Despair

July 23, 2021

Several days ago, my NY Times feed reported covid-19 has caused the largest decline in US life expectancy since World War II.  However, the virus is not the only reason life expectancy fell to its lowest level in almost two decades.  The US was already struggling with rising mortality resulting from what is called “deaths of despair” (from drugs, alcohol, and suicide).  This despair results in other health problems like diabetes and strokes as well, and it is especially hitting the working class.  During the second half of the 2010’s, life expectancy fell on a sustained basis for the first time since World War II (1941 to 1945).  From 2019 to 2020, Hispanics experienced the greatest drop in life expectancy (3 years), while Blacks decreased 2.9 years, and White Americans 1.2 years.

The recent increases in mortality are concentrated among working-class Americans, especially those without a four-year college degree.  Princeton University economists Anne Case and Angus Deaton blamed the deaths on the sense of despair felt by the working class.  For many, daily life lacks the structure, status, and meaning that it once had.   People feel less connected to an employer, a labor union, a church, or to community groups.  They are less likely to be married.  They are more likely to endure chronic pain and to report being unhappy.  The class gap in life expectancy seems starker in the US than in most wealthy countries.  We are indeed caught in the grip of despair.

Case and Deaton also noted that covid has killed more men than women.  This has increased the mortality gap between the sexes that had been shrinking.  Life expectancy was 5.7 years longer for women last year, up from 5.1 years in 2019, while the gap had fallen to a low of 4.8 years in the early 2010’s.  There are many reasons for the working class being affected greater by covid.  At first, the working class were more likely to contract severe versions of covid, in part because they were not able to work from home.  The working class also tended to receive lower-quality medical care after getting sick.  Now that vaccines are readily available, vaccine skepticism is the dominant explanation for getting sick.  Overall life expectancy was at 78.7 years in 2015.  By 2020 it had fallen 1.4 years to 77.3 years.

Thoughts:  The sense of despair felt by the working class has been aggravated by covid and the health inequalities that pervade the US.  This has created a one-two punch that brought life expectancy down by 1 ½ to three years over the last half decade.  This in turn leads to more despair.  The US has a systemic problem that devalues workers, provides abundant access to drugs that contribute to more depression, and then gives messages saying it is your fault.  We have created a vicious cycle of spiraling depression.  We need to send a message that all work is valuable, find ways to provide adequate compensation, and support efforts to improve mental health services.  Do the work.  Follow the science.  Change is coming and it starts with you.