Several years ago two American economists, Anne Case and Angus Deaton — the latter a Nobel Prize winner — made a startling observation: The overall death rate among middle-aged American whites had been increasing in recent years. This ran counter to the general trend of decreasing death rates in America in the 20th century and was opposite to the trend for middle-aged African Americans.
As they dug into the data, they found the increase in deaths was almost entirely found among those without a bachelor’s degree and was mostly due to three factors: suicide, drug overdoses and alcoholic liver disease. They labelled these the “deaths of despair,” a label that stuck. Clearly, something was going badly wrong among working-class white Americans.
In their new book Deaths of Despair and the Future of Capitalism, they provide an in-depth analysis of these diseases of despair. It is a story, they write, “of lives that have come apart and have lost their structure and significance.” It is a story “of worse jobs with lower wages; of declining marriage; and of declining religion.”
While they recognize there have been changes in values and social norms that have contributed to the breakdown, they focus on the “external forces that have eaten away the foundations that characterized working-class life as it was half a century ago.”
These include declining wages — down 13 per cent betweeen 1979 and 2017, while increasing overall nationally by 85 per cent; low rates of job creation for those without a degree and “worse jobs” — part-time, out-sourced, insecure, with no sense of belonging or pride.
The creation of worse jobs is made possible in part by the low level of unionization in the U.S. The Bureau of Labour Statistics reported 10.3 per cent of wage and salary workers were union members in 2019, down from 20.1 per cent in 1983. For comparison, OECD data for 2018 show rates for the five Nordic countries highlighted below ranged from 92 per cent in Iceland to 49 per cent in Norway; it is 26 per cent in Canada.
Case and Deaton note: “Deterioration in job quality and detachment from the labour force bring miseries over and above the loss of earnings.” For one thing, “men without prospects do not make good marriage partners.” Moreover, they note, communities deteriorate; as wages decline, jobs are lost and businesses close, the revenues needed to provide services such as schools, parks and libraries decline.
Add to that “the loss of meaning, of dignity and of self-respect that come with the loss of marriage and of community,” and you have a recipe for disaster.
Behind all this, I think, run two broad themes: The cult of individualism in the United States that downplays the importance of community and the collective, and neo-liberal economics, rooted in individualism and in a cynical disregard for people, prioritizing profits and the enriching of the wealthy.
Contrast this with the five Nordic countries, which ranked in the top 10 in the World Happiness Report every year since 2013, occupying the top three spots for three of the past four years. America, in comparison, ranked 18th in 2019. A chapter in the 2020 report is devoted to what makes the Nordic countries exceptional.
In essence, it’s a story of coming together, not coming apart. In general, the Nordic countries provide “easy access to relatively generous welfare benefits,” while “the labour market is regulated to avoid employee exploitation.” They also have high-quality governments and public institutions, with, in particular, a high quality of democracy, and as a result governments are trusted.
Other factors include low levels of inequality, a high sense of autonomy and freedom, and high levels of social trust and cohesion. In short, the Nordic countries have found a recipe for success, and it shows in the fact that on average they have four years more healthy life expectancy than the U.S.
America, it seems, has lost touch with the philosophy of one of its founders, Thomas Jefferson, who wrote in 1809 that “the care of human life and happiness and not their destruction is the first and only legitimate object of good government.” Creating despair among the poor while enriching the elites is utterly inconsistent with this view. Time for a rethink.
Dr. Trevor Hancock is a retired professor and senior scholar at the University of Victoria’s School of Public Health and Social Policy.