The mysterious mortality of white Americans isn’t about men—or wages

Are white Americans dying to get behind Donald Trump?
Are white Americans dying to get behind Donald Trump?
Image: Reuters/Jonathan Ernst
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Research last year showing a dismaying increase in mortality among poor, middle-aged white men in the US has become a touchstone in US political debates—it’s used to explain everything from Bernie Sanders’ insurgent campaign to Donald Trump’s ability to seize the Republican nomination, as a vessel of white male resentment.

Indeed, Sanders cited the paper obliquely in his post-Brexit op-ed, using falling life expectancy, economic stagnation and Brexit to kick off a recitation of his campaign talking points. Besides Sanders, the connection described in this paper—blaming rising death rates for low-income white men on economic woes—has been cited by everyone from the authors of the study and Paul Krugman to Ross Douthat and the American Conservative.

The case goes like this: White men in the US have lost their social and economic moorings, and have turned to drugs, suicide, and Donald Trump in reaction. (The first two causing an increase in mortality.)

But it turns out the paper (pdf), by economists Anne Case and Angus Deaton (last year’s economics Nobel Prize winner), doesn’t show rising mortality among poor white men. And when it does show shorter life expectancy, we have reason to be skeptical that it is because of economic doldrums.

First of all, it’s not clear at all that poor middle-aged white men are seeing any increase in their mortality. Columbia statistician Andrew Gelman analyzed the same data used by Case and Deaton, and found that they essentially did not adjust for the aging population—the fact that middle-aged people are turning a corner where their mortality is expected to rise naturally.

When you do make that adjustment (pdf), the result is somewhat surprising: Poor male life expectancy stagnated compared to other groups—but poor white female middle-age mortality increased notably.

It’s weird we don’t hear more about how desperation among low-income female whites is driving the campaign of Hillary Clinton to massive leads in battleground states—it might just be!

Case and Deaton have conceded that female mortality is a major issue and that age adjustment can help explain the disparity, but they say that the major findings remain solid. Indeed, while this data just doesn’t really back the popular political narrative, it is still troubling for Americans who want to continue our progress toward a longer, healthier life, especially given that other countries continue to see a trend of increasing life expectancy.

But the question remained—can we trace the reason that gains in life expectancy seem to have halted in the US for poor white men and receded for poor white women? The Hamilton Project, a center-left policy group at the Brookings Institute, has produced some research to answer that question.

There’s no question that income and health correlate strongly, for access to medical care and for healthy habits—high-earning people tend to quit smoking sooner in life and reap the health benefits, while, somewhat astonishingly, poor women over 50 actually saw an increase in smoking.

But the Hamilton analysis offers more evidence that there’s no straight line between wage stagnation and increased mortality for the groups studied. For one, it notes that middle-age male Hispanic and black Americans, who tend to be poorer than middle-age whites, have seen their life expectancies increase even as whites did not. And women’s economic outcomes have been better than those of men in recent decades, but they have still suffered the larger drop in life expectancy. Among children, mortality has fallen, and the gap between wealthier and poor children has narrowed.

The biggest differences appear in the changing causes of mortality among middle-aged whites. While treatable diseases like lung cancer and diabetes have fallen or remained stagnant, the largest increase is in deaths among white people is from “poisoning,” which includes drug and alcohol overdoses. That matches up with the increase in the use of drugs among middle-aged men—which began to increase well before the housing bubble collapsed and brought the US into recession:

The other major increases in causes of death for middle-aged whites are cirrhosis and suicide, and both alcoholism and suicide can correlate with economic distress. But wage stagnation and economic distress hasn’t been limited to white people, especially white women, so its hard to conclude that the economy is to blame for the changing causes of death for white people.

All this leads the authors of the Hamilton report to conclude that health care policy—particularly around addiction and the epidemic of opioid use in the US—and gun safety laws are critical to reducing mortality for this group.

Wage stagnation is a problem, but it doesn’t suffice as an explanation of what’s killing middle-aged white people.