Quote of the Day (Anne Case and Angus Deaton, on a Different Epidemic—‘Deaths of Despair’)

“The epidemic of deaths of despair in the United States neither was nor is inevitable, but other rich countries are not guaranteed to have immunity from this American disease. For now, the United States is something of an anomaly among wealthy nations, a status it owes to specific policies and circumstances. But other countries may find themselves following in American footsteps. If wage stagnation persists in Western countries and if the use of illegal drugs grows, the social dysfunctions of the United States could well spread in a more concerted way. Working classes elsewhere are also grappling with the consequences of globalization, outsourcing, and automation. The dynamic that has helped fuel the U.S. crisis of deaths of despair—of elites prospering while less educated workers get left behind—may produce similar devastating results in other wealthy countries.”— Anne Case and Angus Deaton, “The Epidemic of Despair: Will America’s Mortality Crisis Spread to the Rest of the World?” Foreign Affairs, March/April 2020

Given the long lead times of print magazines, this article was likely written when COVID-19 still had not devastated the American economy. 

Even with this slightly premature analysis, Case and Deaton present alarming numbers on how, in recent years, the American Dream has proven ever more elusive. Increased “deaths of despair”—a phrase they coined five years ago to account for fatalities caused by drug overdose, alcoholic liver disease, or suicide—have, combined with deaths from heart disease, produced a reversal in long-term U.S. gains in life expectancy at birth from 2015 to 2017. 

Nothing like this, they report, has been seen since—but naturally—“the influenza pandemic at the end of World War I.” How much more pointed might have been the conclusions of Case and Deaton—economics professors at Princeton—if they could have sensed the calamity to come.

In a globalized economy, it doesn’t take long for an epidemic—whether a fast-acting medical one or a more slow-moving, metaphorical demographic one—to jump borders.

 

Case and Deaton trace the roots of this crisis partly to the disappearance of good, well-paying jobs and partly to the high cost of health care. Rather than the wholesale state interference with the economy advocated by the likes of Bernie Sanders and Alexandria Ocasio-Cortez, they advocate “public policy that raises wages and builds a more comprehensive social safety net,” especially as it relates to regulating the current out-of-control health-care system. 

In the current era of extremist positions right and left, the authors’ proposals may strike many as nothing unusual. But their explanation of this crisis long in the making is detailed and compelling. As Linda Loman warned her sons about the tragedy befalling her husband in Arthur Miller’s Death of a Salesman: “Attention, attention must be paid.” 

Nobody knows yet just how extensive the psychological fallout from the worst American economic downturn since the Great Depression will be. But does anyone doubt that it will produce more than its share of new Willy Lomans?

(One fictional example of a “death of despair” was the title character of the Roseanne reboot, pictured here. That plot development may have been triggered by toxic comments by the series’ controversial star, Roseanne Barr, a year and a half ago. But Roseanne Conner’s death—which, her shocked family discovers, resulted from an accidental opioid overdose—was very much in keeping with a show that, in its original nine-year original run, was at pains to show how close to the edge the blue-collar Conners came to falling victim to larger forces beyond their control.