March 17, 2021
Deaths of Despair and The Future of Capitalism
Sir Angus Deaton
Senior Scholar, Princeton School of Public and International Affairs, Princeton University
and
Anne Case
Professor of Economics and Public Affairs, Emeritus, Princeton University
Micky Weyeneth, Introducer; Anne Case and Sir Angus Deaton
Minutes of the 24th Meeting of the 79th Year
President Stephen Schreiber called the meeting to order at 10:17 AM. Kathryn Trenner read the minutes of the March 10th meeting. Two candidates for membership were introduced: Doreen Maloof was proposed by Jeffrey Tener and Cynthia Maltenfort was proposed by Jock McFarlane. Miles Gordon was introduced as the guest of Ugy (Irving) Horowitz. A moment of silence recognized the death of member Roland Foster Miller. There were 173 participants of this Zoom meeting.
Micky Weyeneth introduced the speakers, Ann Case, Professor of Economics and Public Affairs Emeritus, Princeton University, and Sir Angus Deaton, Senior Scholar, Princeton School of Public and International Affairs. The topic was “Deaths of Despair and the Future of Capitalism,” going somewhat beyond their book entitled Deaths of Despair, published in March 2020. Sir Angus Deaton was awarded the Nobel Prize in Economics in 2015 for his work on consumption, welfare promotion, and poverty reduction and he was knighted in 2016. The speakers divided the duties with Professor Case giving the talk and Sir Angus Deaton taking the lead on many of the questions.
Professor Case reported that they had been doing research regarding pain and life expectancy. They discovered that the death rates of white people ages 45 to 54 in the United States and in Europe had generally declined by about 2% per year from 1900 to 2000. While that trend continued in Europe, in the United States, unexpectedly, the death rates began to rise in the mid to late 1990s even though it continued to decline for Hispanics and, at an even faster rate, for African Americans. The decline was significant enough to cause the overall life expectancy to decline three years in a row, something that had not happened since World War I and the 1918 flu epidemic. This decline occurred among prime-age adults, 25 to 64, even as life expectancy continued to increase for children and older adults.
The decline in life expectancy was caused by what was called “deaths of despair,” a term coined by Professor Case as a way to include deaths attributable to drug overdoses, alcoholic liver disease, and suicide. The data show that the number of such deaths increased from 65,000 in 1995 to 164,000 in 2019 among non-Hispanic whites.
Because of a new requirement in 1989 that death certificates include education levels, the researchers were able to discern a sharp divide in deaths of despair between those with a bachelor’s degree and those without a bachelor’s degree, beginning in about 1992. This was happening in all parts of the country – urban, rural, rust belt, every state – and among both men and women, although in absolute numbers men were dying at about twice the rate as women from deaths of despair. These deaths did not rise during the Great Recession. Some of the increase, they believe, was caused by a reported increase in pain, social isolation, and poorer mental health. Professors Case and Deaton believe that additional factors are responsible including a decline in long-term labor market opportunities for those without a bachelor’s degree, a dramatic drop in median real wages, a declining employment/population ratio, and jobs being outsourced and good jobs being lost. Replacement jobs were worse, with less commitment and less feeling of belonging. Marriage rates were declining, and there was a loss of status at work, less attachment to churches, and loss of community.
Other factors are globalization and automation but those occurred in Europe as well as in the United States, so those factors do not account for the increase in deaths of despair in the United States. What was different in the United States was opioids.
Opioids account for part of the increase, although deaths of despair were rising before OxyContin became widely available. Professor Case described opioids as essentially heroin in a pill with an FDA label. Perdue Pharmaceutical targeted despair in its marketing. The payment of fines will not be enough to stop this from happening again. People will have to go to jail. Europe, in contrast, does not permit opioids to leave hospitals or the offices of dentists the way we do in the United States.
Broadening the discussion, they believe in capitalism but that it can be fixed and made fairer. Healthcare has much for which to answer in the United States and needs to be reformed. We have the most expensive system but, on many measures, the worst outcomes of the countries in the developed world. There are five healthcare lobbyists for every member of Congress so change will be difficult.
A concluding observation, recently published, is that life expectancy has been converging between whites and Blacks with bachelor’s degrees as it also has been – at much lower levels – between whites and Blacks without bachelor’s degrees, indicating that education and class may be becoming more important than race in accounting for deaths.
Sir Angus Deaton said that he has testified before Congress on these matters and that there is increasing interest in and understanding of this issue in the new administration, He is far from certain that action will be taken. He noted that, ironically, because of pharma’s heroic role in developing a COVID-19 vaccine so quickly, pharma – which is part of the problem – now is seen as our savior.
Respectfully submitted,
Jeffrey Tener
Micky Weyeneth introduced the speakers, Ann Case, Professor of Economics and Public Affairs Emeritus, Princeton University, and Sir Angus Deaton, Senior Scholar, Princeton School of Public and International Affairs. The topic was “Deaths of Despair and the Future of Capitalism,” going somewhat beyond their book entitled Deaths of Despair, published in March 2020. Sir Angus Deaton was awarded the Nobel Prize in Economics in 2015 for his work on consumption, welfare promotion, and poverty reduction and he was knighted in 2016. The speakers divided the duties with Professor Case giving the talk and Sir Angus Deaton taking the lead on many of the questions.
Professor Case reported that they had been doing research regarding pain and life expectancy. They discovered that the death rates of white people ages 45 to 54 in the United States and in Europe had generally declined by about 2% per year from 1900 to 2000. While that trend continued in Europe, in the United States, unexpectedly, the death rates began to rise in the mid to late 1990s even though it continued to decline for Hispanics and, at an even faster rate, for African Americans. The decline was significant enough to cause the overall life expectancy to decline three years in a row, something that had not happened since World War I and the 1918 flu epidemic. This decline occurred among prime-age adults, 25 to 64, even as life expectancy continued to increase for children and older adults.
The decline in life expectancy was caused by what was called “deaths of despair,” a term coined by Professor Case as a way to include deaths attributable to drug overdoses, alcoholic liver disease, and suicide. The data show that the number of such deaths increased from 65,000 in 1995 to 164,000 in 2019 among non-Hispanic whites.
Because of a new requirement in 1989 that death certificates include education levels, the researchers were able to discern a sharp divide in deaths of despair between those with a bachelor’s degree and those without a bachelor’s degree, beginning in about 1992. This was happening in all parts of the country – urban, rural, rust belt, every state – and among both men and women, although in absolute numbers men were dying at about twice the rate as women from deaths of despair. These deaths did not rise during the Great Recession. Some of the increase, they believe, was caused by a reported increase in pain, social isolation, and poorer mental health. Professors Case and Deaton believe that additional factors are responsible including a decline in long-term labor market opportunities for those without a bachelor’s degree, a dramatic drop in median real wages, a declining employment/population ratio, and jobs being outsourced and good jobs being lost. Replacement jobs were worse, with less commitment and less feeling of belonging. Marriage rates were declining, and there was a loss of status at work, less attachment to churches, and loss of community.
Other factors are globalization and automation but those occurred in Europe as well as in the United States, so those factors do not account for the increase in deaths of despair in the United States. What was different in the United States was opioids.
Opioids account for part of the increase, although deaths of despair were rising before OxyContin became widely available. Professor Case described opioids as essentially heroin in a pill with an FDA label. Perdue Pharmaceutical targeted despair in its marketing. The payment of fines will not be enough to stop this from happening again. People will have to go to jail. Europe, in contrast, does not permit opioids to leave hospitals or the offices of dentists the way we do in the United States.
Broadening the discussion, they believe in capitalism but that it can be fixed and made fairer. Healthcare has much for which to answer in the United States and needs to be reformed. We have the most expensive system but, on many measures, the worst outcomes of the countries in the developed world. There are five healthcare lobbyists for every member of Congress so change will be difficult.
A concluding observation, recently published, is that life expectancy has been converging between whites and Blacks with bachelor’s degrees as it also has been – at much lower levels – between whites and Blacks without bachelor’s degrees, indicating that education and class may be becoming more important than race in accounting for deaths.
Sir Angus Deaton said that he has testified before Congress on these matters and that there is increasing interest in and understanding of this issue in the new administration, He is far from certain that action will be taken. He noted that, ironically, because of pharma’s heroic role in developing a COVID-19 vaccine so quickly, pharma – which is part of the problem – now is seen as our savior.
Respectfully submitted,
Jeffrey Tener