocational degrees.

Other economic research has found that a college degree isn’t simply a marker. Students who attend and graduate from college do better in life than otherwise similar students who didn’t get the same opportunities. Graduates are more likely to be employed, earn more, marry and stay married, be satisfied with their lives, be healthy and live longer. These findings suggest that college itself — both the classroom learning and the experience of successfully navigating college — brings long-term benefits.

The focus of Case and Deaton’s book isn’t education, but it lingers as the backdrop to all of their findings. “This B.A./non-B.A. divide,” Deaton says, “just comes up again and again and again.”