Human lifespans have tended to rise over the past century. That’s been a signal achievement of modernity, a combination of improved knowledge, health care, sanitation, and education. But one American population has seen its lifespan decline since around 2000.
Anne Case and Angus Deaton first published on rising death rates among adult white people in 2015, shocking the American public. Last week they issued an updated report (pdf), which has many implications for the future of American society, including the education sector.
[W]e see our story as about the collapse of the white, high school educated, working class after its heyday in the early 1970s, and the pathologies that accompany that decline.
To begin with, they articulate a new explanation for increasing morbidity. (Actually, the term they prefer is “age-specific mortality”.) It’s a combination of factors, anchored on economics:
We propose a preliminary but plausible story in which cumulative disadvantage over life, in the labor market, in marriage and 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. [emphases in original]
“Cumulative disadvantage” is a resonant, gloomy phrase, and one we might hear widely used. Note how it draws together multiple factors – and the trigger is economics. “[W]e emphasize the labor market, globalization and technical change as the fundamental forces,” which lead to disappointment, fewer marriages, less education, and more dangerous behaviors.
In contrast, black and Latino life spans are increasing, “similar to the rate of mortality decline in other rich countries.” One important detail:
Mortality rates of black non-Hispanics have been and remain higher than those of white non-Hispanics as a whole, but have fallen rapidly, by around 25 percent from 1999 to 2015; as a result of this, and of the rise in white mortality, the black-white mortality gap in this (and other) age group(s) has been closing… due both to mortality declines for blacks, and mortality increases for whites.
Gender differences are stark here, with women’s death rates soaring past men’s:
the increase in all-cause mortality is larger for women, a result we have confirmed on the data to 2015 (36 per 100,000 increase for women, 9 per 100,000 increase for men, between 1998 and 2015, age-adjusted using 2010 as the base year, with little variation in the increases across different base years).
The key story… is the increase in mortality rates for both men and women without a BA, particularly those with no more than high school degree. For both men and women, deaths of despair are rising in parallel, pushing mortality upwards… [emphasis added]
In the international setting, comparing America to related (OECD) nations, this mortality change is unusual. “[T]he US has pulled away from comparison countries…other wealthy countries continued to make progress while the US did not.”
Geographically, this mortality shock is now happening everywhere. In the early 2000s it was restricted to a small area, and then it just grew:
The epidemic spread from the southwest, where it was centered in 2000, first to Appalachia, Florida and the west coast by the mid-2000s, and is now country-wide… This increase was seen at every level of residential urbanization in the US …; it is neither an urban nor a rural epidemic, rather both.
For white people in middle age dying of despair, for example:
Although there are regional differences in intensity, when all mortality causes are on the table:
That brings us back to the south and Appalachia, although not exclusively (note the southwest, west coast, and lower midwest).
Why is this happening? In their “cumulative disadvantage” model Case and Deaton include medical causes, such as heart disease, rising rates of cancer (based in part on persistent smoking), obesity-related problems (diabetes, etc), and “‘deaths of despair’ (suicides, overdoses, and alcoholism)”. Economic problems are crucial, but “the economic story can account for part of the increases in mortality and morbidity, but only a part, and that it leaves more unexplained than it explains…”
What is to be done? Case and Deaton see this mortality regression as a huge policy challenge. Like carbon currently present in the atmosphere promising decades of rising temperatures to come, this rising mortality is already baked into a lot of people:
[P]olicies, even ones that successfully improve earnings and jobs, or redistribute income, will take many years to reverse the mortality and morbidity increase, and that those in midlife now are likely to do much worse in old age than those currently older than 65. This is in contrast to an account in which resources affect health contemporaneously, so that those in midlife now can expect to do better in old age as they receive Social Security and Medicare.
They don’t offer policy prescriptions in this paper.
What does this mean for education?
To begin with, the research saw strong correlations between educational levels and health outcomes.
From ages 25-29 to ages 55-59, men and women with less than a four-year college degree saw mortality rates rise between 1998 and 2015, while those with a BA or more education saw mortality rates drop, with larger decreases at higher ages.
Case and Deaton found this in people’s description of their own physical and mental health:
In the period 1999-2001, there are marked differences between the education groups in self-assessed health: 73 percent of 50 year olds with a BA or more report themselves in excellent/very good health, true of 61 percent of those with some college education, and only 49 percent of those with a high school degree or less.
That was almost twenty years ago. Since then, “[o]ver the period 1999-2015, differences between education groups became more pronounced…”
This research could lead to policymakers and individuals deciding that more post-secondary education is (literally) vital, and pushing policies accordingly. On the flip side, the relatively bad outcomes attached to high school education (only) could lead to changes in K-12 curriculum around wellness.
Second, the reverse could occur. A number of pundits have loudly proclaimed their lack of interest in relatively undereducated whites because of their voting choices, as in this recent Frank Rich piece. Perhaps policymakers will decide that this population isn’t worthy of more education or other attentions.
Third, there’s a financial problem growing alongside the humanitarian disaster this death rise constitutes. So many diseases and health crises cost governments more money, as do increased crime rates. Education already has a hard time competing for limited funding; will that competition get even harder?
Fourth, Case and Deaton’s findings speak to the contemporary role of education in constructing and reinforcing inequality. Can we really argue for more schooling as a means for human advancement, when it so clearly demarcates a brutal divide right in the heart of American life?