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Economic despair leading to death of white working class Americans, study finds

Feelings of economic desperation among middle-aged white Americans are contributing to a sharp rise in mortality rates, particularly among those with less education, two Princeton University economists say in a new study.

In new findings published Thursday in the Brookings Papers on Economic Activity, Anne Case and Angus Deaton said many of these Americans are dying from "deaths of despair," such as drug and alcohol overdoses, suicide and alcohol-related liver disease. They also are dying from chronic problems such as cardiovascular disease and cancer.


The researchers say the trend is being seen in all parts of the country from rural Appalachia to cities such as Baltimore, which has very high death rates related to drug and alcohol abuse.

As jobs and other economic opportunities have eroded for working-class families it has led to personal problems such as marital discord and mental health problems that accumulate and spiral out of control, the study found.


"We propose a preliminary but plausible story in which cumulative disadvantage over life, in the labor market, in marriage, in child outcomes, and in health, is triggered by progressively worsening labor market opportunities at the time of entry for whites with low levels of education," the report said.

During a teleconference with reporters, Deaton said the build up of stress might explain why someone turns to suicide.

"Your family life has fallen apart, you don't know your kids anymore, all the things you expected when you started out your life just haven't happened at all," he said.

The findings follow up on groundbreaking research Case and Deaton published in 2015 that first chronicled the steadily increasing death rate of middle-aged non-Hispanic white Americans. Thursday's findings sought to determine the reasons behind the rising deaths.

While midlife mortality rates are falling around the world, middle-aged Americans with no more than a high school diploma have been dying at higher rates since the 1990s.

The trend has contributed to a narrowing health gap between whites and African-Americans, although whites still live longer, the researchers said.

The mortality rate for whites aged 50 to 54 with only a high school diploma was 30 percent lower than that of similar blacks in 1999, but in 2015 it was 30 percent higher. Similar reversals are seen in those from 25 to 64.

Dr. Ben Borja, medical director of crisis services at Sheppard Pratt Health System, said that white men in particular don't always have the skills to deal with adversity.


"They have less experience in dealing with a setback and don't know how to cope," he said.

The University of Maryland School of Social Work is using funding from the Centers for Disease Control and Prevention to find ways to reduce suicide rates among middle-aged men through community outreach.

Mental illness in men often goes undetected because they don't seek medical intervention, said Jodi Jacobson Frey, an associate professor at the school of social work and lead investigator on the suicide study. They also don't necessarily show the typical signs for mental illness. A man who is depressed may express anger rather than sadness.

Frey is working in Michigan, but she hopes to apply her research in Maryland and get men to do online mental health assessments. They can be referred to care if needed. She said current research on suicide prevention focuses on teenagers even though the rates among middle aged men and women are growing.

"The research agenda is just starting to look at what is going on with this population," Frey said. "Once we find out why, we have to figure out what to do because traditional interventions were not designed to reach out to the middle-aged population."

Jim Kyung-Soo Liew, an assistant professor of finance at the Johns Hopkins Carey Business School, said the study, like the presidential election, is a sign that a certain segment of the American population feels left behind.


Liew, who grew up in Oklahoma, said he knows many people from his childhood who struggle financially. The Princeton study further illustrates the reach of the issue, he said.

"There is a part of America we haven't been focusing on," he said. "It's like their cry for help. They are telling us that not everyone is prospering from globalization."

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He suggested President Donald Trump should consider investing in providing high tech skills in areas where traditional blue collars jobs have disappeared.

The Princeton researchers said the trends could take many years to reverse and predict those who are middle age and suffering will do worse as they get older.

One solution they suggested would be to curb the over prescribing of opioids.

"This account, which fits much of the data, has the profoundly negative implication that policies, even ones that successfully improve earnings and jobs, or redistribute income, will take many years to reverse," they wrote.


The Washington Post contributed to this article.