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'Deaths Of Despair' Author Discusses How Economic Crises Can Worsen Mortality Rates


As the coronavirus upends the economy, there's been a new definition of essential workers. They are the truck drivers, the store checkout clerks and the people delivering our Amazon packages. Yet this same group of people, America's working class, has been steadily losing economic ground for years, long before the coronavirus appeared. This is the most pronounced among whites without a college education. Here's Anne Case, professor of economics at Princeton.

ANNE CASE: Since the early 1990s, death from suicide from drug overdose and from alcoholic liver disease has been rising, first slowly, and then it picked up speed. We see these all sort of as being of a piece because it's all death by one's own hand. And they all signify a great deal of despair.

GARCIA-NAVARRO: Anne Case is the co-author of "Deaths Of Despair And The Future Of Capitalism." I asked her to explain.

CASE: It turns out these deaths have been rising for people without a four-year college degree and really not for people with a college degree. In fact, this is an epidemic that's invisible, more or less, to people who have been to college. So we started to dig to try to find out, like, what could be behind this large epidemic - which every year takes about 158,000 lives - in 2018, which is the most recent year for which we've got data.

GARCIA-NAVARRO: You describe that as being equal to three fully loaded Boeing 737 Max jets falling out of the sky every day for a year. That's quite an image.

CASE: That is quite an image, and the fact that it's taking place below the radar screen, we think, is pretty stunning.

GARCIA-NAVARRO: Yeah, you call out the health care system, which is reliant on employer-funded insurance, as contributing to these numbers. How so?

CASE: Well, it turns out that from the late 1970s through to today, there's been this long downward trend in wages for men without a BA. And simultaneously, there's been a long downward trend in their attachment to the labor force. And if you look at what happened with how we fund our health care system, employers pay a large share - on average, about 71% of the premium - for workers' health insurance. And that has become costlier and costlier every year. And the employer looks at their low-wage workforce, and they think, can we afford these workers? So jobs have been cut because the insurance premiums go up and up and up every year.

But we think it's not necessarily the loss of wages that are causing people to take their lives one way or another. We think it's the knock-on effects - that without a good job, without prospects, it's really hard to get married. So work life is unstable. Home life is unstable. Community life has disappeared. And so the pillars that used to hold up life and make life worth living have really crumbled terribly for this group - not so for people with a BA. And so it's really become two Americas, one for people who went to college and one for people who didn't.

GARCIA-NAVARRO: What will you be looking at during this era? What is it that you're going to be paying very close attention to to try and make sense of how this moment might affect this group of people?

CASE: We're currently looking for signs of what's happening to the drug epidemic. We have a million people in this country who take heroin on a regular basis, for example. Those people are invisible. We're also listening very closely to the discussion that's taking place about whether we need a profound change in the way we deliver health care in this country. We have the most expensive health care system in the world. It has been delivering the poorest health of any rich country. Our life expectancy is lower than any other rich country.

But the industry is really well-protected in Washington. And we thought that it would take something to break very badly before we saw real change in the way we deliver health care in this country. And this may be the thing that's profound enough that's going to break the health care system open for reform.

GARCIA-NAVARRO: Anne Case is professor emeritus at Princeton University. She and Angus Deaton are the authors of "Death Of Despair And The Future Of Capitalism" (ph).

Thank you very much.

CASE: Thank you. Transcript provided by NPR, Copyright NPR.

Lulu Garcia-Navarro is the host of Weekend Edition Sunday and one of the hosts of NPR's morning news podcast Up First. She is infamous in the IT department of NPR for losing laptops to bullets, hurricanes, and bomb blasts.