This is a problem that’s a serious tragedy on more important levels than politics, but it may explain why people like me cannot understand why Donald Trump is so popular: middle-aged white men without college educations are dying in record numbers, and they’re killing themselves. From the NYT:
Something startling is happening to middle-aged white Americans. Unlike every other age group, unlike every other racial and ethnic group, unlike their counterparts in other rich countries, death rates in this group have been rising, not falling.
That finding was reported Monday by two Princeton economists, Angus Deaton, who last month won the 2015 Nobel Memorial Prize in Economic Science, and Anne Case. Analyzing health and mortality data from the Centers for Disease Control and Prevention and from other sources, they concluded that rising annual death rates among this group are being driven not by the big killers like heart disease and diabetes but by an epidemic of suicides and afflictions stemming from substance abuse: alcoholic liver disease and overdoses of heroin and prescription opioids.
The analysis by Dr. Deaton and Dr. Case may offer the most rigorous evidence to date of both the causes and implications of a development that has been puzzling demographers in recent years: the declining health and fortunes of poorly educated American whites. In middle age, they are dying at such a high rate that they are increasing the death rate for the entire group of middle-aged white Americans, Dr. Deaton and Dr. Case found.
The mortality rate for whites 45 to 54 years old with no more than a high school education increased by 134 deaths per 100,000 people from 1999 to 2014.
“It is difficult to find modern settings with survival losses of this magnitude,” wrote two Dartmouth economists, Ellen Meara and Jonathan S. Skinner, in a commentary to the Deaton-Case analysis to be published in Proceedings of the National Academy of Sciences.
“Wow,” said Samuel Preston, a professor of sociology at the University of Pennsylvania and an expert on mortality trends and the health of populations, who was not involved in the research. “This is a vivid indication that something is awry in these American households.”
They don’t really know why this is happening. This, below, is an important part of this story too. From the WaPo:
Deaton and Anne Case, both Princeton economists, received international media attention for the paper published Monday in the Proceedings of the National Academy of Sciences (PNAS). But before they submitted it there, they tried to get it published in the Journal of the American Medical Association (JAMA), Deaton said.
“We got it back almost instantaneously. It was almost like the e-mail had bounced. We got it back within hours,” said Deaton, who was interviewed in Dublin, where he was attending a conference on the Ebola crisis and global public health sponsored by Princeton University.
Deaton and Case then tried the New England Journal of Medicine, putting their work in the form of a two-page “Perspective” that summarized the alarming trend they’d discovered in government mortality statistics. Again they were rejected.
Why do you suppose that is? Is it that elites don’t want to hear about the suffering unto death of middle-aged white men with high school educations or worse?
A lot of people in this dismal demographic are backing Donald Trump, says this Real Clear Politics analysis of his supporters:
In terms of demographics, Trump’s supporters are a bit older, less educated and earn less than the average Republican. Slightly over half are women. About half are between 45 and 64 years of age, with another 34 percent over 65 years old and less than 2 percent younger than 30. One half of his voters have a high school education or less, compared to 19 percent with a college or post-graduate degree. Slightly over a third of his supporters earn less than $50,000 per year, while 11 percent earn over $100,000 per year. Definitely not country club Republicans, but not terribly unusual either.
… [H]is support comes from across the full range of Republican identifiers but is slightly higher among those who are less well educated, earn less than $50,000 annually and are slightly older.
The death story doesn’t explain Trump, to be clear, but it gives a pretty good idea where a lot of Trump’s support comes from.
Perhaps painkiller overdoses, mental health declines, reported pain, disability, dropping out of the labor force, lower wages, and The Big Unmentionable (immigration) all tie together. As Hispanics flooded in, lowering wages, blue collar whites felt less motivated to stay in the labor force as they aged and their bodies got creakier. Getting on disability requires, I imagine, an ability to get doctors and other authority figures to believe your account of musculoskeletal and/or mental health disabilities. The most effective way to get other people to believe you are disabled by physical and mental pain is to believe it yourself. And if you tell the doctor your back is killing you so much you can’t work and you persuade him, he’ll likely write you a prescription for some pills.
Note this passage from the Deaton/Case paper; emphases mine:
The three numbered rows of Table 1 show that the turnaround in mortality for white non-Hispanics was driven primarily by increasing death rates for those with a high school degree or less. All-cause mortality for this group increased by 134 per 100,000 between 1999 and 2013. Those with college education less than a BA saw little change in all-cause mortality over this period; those with a BA or more education saw death rates fall by 57 per 100,000. Although all three educational groups saw increases in mortality from suicide and poisonings, and an overall increase in external cause mortality, increases were largest for those with the least education.
And note this too, while asking yourself what Republicans have done for these people lately:
Although the epidemic of pain, suicide, and drug overdoses preceded the financial crisis, ties to economic insecurity are possible. After the productivity slowdown in the early 1970s, and with widening income inequality, many of the baby-boom generation are the first to find, in midlife, that they will not be better off than were their parents. Growth in real median earnings has been slow for this group, especially those with only a high school education. However, the productivity slowdown is common to many rich countries, some of which have seen even slower growth in median earnings than the United States, yet none have had the same mortality experience (lanekenworthy.net/shared-prosperity and ref. 30). The United States has moved primarily to defined-contribution pension plans with associated stock market risk, whereas, in Europe, defined-benefit pensions are still the norm. Future financial insecurity may weigh more heavily on US workers, if they perceive stock market risk harder to manage than earnings risk, or if they have contributed inadequately to defined-contribution plans (31).
Remember a decade ago, how George W. Bush used his re-election mandate to try to privatize Social Security? Those were the days.
It’s important to note again that Deaton and Case say that nobody knows what is causing this. They offer possible economic causes. R.R. Reno at First Things offers some possible cultural causes:
The male-female difference is a fundamental, orienting reality in every culture. Having a sense of oneself as a man or woman gives us a place to stand in the world. The transgender revolution represents that latest, most dramatic stage in today’s efforts to efface the social authority of the male-female difference. Well-educated adepts know how to use today’s multicultural patois to navigate in our brave new world of officially mandated gender blindness. They can affirm the progressive orthodoxies in words, while conveying to their children in their deeds a plastic but nevertheless gender-differentiated approach to life. Meanwhile, kids and young adults from poorly educated households are deprived of a functional language to talk about what it means to be a man or woman. Without such a language, they can’t see themselves as successfully being men or women. And so they are deprived of a baseline adult achievement that come-of-age rituals in traditional cultures have always celebrated.
To a great extent, our progressive culture strips ordinary people of almost all settled roles, other than economic ones. This heightens the existential pain of the already harsh economic realities of our globalized economy, which can be very punitive to the poorly educated. Two generations ago, a working class man was often poor or nearly poor, but he could be respected in his neighborhood as a provider for his family, father to his children, law-abiding citizen, coach of a Little League team, and usher in church. The culture that made such a life possible has disintegrated, partly due to large-scale trends in our post-industrial society, but also because of a sustained and ongoing ideological assault on the basic norms for family and community. Death rates are likely to continue to rise for poor Americans. I see no signs that the war on the weak will abate.
I can hear it now: “That right-wing religious hater is blaming transgenders for working-class white people drinking and doping themselves to death!” If you think that, you run the risk of dismissing a more profound critique of the way both free-market capitalism and the permissive morality of post-Sixties America have conspired to wreak havoc on those least able to bear the burdens they impose.
But even that is only a partial explanation (though one that I, obviously, find plausible). Why is this not happening to Hispanics and African-Americans, neither of whom are getting rich, and both groups of which are also suffering from the problems of fatherless children and family disintegration? Here there might be a religious explanation, or at least a spiritual one: white people do not know how to suffer successfully.
Hear me out. Here is a link to a paper by sociologist Brad Wilcox and several colleagues that gives insight to this problem. From the abstract:
We find that religious attendance among moderately educated whites has declined relative to attendance among college-educated whites. Economic characteristics, current and past family characteristics, and attitudes toward premarital sex each explain part of this differential decline.
Religion is becoming increasingly deinstitutionalized among whites with moderate levels of education, which suggests further social marginalization of this group. Furthermore, trends in the labor force, American family life, and attitudes appear to have salient ramifications for organized religion. Sociologists of religion need to once again attend to social stratification in religious life.
The authors say “the evidence we present here suggests that the middle is dropping out of the American religious sector, much as it has dropped out of the American labor market.”
Going deeper into the paper, Wilcox et al. show that:
We then turn to a consideration of the economic, demographic, and cultural correlates of the religious disengagement of moderately educated whites. We do so from a broadly institutional perspective, recognizing both that religion is not only a social institution that supplies norms, beliefs, and rituals that pattern social behavior, or moral logics, but also an institution that depends on social and cultural structures from other institutions to sustain these moral logics (Friedland & Alford, 1991). In particular, we explore the possibility that working class disengagement from the institutions of work and marriage (Cherlin, 2009;Wilcox, 2010) are strongly associated with recent declines in religious attendance among white working class Americans. We view these two institutions as particularly important objects of inquiry because American religion has both legitimated and been bolstered by an “American Way of life” marked by stable employment and marriage over much of the last century (Edgell, 2006; Herberg, 1955). Thus, if moderately educated whites are now less likely to be stably employed, to earn a decent income, to be married with children, and to hold familistic views, they may also be less likely to feel comfortable or interested in regularly attending churches that continue to uphold conventional norms, either implicitly or explicitly (Edgell, 2006; Wilcox, 2004). We also view the institutions of work and marriage as important sources of social and normative integration that link Americans to religious institutions (Schwadel, McCarthy, & Nelsen, 2009). For these reasons, this paper relies on the GSS and NSFG to explore the links between declines in working class religiosity and patterns of employment, income, family structure, sexual behavior, and attitudes toward premarital sex.
The religious disengagement of working class whites is important for at least three reasons. First, religious institutions typically supply their members with social and civic skills, and often a worldview that motivates them to engage the political or civic spheres, that increase their civic and political participation (Putnam, 2000; Verba et al., 1995; Wuthnow, 1995). Second, religious institutions appear to foster higher levels of physical and psychological health among their members, both by providing social support and by furnishing people with a sense of meaning (Ellison, 1991; Ellison & Levin, 1998). Third, and most important for our perspective, some research suggests that least- and moderately-educated Americans are especially likely to benefit from the social support and civic skills associated with religious institutions. The non-college-educated often lack the degree of access to social networks and civic skills that the college-educated have; and religious activity can compensate for this deficit.
There follows a brief but fascinating discussion about the cultural attitudes of working-class whites toward work, self-esteem, marriage, and church life. It’s too long to quote it all here, but the bottom line is that the changes in the American economy over the past few decades have worked to alienate working-class whites from religious life because of the way the white working class connects its sense of self, and of justice, to the ability to be rewarded for hard work, being honest, playing by the rules, and delaying gratification. When this formula fails, they don’t know how to deal with it. Say the sociologists, “In brief, the declining economic position of white working class Americans may have made the bourgeois moral logic embodied in many churches both less attractive and attainable.”
What’s more, say the sociologists, white churches are strongly oriented towards the traditional family, and traditional Christian prohibitions on premarital sex. When working-class families fall apart because of divorce and/or having babies outside of wedlock, those whites feel less comfortable going to church.
Why don’t sociologists observe the same phenomenon in black and Hispanic working-class people? Because black and Hispanic Christians don’t have the same kind of religious sensibility:
Black churches, however, emphasize marriage less than white churches, relative to qualities such as shared struggle and perseverance (Cherlin, 2009; Ellison & Sherkat, 1995; Lincoln & Mamiya, 1990). For instance, when it comes to family life, they speak of parent and child, of broader networks of kin, and of the fictive kinship to be found among one’s brothers and sisters in church. It is possible, then, that African Americans could achieve the caring sense of self, even in an unfavorable economy and without benefit of marriage, and find support at church. This suggests that declines in church attendance among the moderately educated should be less for blacks than for whites.
Assessing trends over the past few decades in attendance among Hispanics is difficult because of changes in the composition of the Hispanic population. Given that issues related to immigration, discrimination, and incorporation into American society loom large for churches serving Hispanics (Figueroa Deck, 1989), we suspect that Hispanic churches are less focused on family structure and employment, and more focused on providing a sense of solidarity and practical support to their members, than are non-Hispanic white churches. Moreover, there is less class heterogeneity among Hispanics, who tend not to be college-educated or affluent; this probably affords working class Hispanics a sense of comfort in the churches they attend (Schwadel, McCarthy, & Nelsen, 2009). Thus, we would expect that employment difficulties and lower incomes would be less likely to influence the church attendance of Hispanics than non-Hispanic whites.
So, if Wilcox et al. are right, the black and Hispanic working classes are better able to weather economic adversity and family setbacks because they are more closely tied in to their churches. Their faith gives them resilience that whites more or less do not have, because of the way we whites believe. I believe that as holding to traditional Christianity begins to cost the white middle class something serious, we are going to see a mass apostasy. We whites had better get busy learning from the black and Hispanic church if we are going to make it.
Now, there is one more aspect to white working-class despair: dispossession. It does not take a sociologist to grasp that the tectonic social changes in American life since the 1960s have been at the very least disorienting to whites. The point to grasp here is not that we shouldn’t have had those changes; many of them were just and necessary, others, not so much. The point to grasp is that the experience of those changes may have been psychologically traumatic to certain whites who expected the world to work in a different way — a way that favored them.
Perhaps there is a comparison to be made with Russians after the collapse of the Soviet Union — which was, of course, a vastly more severe phenomenon, but I think there may be some comparison to be made, re: a people who assumed that the world was a certain way, and woke up rudely to the fact that it was not. Add to that the fact that among elites in our culture — especially academic and media elites — white working-class people are the bungholes of the universe, and, well, here we are.