Tuesday, April 25, 2017

Hopelessness and the American Middle Class

In November 2016, I wrote Life Expectancy Changes. For decades, Americans have experienced increasing life expectancies. But, 2016 brought the shocking news of American life expectancy decreasing. Life Expectancy Changes notes a variety of potential causes for the decrease, and acknowledges that the reported statistics could evidence a true change in trend or may merely be a statistical anomaly. More time and more data will be required before an educated conclusion is practical on that distinction. 

The Washington Post recently delved into the death rates and concluded The disease killing white Americans goes way deeper than opioids. It notes the presumption that "in rich countries, death rates are supposed to decline," and the truth that "in the past decade and a half, middle-aged white Americans have actually been dying faster." This reiterates the news from last fall. But, then it proceeds beyond the outcome and tries to answer why people are dying. I would suggest that its attempt fails. After pondering the Post's explanation, I remain as curious about the cause as I began.

A too-easy answer for the cause is the "three 'diseases of despair': drugs, drinking and suicide." These were mentioned last fall when this life expectancy curiosity was published. But researchers now conclude the decreasing life expectancy "can’t only be blamed on rising rates of drug overdoses, suicides and chronic alcoholism." Reminiscent of a quote in the 1990s, they posit that perhaps the answer is "it's the economy stupid." However, the evidence cited by the Post just does not support its hypothesis. 

The Post says that researchers now contend that "society has left behind the working class." This is an outcome precipitated, they say, by the "collapse of the white, high-school educated, working class after its heyday in the 1970s." The new analysis is not a repudiation of the earlier conclusions blaming "diseases of despair," but is an effort to move beyond that diagnosis, and explore causes or explanations of the diagnosis.  

The cause appears to be somewhat uniquely American. Certainly, the economic challenges of the "working class" are not uniquely American. The Post notes that "globalization and automation" are "economic trends" that have similarly "afflicted" America and "countries like the U.K. and Germany." However, for whatever reason, the death rates in those countries has continued to drop. 

Despite the similarity in the economic impacts, American "middle-aged whites are dying faster," while "mortality rates have been dramatically declining in nearly every other rich country." While mortality "rates in America rose slightly, death rates in" "European countries like France, Germany and the United Kingdom" "continued to plummet." This is not supportive of the Post hypothesis that economic strife is responsible for the decrease in life expectancy.

Americans are dying at greater rates compared to these "rich" European countries. The Post claims that some volume of the difference is "explained by the spike in deadly drug use, drinking and suicides." But, the researchers struggle to explain a large portion of the difference compared to other countries. They point off-handedly to heart disease as one cause, and lament that "improvements in heart disease (have) also slowed down." The suggestion is made, but no evidence is cited. If the American diet and lifestyle are the critical difference, the Post analysis certainly does not solidify such a conclusion.

What is known is that "most of the increase in white deaths is concentrated among those who never finished college." Researchers lament that these people have been "pummeled by the economy," and they find it "more difficult . . . to find jobs" that are economically rewarding. But, education and economy alone arguably do not explain the death rates. While death rates for "less educated" white Americans have increased, "the death rate among less-educated black Americans has actually been decreasing." That inconsistency likewise does not support the Post's hypothesis that economic opportunity explains the life expectancy changes.

Essentially, it seems researchers are not able to explain the increasing death rates among white Americans. They eschew "rising rates of drug overdoses, suicides and chronic alcoholism," insisting that there must be more to the explanation. They propose explanations, but those seem rife with inconsistency. They claim it is the economy, but cannot explain the absence of similar expectancy results in "rich European countries." They claim it is education, but cannot explain the decreasing mortality rates of "less-educated black Americans."  

The researchers therefore settle on the conclusion of "despair." They conclude that "white Americans may be suffering from a lack of hope." They explain their conclusion that the white American working class is suffering from "a 'spiritual' pain caused by 'cumulative distress, and the failure of life to turn out as expected.'” Does this explanation necessarily assume that other American groups and people in other countries perhaps start with less expectations, experience less stress, or somehow sustain more hope? Hope is hard to define and perhaps harder to measure. The cynic may therefore find "hope" nothing but a convenient excuse. 

The Post posits that restricting access to opioids will not reduce deaths. It suggests that requiring "insurers to cover mental health costs" will not reduce deaths (does this suggest that expectations and hope cannot be developed or encouraged?). It suggests instead that the death rate will maintain current trends because of hopelessness. That conclusion to me sounds just a little to much like "we don't know" why life expectancy decreased. It also returns to the article's theme, that the changes "can’t only be blamed on rising rates of drug overdoses, suicides and chronic alcoholism." Perhaps, in the absence of a credible argument supporting some other cause, the changes may in fact be explained by these three. Perhaps that is exactly the answer. 

However, if the Post's hypothesis about economic expectation or hope is accurate, then the future may be troubling. Economic opportunity is ever-evolving. Automation will increase in coming years, and I have questioned How Will Attorneys (or any of us) Adapt? The working world is going to change. The way we accomplish economic exchange may likewise change markedly (discussed in Universal Income, a Reality Coming). Those changes will affect us all, whether our future is dystopian or not. Admittedly, the impact of those changes may prove to be more intense on some particular economic sectors, professions, and industries. 

If the Post's "hope" or "hopelessness" hypothesis holds, then the challenges "of drug overdoses, suicides and chronic alcoholism" may become more troublesome. If the researchers' hypothesis regarding heart disease and other factors is eventually demonstrated, then challenges of diet and activity may become more troublesome. From a public health perspective, knowing the enemy would be a great advantage. It is hard to battle an adversary that is unknown or concealed.

But, in the end, it may be that what drives those challenges, or symptoms cannot be determined. It is possible that "drug overdoses, suicides and chronic alcoholism" themselves are the challenge that we must face, without knowing or understanding their cause(s). Alternatively, perhaps further research will do a better job identifying what underlies these symptoms than what the Post has recently reported. 

Regardless, America faces a challenge. I hope that it can find a solution.  

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