The newly released paper by Anne Case and Angus Deaton showing that mortality rates amongst middle-aged White American males (MAWAM) increased from 1999-2013 has been generating a lot of discussion of late. This mortality increase was concentrated amongst MAWAMs with a high school degree or less (“Fishtown,” to borrow from Charles Murray’s archetype of a White working class town), who now have a mortality rate even greater than that of US Blacks with their much-discussed health and violent crime problems. But mortality continued falling amongst the better educated Whites (“Belmont,” Murray’s archetypical White American upper middle class suburb).
This mortality increase was apparently driven by a surge in deaths from external causes, especially poisonings, suicide, and chronic liver cirrhosis. Even MAWAMs with a BS degree or higher saw a tiny increase in deaths from external causes, to the extent that MAWAMs are now more likely to die from external causes in their middle age than Latinos, or even Blacks.
It is worth pointing out that it seems to be a very unusual pattern relative not just to other ethnic groups in the US but to other developed European and Anglo countries. The graph below shows all-cause mortality for 45-54 year old MAWAMs relative to their peers in France, Germany, the UK, Canada, Australia, and Sweden. Americans went from being middle of the pack to an outlier.
As someone familiar with Russian demographic history, this was a depressingly familiar pattern to me.
Russian demographic history 101: By the mid-1960s, Russian life expectancy – both male and female – had basically converged with that of the First World.
Then it essentially stagnated… for half a century.
Remarkably, a Russian 50 year old man in 1964 had a smaller chance of dying (1,129/100,000 annually) than his grandson in 2010 (1,655/100,000) – regardless of all the medical advances in the intervening half century.
This mortality tsunami was driven by a huge rise in alcoholism from the 1960s, coupled with the Soviet Union’s lack of interest in creating a modern hi-tech medical system (as the West started to do in earnest from the 1970s). Although there was a modest interruption to these negative trends in the mid-to-late 1980s, when there was a modest improvement thanks to Gorbachev’s anti-alcohol campaign, the decline resumed with a vengeance in the 1990s as the Soviet state lost its monopoly on vodka production and vodka prices plummeted. In the 2000s things started looking up again, as the Putin government raised excise taxes on vodka, invested in modern medical care, and changing social mores and the labor discipline promoted by capitalist economics started making binge drinking less cool. Even so, as of 2015, the health profiles of Russian men – though far improved relative to the days of the late Brezhnev, to say nothing of Yeltsin – have yet to exceed their mid-1960s peaks.
Although there were some “bad trends” in terms of healthy lifestyle in the West as well from the 197os – it was from this period onwards that the US got started on its obesity epidemic – these were much less detrimental to overall health than the hardcore vodka binge drinking that became prevalent in Soviet life by the 1970s, and their negative effects were in any case more than fully counteracted by vast improvements in emergency response and cardiac medical care.
The great stagnation in MAWAM mortality in the 1990s and 2000s revealed by Case and Deaton – down to the social differentiation, with the situation improving slightly in well-educated, upper class Belmont, but positively plummeting in poorly-educated, lower class Fishtown and more than cancelling out improvements in Belmont so far as MAWAMs as a whole are considered – seems to have a striking parallel with what happened after the collapse of the Soviet Union.
Although the post-Soviet mortality crisis was felt across all social groups, it impacted middle-aged Russian men (MARMs) especially hard. Mortality for the best educated segments of the population, while rising initially in the early 1990s, quickly reversed and soon fell below Soviet-era levels. In contrast, the lower class Russians – the “gopnik” class of popular culture – have far poorer health today (despite the Putin era recovery) than even in the most vodka-drenched days of the Soviet Union in the mid-1980s. Here is a 2005 article from the American Journal of Public Health:
The mortality advantage of better-educated men and women in 1980 increased substantially by 2001. In 1980, life expectancy at age 20 for university-educated men was 3 years greater than for men with elementary education only, but was 11 years greater by 2001, reflecting not only declining life expectancy in less-educated men but also an improvement among better-educated men. Similar patterns were seen in women.
Looking at causes of mortality, mortality increases were driven above all by the rise in deaths from poisonings – almost exclusively alcohol deaths, in Russia’s case – and associated factors, such as deaths from external causes (these are linked: When you imbibe vodka in regular binges, you will be more likely to commit suicide, have car accidents, murder your drinking partners in a fit of drunken homicidal rage, etc). Moreover, increases in alcohol death were also reflected in and magnified to a large extent by deaths from cardiovascular diseases – chronic bingeing, needless to say, has bad effects on your overall health – which was further compounded by Russia’s traditional lack of modern medical facilities to treat expensive modern ailments. That is because neither the USSR nor Yeltsinite Russia cared much for the health and welfare of ordinary Russians: So far as the Soviets were concerned, the main thing was to get people through military and reproductive age in more or less adequate shape, and not bother themselves overmuch with what happened to them from their 50s; while the oligarchs who ruled Russia from behind the scenes in the 1990s didn’t care even about that.
To be sure, there are also major differences between the American and Russian experiences. For instance, in Russia, the 1990s and 2000s saw a big dip, and then a big recovery back to late Gorbachev levels of MARM mortality, whereas the mortality rates of MAWAMs simply stagnated at a more or less steady level throughout from 1990 to 2013.
And critically, 1980s Soviet mortality levels themselves began from a much higher base relative to the US. While according to Case and Deaton’s graph MAWAM annual mortality levels for the 45-54 age group were 415/100,000 in 2013, rising to 736/100,000 for poorly educated MAWAMs, that is still far less than the 1,655/100,000 mortality rate for 50 year old MARMs in 2010 (or even in 2014 when it is now perhaps 1,300/100,000).
Nonetheless, regardless of the fact that the US mortality crisis is far less severe in absolute terms, and didn’t undergo the catastrophic “spike” that post-Soviet Russia experienced, the similarities – a major demographic group experiencing a sustained deterioration in its mortality prospects over a period of decades in an industrialized country – are otherwise quite remarkable.
Steve Sailer suggests that the cause of this might be in the stress inflicted on poorer MAWAM workers by mass immigration and other woeful trends:
Perhaps painkiller overdoses, mental health declines, reported pain, disability, dropping out of the labor force, lower wages, and The Big Unmentionable (immigration) all tie together. As Hispanics flooded in, lowering wages, blue collar whites felt less motivated to stay in the labor force as they aged and their bodies got creakier. Getting on disability requires, I imagine, an ability to get doctors and other authority figures to believe your account of musculoskeletal and/or mental health disabilities. The most effective way to get other people to believe you are disabled by physical and mental pain is to believe it yourself. And if you tell the doctor your back is killing you so much you can’t work and you persuade him, he’ll likely write you a prescription for some pills.
Or perhaps it was the 1960s Big Party generation finally burning itself out:
I think there is definitely a pattern in that coming of age in the Late 1960s / 1970s seem to have taken a toll on people, leaving them more vulnerable to dying of overdoses, suicide, and alcoholism later in life.
It’s kind of like how homeless people and AIDS sufferers started showing up in the 1980s. There are all sorts of explanations for these separate effects, some valid, some tendentious, but a common theme that’s almost totally overlooked today is that the 1970s were a Big Party and that took its toll on some people.
Then there is my 2013 post on health inequalities in the US, in which I noticed that unlike Blacks, Asians, and Latinos – whose counterparts abroad have universally lower life expectancies – US Whites are near the bottom of the life expectancy league tables of other majority White countries.
In contrast, US White life expectancy is equivalent to that in not fully developed Chile, and Denmark, the shortest-lived West European country.
This is pretty strange for a country supposedly dominated by “structural racism” and discrimination against its minorities (as many European and American Leftists allege).
Some speculations as to the cause of this pattern were advanced by myself and other people in the comments. One by the commentator Thorfinsson was particularly intriguing:
Extreme Hispanic apathy probably results in good mental health and thus longer lifespans. In America our abundance allows them to achieve the rusty pickup trucks, crappy houses with cars parked on the lawn, Tecate beer (‘scuse me that’s CERVEZA), and 24/7 access to their desired entertainment of telenovelas and pro-wrestling.
As for Asian-Americans being longer lived than their coethnics across the Pacific, I suspect America’s more laid back culture makes for better mental health than the cram and shame obsessed cultures back home.
White Americans on the other hand not only have less healthy lifestyles than their cousins across the pond, but are constantly bombarded with propaganda about how evil they and their ancestors are. Unlike less introspective and curious peoples, they are also given to introspection and moral neurosis. Not a good recipe for good mental or physical health.
But I doubt the explanation is as simple as any of those.
Note that the mortality prospects of middle-aged men in the developed European countries, not to mention Canada and Australia, have continued to improve throughout the 1990s and 2000s, even though many of them too have had a lot of Third World immigrants. That train left the station in the 1960s, not the 2010s, today’s angry rhetoric regardless.
And Yuropeans have been partying at least as hard as Americans since the 1970s. In fact, as someone who has lived in both the UK and the US, I can attest that the prevalence of binge drinking is FAR higher in Britain. Even so, it does not impose a heavy mortality burden even there. That is because British binge drinking mostly occurs amongst robust 16-25 year olds youngsters and only lasts for an evening. The sort of reckless binge drinking that afflicted Russia – and in earlier times, Finland - carried on throughout life and not infrequently degenerated into alcohol layovers lasting several days. Moreover, the “party hard” and recreational drugs culture in both Britain and the US is more of a Belmont thing, while the denizens of Fishtown have to work hard to put food on their family, and in jobs where they are much more likely to be tested for drugs besides.
As for Thorfinsson’s hypothesis, it is entertaining but not very serious. It is intellectual White liberals who read Howard Zinna and agonize over white guilt and have a growing cuckoldry fetish. They are also precisely those MAWAMs whose mortality rates have continued falling.
Otherwise, explanations from the “Left,” like increasing inequality .are not particularly persuasive either. Why didn’t it affect Blacks and Hispanics, who mortality rates continued falling? And besides, virtually the entire world got a great deal more unequal after 1990. Nonetheless, that didn’t stop Western Europe and other Anglo offshots from continuing to improve middle-aged male mortality rates.
Some suggest a connection between neoliberal reform and rising mortality. Contrary to that, after a brief mortality shock in the early 1990s, even decommunizing countries with their own “shock therapies” like Poland started to rapidly increase their life expectancy. This suggests that the primary cause of Russia’s mortality crisis in the 1990s and early to mid 2000s was not so much the much-hated “shock therapy,” as suggested in a famous 2009 Lancet article, but the specific fact of the collapse of the state’s authority, which expressed itself in the loss of control over the hard liquor monopoly, as well as the inability to check the proliferation of underground moonshine operations to serve the alcohol needs of the most far gone Russian alcoholics. At the end of the day, the simple fact was that hard booze got a lot cheaper, and there were many Russians who were willing to take advantage of it. Since vodka is so dominant as a driver of Russian mortality, to the extent that neoliberal reform was responsible for the 1990s Russian mortality crisis, it was because it made cheap hard alcohol more accessible to many Russians.
To wrap this up – while I don’t have any particularly good explanations for the great stagnation in MAWAM mortality prospects, I will suggest the following scenario:
As Case and Deaton state, from the mid-1990s, the US pharma industry has pushed all sorts of painkiller prescriptions including opioids onto the American population. Americans enthusiastically gobbled them up to deal with the bodily pains and discomforts caused by the contemporaneous advance of the obesity epidemic.
The increase in midlife morbidity and mortality among US white non-Hispanics is only partly understood. The increased availability of opioid prescriptions for pain that began in the late 1990s has been widely noted, as has the associated mortality (14, 20‒22). The CDC estimates that for each prescription painkiller death in 2008, there were 10 treatment admissions for abuse, 32 emergency department visits for misuse or abuse, 130 people who were abusers or dependent, and 825 nonmedical users (23). Tighter controls on opioid prescription brought some substitution into heroin and, in this period, the US saw falling prices and rising quality of heroin, as well as availability in areas where heroin had been previously largely unknown (14, 24, 25).
While rising obesity and the growing reach of the pharma industry has been prevalent throughout the First World in the past two decades, nowhere have both of these trends gone as far as in the United States. Possibly it is their combination that has magnified the effects of each to create a much bigger overall effect on the segment of the population most vulnerable to them?
So why, then, did this trend not affect Blacks and Hispanics? After all, their obesity crises are even bigger than those of White Americans. They are also far poorer than Whites. However, possibly their innately much more positive outlooks – Latinos clearly have a higher joie de vivre, while even the poorest Blacks have higher levels of self esteem than the richest Whites – might have translated into a tendency to use fewer pain meds, and perhaps greater defenses against getting seriously hooked on them or gatewaying into stuff like heroin and deciding to end their lives, as far more neurotic Whites are wont to do. In other words, Africanist rhetoric about the psychological dispositions of Sun People vs. Ice People does have some validity to it.
East Asians are relatively neurotic too. But they are also the one racial group in the US that is not having a major obesity crisis, plus their high average IQ ensures few of them live in depressed Fishtown anyway. Their mortality profile has therefore also continued to improve unimpeded.
In effect, maybe MAWAMs have won a sort of genetic anti-lottery: Intelligent enough to be deeply neurotic and prone to suicide, but not intelligent enough to almost entirely avoid Fishtown like Asian-Americans; and wealthy and privileged enough to have bottle of Vicodin as a retirement plan, but not wealthy or genetically endowed enough to avoid obesity on a large scale, which in turn further feeds into the pain meds and neuroticism spiral.
Last but not least, they live in a country where untramelled market forces and technological preeminence have resulted in the complete commercialization of agriculture and healthcare, paradoxically resulting in suboptimal outcomes like the spread of cheap empty carb diets that have led to mass obesity, and the usage of addictive and harmful pharma products to treat those very symptoms.
I am not sure this is anywhere near the correct explanation but I have yet to hear of anything more convincing.
Finally, it’s worth pointing out at least in passing that it is precisely these Fishtown MAWAMs who constitute the core of Donald Trump’s support base. The ordinary, lower class Russians hit hardest by the 1990s mortality shock – for instance, the Uralvagonzavod workers, so despised by Western liberal journalists – are likewise the class showing the biggest support for Putin. As such, this is just the latest if rather small commonality on which there is a kind of Trump-Putin convergence.