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The Hole in the Middle of Life

by Edward Hadas

https://www.breakingviews.com (March 29 2017)

For more than a century, it has required war, plague or natural disaster. But it happened when the Soviet Union collapsed, and it is happening now in the United States. Americans, in particular poorly educated white citizens, are dying younger than in the past. The main reasons are drugs, alcohol and suicide.

Princeton professors Anne Case and Angus Deaton provide the numbers behind these “deaths of despair”. Their latest research, compiled for the Brookings Institution, shows that death rates for white Americans aged between 25 and 29 have increased at almost a two percent annual rate since 2000. In other rich countries, deaths in that age group have declined at almost the same pace. Among fifty to 54 year-olds, where the trend has been particularly dramatic, American deaths of despair have increased at a five percent annual rate. In Germany and France they have declined.

The picture is particularly dark at the bottom of American society. Death rates of people with no more than a high school education have increased at least twice as fast as the national average in every age group. Poorly educated Americans are also much more likely to say they are in bad health than in the past, or compared with their more successful compatriots.

Something is going seriously wrong. It cannot simply be the economy, because the US experience of growth, unemployment and de-industrialisation is shared by other prosperous countries, which have not suffered an increase in deaths of despair. There must be some other reasons for this grim variation on American exceptionalism.

Case and Deaton suggest the “cumulative disadvantage” of the poorly educated is a greater problem in the United States than elsewhere. That sounds right, but it might be better to think of a literally fatal interaction of three national weaknesses.

First, US welfare programmes are inadequate. The spread of addiction to opioid painkillers would have challenged any system, but US states probably have the most disjointed and least generously funded arrangements of any developed country. Defenders of the weak American welfare state often point to the strength of the country’s private and religious charities. In this case, their efforts have also fallen short.

Second, the healthcare system is out of control. Regulators and practitioners have been lax in their oversight of opioid prescriptions. It is easy to blame lobbying from companies like Purdue Pharma, which makes the painkiller OxyContin. The company pleaded guilty to “misbranding” and paid a $600 million fine in 2007. But the authorities’ difficulty in standing up to relatively small companies sounds like a story from a developing economy. The opioids are part of a broader pattern: Americans are unusually reckless in their use of many behaviour- and mood-altering prescriptions drugs.

Third, Americans are unusually willing to be self-destructive. Understanding this national trait starts with a longstanding discussion among scholars about the despair of the modern world.

Emile Durkheim’s 1897 book on suicide pretty much initiated the statistical sociology practiced by Case and Deaton. He postulated a distinctly modern loneliness which was caused by the removal of the traditional guidelines provided by family, community and organised religion. He called it anomie. Political observers speak of alienation and cultural critics of disenchantment. Psychologists study the clinical depression of isolated individuals and sociologists note how economic shifts bring the widespread loss of social standing and self-respect.

The experts are probably right. There are many contemporary forces which weaken the communities and beliefs that help provide what philosophers sometimes call meaning. Without meaning, life is easily reduced to a desperate search for pleasure, or living is just rejected altogether.

It makes sense that anomie, alienation and the loss of communities are doing more damage in the United States than in other modern lands. Loneliness comes especially easily in a country that has always valued rugged individualism. It also makes sense that the damage is greatest among the Americans who have been most dislocated by the social devaluing of less-skilled labour. The economic pain of this group has been amplified by the fragmentation of families and the decline of what was once another example of American exceptionalism among rich nations: deep religious belief.

The same national flaws which left the United States vulnerable to opioids and suicide help explain the country’s weak political response. An instinctive mistrust of government, the inability to adopt a coherent approach to healthcare and a reluctance to admit a national failure all point away from bold policies.

Still, the US government has been assertive in the past. In the 1960s, the “War on Poverty” and the associated programmes of President Lyndon Johnson’s “Great Society” mostly achieved their goals. A war on despair would certainly be harder, but official money and expertise can help. Without a successful attack, there is not much chance of making America great again.


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