U.S. Life Expectancy Falls for First Time Since 1993

Dying of drugs and despair — causes of death in the working class, from a 2015 study.

by Gaius Publius

Part of the surprising primary-season discovery that Trump was popular, was the discovery of where he was popular. Put bluntly, he was popular where people, especially working class people, were dying. From Jeff Guo last March in the Washington Post:

Death predicts whether people vote for Donald Trump

A few weeks ago, following the Republican Iowa caucuses, I pointed out an eerie correlation in the voting data. It seems that Donald Trump performed the best in places where middle-aged whites are dying the fastest.

That wasn't a fluke. The relationship between white mortality and Trump support is real, as the fresh results from Super Tuesday confirmed.

The Post produced scatter plots to prove the point:

Note that only in the Massachusetts chart does mortality not correlate to Trump support.

This analysis can take us in several directions. One, naturally, is to see this as part of the "Trump phenomenon," part of the "what makes Trump special" discussion. Taking things that way, the discussion turns on race, especially as it relates to the 2016 electoral context.

Guo himself falls into this group, writing, "The people I've been describing — this distressed, dying demographic slice of America — are similar to the people who tend to vote for Trump, according to phone and exit polls. Trump supporters are mostly white; skew older; and are less likely to have college degrees than other Republicans." He also asserts, "Trump’s promise to 'Make America Great Again' has been most enthusiastically embraced by those who have seen their own life's prospects diminish the most — not [only] in terms of material wealth, but in terms of literal chances of survival."

Guo is not alone in making that correlation. Put briefly, that correlation states: "It's an important part of the Trump phenomenon that less educated, working class white people, who are now at increased risk of dying, are voting him."

The underlying study, however, was non-political and only seems to reach that conclusion. The report, published in the Proceedings of the National Academy of Sciences (PNAS) in September of 2015, found

a marked increase in the all-cause mortality of middle-aged white non-Hispanic men and women in the United States between 1999 and 2013. This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround.

Note the lack of a political dimension in the study. 

Of course, even outside of the electoral context, the study made news, since the reversal of decades of progress in life expectancy was both astonishing and unprecedented in modern America. Causes for increased mortality, as you may have read, included "midlife increases in suicides and drug poisonings," which lead some writers like myself to conclude that people in the working class were "dying of drugs and despair."

But Is This a Trump Phenomenon or an American Phenomenon?

Here is where the analysis gets interesting. This is not really a statement about Trump per se. Three points to note:

First, while Trump voters are overwhelmingly white, the country is overwhelmingly white as well, at least for now.

Second, the point that this was about Trump was made in the primary, when Trump's chief competition for these voters — Bernie Sanders — was not running in head-to-head contests against him. Note that Sanders, somewhat famously, also had strong white working class support — though he had broader support as well, despite the "white Bernie bro" meme that the Clinton campaign, strategically and perhaps cynically, deployed at the time.

Third, in the general election, it certainly seemed that Clinton & Co. did as much as they could to distance themselves from the white working class electorate. Clinton herself uttered the now-infamous "basket of deplorables" remark, and Chuck Schumer was widely noted as saying, "For every blue-collar Democrat we lose in western Pennsylvania, we will pick up two moderate Republicans in the suburbs in Philadelphia, and you can repeat that in Ohio and Illinois and Wisconsin." In short, the Democratic Party's "identity politics" strategy seemed almost designed not to appeal to the white working class, which made it easy, in the end, for Trump to pick them up as voters.

Would Trump have picked up the same percentage of these voters in a head-to-head contest with Sanders? I for one think not. Michigan voters went for Sanders (against Clinton) in droves. He would certainly have held many of those voters in a general election against Trump, while not losing any of Clinton's voters in those states. As many see it, in a Trump v. Sanders contest Sanders wins the Rust Belt vote hands down — and thus wins the general election as well.

All of which means that the "dying of despair" voters are not just Trump voters. They're American voters.

Death Rates Are Rising Generally in the U.S. 

Now comes another study to bolster that conclusion. General life expectancy in the U.S. is now in decline. The Washington Post again:

U.S. life expectancy declines for the first time since 1993

For the first time in more than two decades, life expectancy for Americans declined last year — a troubling development linked to a panoply of worsening health problems in the United States.

Rising fatalities from heart disease and stroke, diabetes, drug overdoses, accidents and other conditions caused the lower life expectancy revealed in a report released Thursday by the National Center for Health Statistics. In all, death rates rose for eight of the top 10 leading causes of death.

The article goes on to note:

Its findings show increases in “virtually every cause of death. It’s all ages,” said David Weir, director of the health and retirement study at the Institute for Social Research at the University of Michigan. Over the past five years, he noted, improvements in death rates were among the smallest of the past four decades. “There’s this just across-the-board [phenomenon] of not doing very well in the United States.”

What should we make of this?

Bottom Lines

I'm going to make these points quickly, and expand on them (defend them) later. I think we can easily draw three conclusions:

First, as Thomas Frank and others have extensively argued, it's not just the white working class that's been going over the cliff, it's everyone in the country not served by the two political parties, which means, everyone below the top 10% of the population. That's a lot of population (and a lot of Sanders voters, by the way). I'm not alone in arguing that in America today most of the country is represented by no one, that their interests are served by neither political party.

Second, the despair covers almost every demographic group, from older white and black workers, broken in body by years of physical labor, to students and former students of all economic classes who leave college with debt like a mortgage but no house, and with a degree they'll never use because no jobs. No one in the bottom 90% escapes this devastation. People who aren't themselves victims know someone who is. It's a painful country to live in for the lower 90%, and worse, no one suffering in it sees things getting better.

Which means the nation is "Brexit-hungry" for change, any change. In the general election, only Trump was on offer as "change," yet with cabinet pick after cabinet pick he's already proving to be no change at all.

Which also means, third, the U.S. is in trouble as a nation. A nation in despair has elected a wealth-serving autocrat as an economic savior, a "change agent" who's making no changes. It seems we're doomed to disappointment and worse. What's next?

Will the working class continue to commit suicide and still cheer Trump on? Not when they see no real improvement in the hopelessness of their lives — more crappy jobs, more degenerative diseases and conditions, more meth labs and oxycontin use, more suicides, more deaths from inadequate health care, or worse, inadequate health care withdrawn.

What will the increasingly dependent do when Medicare is cut or privatized, when Social Security benefits are sliced, when the now-unified government passes the old "grand bargain" between "entitlements" and taxes that Obama couldn't get through a Republican Congress, but Trump surely will?

I've said before that the U.S. is in a pre-revolutionary state. Trump beat every Establishment candidate in the Republican field by a lot. Sanders nearly toppled a former senator and First Lady, a woman running with every Establishment advantage at her disposal, including almost all media but that on the right. In the general election, Trump beat Clinton in a squeaker, but it's a race that should never have been close, except that Trump was on offer as the "change candidate," and she was not.

What will the nation do if people keep dying? The entire population, almost, is hungry for economic change, real betterment in their lives. If elections don't provide that change, the people may provide it themselves in some other way. And if they do that, there will be rough times ahead.

GP