Living and Dying in America: An Essay on Deaths of Despair and the Future of Capitalism

Abstract

This essay reviews Deaths of Despair and the Future of Capitalism (hereafter, DEATHS) by Anne Case and Angus Deaton, a fascinating account of life and death in the United States during the late twentieth and early twenty-first centuries. While primarily targeted toward a popular audience, the volume will be of interest to many economists and other social scientists. It postulates how American capitalism run amok—combined with and partially causing the declining economic circumstances of the less educated—has increased mortality from drugs, suicide, and chronic liver disease. After describing the material in DEATHS in considerable detail, I suggest a variety of research questions that need to be answered to confirm or refute Case and Deaton’s arguments and describe challenges to their key hypotheses. Among the latter are the ability of the postulated relationships to explain the sharply differing mortality trajectories of non-Hispanic Whites, compared with other groups, and the timing of the observed mortality changes. Along the way, I raise doubts about the usefulness of the “deaths of despair” conceptualization, with its strong implications about causality. (JEL I12, I14, I18, J11, J18)

Reevaluating the “deaths of despair” narrative: Racial/ethnic heterogeneity in the trend of psychological distress-related death

“…Lastly, we employ counterfactual analysis to discern whether the trend in PD-related deaths stems from shifts in PD prevalence or from a changed impact of PD on mortality and to examine how this pattern manifests across different racial groups. This analysis sheds light on existing literature ( 19 , 20 ) regarding whether the racial heterogeneity in the temporal trends of PD-related mortality reflects varying levels of distress or vulnerability to distress.…”

“…A counterargument is that Whites’ sense of despair is not due to economic decline but results from a perceived loss of relative status ( 7 ). Other researchers argue that Blacks face historical economic disadvantages and racial discrimination, but have a lower level of despair and have experienced a smaller increase in DAS-related deaths than Whites ( 9 , 19 , 20 ). A possible counterargument is that despite lower exposure to these negative social stressors, Whites may be more susceptible to them, and this vulnerability could have led to greater psychological consequences and mortality.…”

Ukraine War: Policy Miscalculations or Contradictions of Capitalism?

“…There are also signs of disruption of the "social fabric," such as the "deaths of despair" explored by work of Case and Deaton (Ruhm 2022), and polarized politics within and between states in United States and Europe (Brown 2019). There is the risk of waves of refugees, now from Ukraine following earlier waves from Syria, and a renewed arms race between East and West.…”

An Emerging Storm? Increased Health Inequities in the Context of Racialized Patriarchal Capitalism, Deaths of Despair and Covid-19

“…11 Several populations, including Indigenous, Black, Latinx, and working-class White Americans, account for the recent increase in mortality in the US, although with different trajectories, diseases and underlying causes. 7,22 While some countries may exhibit patterns like the DoD (e.g., the Scottish opiate overdose epidemic) they do not necessarily reproduce the mortality triad and have different underlying causes. 11 Looking at social epidemiology as a social science helps accept the difficulty of generalizing a contextual, historical phenomenon like DoD 23 while simultaneously searching for regularities.…”