This paper documents a marked increase in the all-cause mortality of middle-aged white non-Hispanic men and women in the United States between 1999 and 2013. This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround. The midlife mortality reversal was confined to white non-Hispanics; black non-Hispanics and Hispanics at midlife, and those aged 65 and above in every racial and ethnic group, continued to see mortality rates fall. This increase for whites was largely accounted for by increasing death rates from drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis. Although all education groups saw increases in mortality from suicide and poisonings, and an overall increase in external cause mortality, those with less education saw the most marked increases. Rising midlife mortality rates of white non-Hispanics were paralleled by increases in midlife morbidity. Self-reported declines in health, mental health, and ability to conduct activities of daily living, and increases in chronic pain and inability to work, as well as clinically measured deteriorations in liver function, all point to growing distress in this population. We comment on potential economic causes and consequences of this deterioration.

Recent research has begun to distinguish two aspects of subjective well-being. Emotional well-being refers to the emotional quality of an individual's everyday experience—the frequency and intensity of experiences of joy, stress, sadness, anger, and affection that make one's life pleasant or unpleasant. Life evaluation refers to the thoughts that people have about their life when they think about it. We raise the question of whether money buys happiness, separately for these two aspects of well-being. We report an analysis of more than 450,000 responses to the Gallup-Healthways Well-Being Index, a daily survey of 1,000 US residents conducted by the Gallup Organization. We find that emotional well-being (measured by questions about emotional experiences yesterday) and life evaluation (measured by Cantril's Self-Anchoring Scale) have different correlates. Income and education are more closely related to life evaluation, but health, care giving, loneliness, and smoking are relatively stronger predictors of daily emotions. When plotted against log income, life evaluation rises steadily. Emotional well-being also rises with log income, but there is no further progress beyond an annual income of ~$75,000. Low income exacerbates the emotional pain associated with such misfortunes as divorce, ill health, and being alone. We conclude that high income buys life satisfaction but not happiness, and that low income is associated both with low life evaluation and low emotional well-being.

Summary Psychological wellbeing and health are closely linked at older ages. Three aspects of psychological wellbeing can be distinguished: evaluative wellbeing (or life satisfaction), hedonic wellbeing (feelings of happiness, sadness, etc), and eudemonic wellbeing (sense of purpose and meaning in life). We review recent advances in this field, and present new analyses concerning the pattern of wellbeing across ages and the association between wellbeing and survival at older ages. The Gallup World Poll, an ongoing survey in more than 160 countries, shows a U-shaped relationship between evaluative wellbeing and age in rich, English speaking countries, with the lowest levels of wellbeing around ages 45-54. But this pattern is not universal: for example, respondents from the former Soviet Union and Eastern Europe show a large progressive decline in wellbeing with age; Latin America also shows falling wellbeing with age, while wellbeing in sub-Saharan Africa shows little change with age. The relationship between physical health and subjective wellbeing is bidirectional. Older people suffering from illnesses such as coronary heart disease, arthritis and chronic lung disease show both raised levels of depressed mood and impaired hedonic and eudemonic wellbeing. Wellbeing may also have a protective role in health maintenance. In an illustrative analyses from the English Longitudinal Study of Ageing (ELSA), we find that eudemonic wellbeing is associated with longer survival; 29.3% of people in the lowest wellbeing quartile died over the average follow-up period of 8.5 years compared with 9.3% of those in the highest quartile. Associations were independent of age, gender, demographic factors, and baseline mental and physical health. We conclude that the wellbeing of the elderly is an important objective for both economic and health policy. Current psychological and economic theories do not adequately account for the variations in pattern of wellbeing with age across different parts of the world. The apparent association between wellbeing and survival is consistent with a protective role of high wellbeing, but alternative explanations cannot be ruled out at this stage.

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