Rising deaths among white middle-aged Americans could exceed AIDS toll
November 2, 2015 8:19 PM   Subscribe

Rising deaths among white middle-aged Americans could exceed AIDS toll in US A sharp rise in death rates among white middle-aged Americans has claimed nearly as many lives in the past 15 years as the spread of Aids in the US, researchers have said. The alarming trend, overlooked until now, has hit less-educated 45- to 54-year-olds the hardest, with no other groups in the US as affected and no similar declines seen in other rich countries.

Case and Deaton found that death rates from drugs, alcohol and suicides had risen for middle-aged white men and women across all educational backgrounds. But Case said the less educated bore the brunt of the trend: for those with a high school degree or a lower level of education, deaths from drug overdoses and alcohol poisoning rose fourfold, suicides by 81%, and deaths from liver disease and cirrhosis by 50%. For this least-educated group, deaths from all causes rose more than a fifth. Only for those with a bachelor’s degree or higher did overall death rates continue to decline.
posted by modernnomad (129 comments total) 49 users marked this as a favorite
 
Since real wages haven't risen since roughly the Nixon administration, and the highest levels of income get all of the gains in the economy, I wonder if this is a grim portent for the future. We're automating whole careers out of existence without a thought about what these folks are going to do with themselves.
posted by fifteen schnitzengruben is my limit at 8:28 PM on November 2, 2015 [65 favorites]


Wait, what? The FDA approved oxycontin for children?

And yeah, maybe this is why so many think that rising equality for minorities is making "equality" in their minds a zero-sum game?
posted by qcubed at 8:34 PM on November 2, 2015 [3 favorites]


We're automating whole careers out of existence without a thought about what these folks are going to do with themselves.

Oh, tut tut, haven't you heard? Sure, some folks will lose their jobs, but new jobs will open up and blah blah I can't even finish.
posted by Steely-eyed Missile Man at 8:56 PM on November 2, 2015 [22 favorites]


Derail, but is this where I can drop a subtle reminder that HIV is not a death sentence, and emphatically stress that just how terrible of a headline this is?

If you think you might have HIV, go get tested, and get treated if necessary. Modern treatments are extremely effective -- many patients end up with undetectable viral loads, and our president fought a long and hard battle to make it possible for everybody to have easy and affordable access to these treatments. Patients with well-managed HIV are also far less likely to transmit the disease.

If you think you might be at risk for HIV for any reason, talk to your doctor about PrEP. It's extremely effective at blocking HIV transmission.

If you think you might have been exposed to HIV, go to an Emergency Room immediately -- there are treatments that can block the virus from taking hold if they are administered quickly. Call 911 if that's your only option for getting to a hospital.

Seemingly none of these things are common knowledge, so I like to repeat them whenever even a tangential opportunity presents itself, because they are a goddamn miracle of science and human achievement, and we are seriously doing society a disservice by not screaming this from the rooftops.

posted by schmod at 9:01 PM on November 2, 2015 [231 favorites]


suicides by 81%

jesus fucking christ. someone fix this brokeness now.
posted by cotton dress sock at 9:04 PM on November 2, 2015 [10 favorites]


Since real wages haven't risen since roughly the Nixon administration, and the highest levels of income get all of the gains in the economy, I wonder if this is a grim portent for the future. We're automating whole careers out of existence without a thought about what these folks are going to do with themselves.

I'd be interested in seeing whether there's a similar phenomenon in Great Britain, for example - where whole regions were basically removed from the national economy during Thatcherism. The phenomenon you're describing isn't restricted to the USA, so if this is a direct correlation it should show up elsewhere, too.

Alternatively, it says something about how our own cultural values function - Japan has a very high suicide rate with a very different set of cultural structures underlying it, for example. Self-worth, or its absence (and looking at the suicide+substance abuse element here, I can't help but feel that this is the core of it) is culturally mediated. What about the world around them makes middle-aged white men with limited education feel worthless? It may or may not just be the economic situation.
posted by AdamCSnider at 9:14 PM on November 2, 2015 [8 favorites]


Lower white middle class voters are experiencing what it means to be left behind, holding onto the failed promises of the American dream and various fraudulent religious contracts to be elevated for their devotion. So they try to cope, then surrender to addictions. This is also evident in their voting patterns, where they tend to support Republicans out of a sentimental ideology, because they can't understand, let alone admit, that they are second-class citizens in an economic serfdom. Adopting abortion and guns as their core issues also point to their desperation, clinging to issues that symbolize last ditch survival, same with rejecting global warming. The overt political hatred among this group is due to the fact that poorer whites will rarely admit to their subjugation, while liberals freely and openly express it, reminding them of their political betrayal, triggering denial.
posted by Brian B. at 9:25 PM on November 2, 2015 [52 favorites]


Russia went through something similar during its economic freefall, yes?

...how many years to the Putin of the US, then?
posted by clew at 9:29 PM on November 2, 2015 [6 favorites]


Wow, haven't finished reading the paper yet but Figure 1 [pdf link] certainly looks pretty striking.
posted by en forme de poire at 9:32 PM on November 2, 2015 [1 favorite]


FWIW the researchers made the comparison to the AIDS epidemic, not the Guardian, intentionally to demonstrate that we reduced AIDS deaths by five-fold over a decade but have not even recognized the deaths described here.
posted by RobotVoodooPower at 9:36 PM on November 2, 2015 [15 favorites]


Well, clew, not sure there's much difference between Putinism and Trumpism...
posted by twsf at 9:37 PM on November 2, 2015 [5 favorites]


It's sort of interesting to me that we're all so obsessed with the obesity epidemic, but what seems to be driving this is suicide and substance abuse. It strikes me that our public health priorities are not entirely what they should be.
posted by ArbitraryAndCapricious at 9:41 PM on November 2, 2015 [35 favorites]


Well, clew, not sure there's much difference between Putinism and Trumpism...

Well, Putin is an effective dictator with years of KGB experience...and dangerous as he's a completely remorseless killer.

Trump is a clownish aristocrat with experience repeatedly going bankrupt with the deck stacked ridiculously in his favor...and he's dangerous as he's an un-self-aware buffoon.
posted by Abehammerb Lincoln at 9:46 PM on November 2, 2015 [8 favorites]


From the Washington Post article on the same study.
An increase in the mortality rate for any large demographic group in an advanced nation has been virtually unheard of in recent decades, with the exception of Russian men after the collapse of the Soviet Union.
posted by action man bow-tie at 9:46 PM on November 2, 2015 [22 favorites]


[Couple comments deleted. This touches a bunch of difficult subjects, please try not to pick fights.]
posted by LobsterMitten (staff) at 10:05 PM on November 2, 2015 [1 favorite]


FWIW the researchers made the comparison to the AIDS epidemic, not the Guardian, intentionally to demonstrate that we reduced AIDS deaths by five-fold over a decade but have not even recognized the deaths described here.

HIV/AIDS was treatable with increasingly sophisticated technical/scientific means. There could be a routinely employed vaccine soon. We may have a vaccine for ebola within the decade (the most recent outbreak proved to be a huge, if tragic opportunity for R&D).

As a rule, we've always been better at technical fixes than solutions that require actual sacrifice, political will, and long-term thinking.

Controlling the availability of opioids and prescription medications is treating symptoms, not causes. Virtually everything to do with our drug/alcohol/mental health policies is about symptoms, not root causes.
posted by Strudel at 10:07 PM on November 2, 2015 [18 favorites]


We're automating whole careers out of existence without a thought about what these folks are going to do with themselves.
Automation sounds better than "the 0.1% stole all the money we needed to support a middle class".

If gains were spread equally among the population we should all be making about 2X what we currently are.
posted by benzenedream at 10:17 PM on November 2, 2015 [53 favorites]


If the study holds water, then it's a pretty devastating reflection on how the economic aquifer has been diverted over the course of these people's lives, mostly to benefit the very richest. (We heard again this week about the hollowed middle in consumer products: it's either artisanal single-origin chocolate or crappy sub-Hersheys stuff.)

A large chunk of American social policy in the 20th century was devoted to converting poor white people (especially 'white ethnic' groups a generation or so off the boat) into property-owning citizens who could live in modest, respectable houses with modest, respectable incomes and the prospect of modest, respectable pensions. Their kids could perhaps go to college and do great things, and inherit some capital in their own middle age.

If you're white and poor in the US, hit middle age and realise you've been sold a lie about your financial security, then you'll get mad and sad and look for someone to blame -- I give you the GOP primary -- and there's a good chance you'll ultimately blame yourself.

I'd be interested in seeing whether there's a similar phenomenon in Great Britain, for example - where whole regions were basically removed from the national economy during Thatcherism.

And are being removed again under the current crop of Tory aristocrats. Yes, up to a point, but the steel mills and chemical plants knocked ten years off your life no matter what.

There's a right-wing line about how poor Americans are the richest poor people in the world. That's bullshit. It's possible to be really fucking poor in the US: living in a trailer, queuing up in darkness for charity healthcare, eating what the food banks can provide. But you might have a flat-screen TV or a cellphone, so that doesn't count apparently.
posted by holgate at 10:29 PM on November 2, 2015 [44 favorites]


One in two Americans lives with at least one chronic condition and more than one in four American adults have more than one chronic condition.

Health care costs are increasing, but spending is highly concentrated. Ten percent of the population – often people living with multiple chronic conditions – account for $2 out of $3 dollars spent on medical care.


If you've ever been poor and extremely sick, take a moment to imagine being poor and sick constantly.

And it's easy to blame the drugs, but there are other reasons for liver failure, and these are the people who've been exposed to toxic chemicals for a pittance as a matter of course in their work lives.

There are no pensions waiting for them, no nice retirement homes. If you don't have a family to support you, you're going to be warehoused someplace as soon as you're no longer useful, to rot out your days being cared for haphazardly by disinterested low-wage workers. Keep in mind that around fifty, they've probably watched our parents go through the same thing.

Throw in the complete lack of any jobs with a future, a decent wage, or any personal dignity, and you've got a huge cohort with an enormous incentive to say fuck it.
posted by MrVisible at 10:34 PM on November 2, 2015 [38 favorites]


It strikes me that our public health priorities are not entirely what they should be.

The US doesn't really treat public health as a matter of broad public policy, unless it's people losing their shit over the idea of black people bringing ebola from the country of Africa.

This study is the story of West Virginia and eastern Kentucky and everywhere there's an opioid belt -- thanks, Florida! -- or meth country or vast acreage of shitty pointless existence because there's no exit other than the one you make for yourself.
posted by holgate at 10:38 PM on November 2, 2015 [4 favorites]


What about the world around them makes middle-aged white men with limited education feel worthless? It may or may not just be the economic situation.

You're taught you're the strongest, the best, the ideal. You're taught you're entitled to have it all. The world is your oyster.

Then you hit middle-age, you see your youth receding and your career opportunities gone. The future looks bleaker every day. Maybe you blame others--indulge in blaming racism, sexism, the collapse of the USA. Or maybe you blame yourself. And when the latter happens you sink into despair.
posted by schroedinger at 10:38 PM on November 2, 2015 [10 favorites]




I thought the report says that there is no parallel drop in the UK and that the US is unique in their study. Perhaps the NHS and a somewhat more supportive welfare state makes a difference, despite the pressures both systems have been under lately.
posted by Aravis76 at 10:40 PM on November 2, 2015 [6 favorites]


I don't think it's that complex. Social atomization has progressed such that the only way we know to measure our worth is by where we fall on a capitalist/consumerist scale, and if you're too low on that scale you're essentially without worth. At the same time the scale has been rigged, wealth vastly concentrated upward and political solutions neutered. If you reach middle age and are without resources and education -- increasingly even with education -- you have few prospects, and the connective tissues of human society that don't concern wealth, profit and accumulation of status-indicators are growing weaker every day.

They don't feel they belong in this society because this society has no place for them. They're disposable, and having been used up they've been discarded.
posted by Ray Walston, Luck Dragon at 11:58 PM on November 2, 2015 [18 favorites]


[A couple of comments deleted. Oblique contemptuous sideswipe at Metafilter members generally for obscure reasons isn't communicating whatever it is you supposedly want to communicate. If the goal isn't to actually participate, please skip the thread, and maybe the whole site.]
posted by taz (staff) at 11:59 PM on November 2, 2015 [16 favorites]


I see this in the homeless population all the time.
In my experience my lower class white males fair the worst. One is that they preference alcohol, which does way more damage than other drugs. They are more likely to have difficulty working meaningless jobs, and less likely to aknowledge their mental illness, especially crippling anxiety.

They have this wierd mix of privalage and dispair. They are less likely to tolerate the ways we treat poor people - the hours wait for services such as food stamps, the waiting on lines for good food pantries, the complicated nature of medicaid . They are continuously ignored. They also have more trust in the system which screws them over and over and don't know how to navigate the system.

I think discriminated minority groups have much more of a realistic idea about what it takes to carve a piece of happiness out of a terrible, frustrating situation. They'ver been taught about these systems and have a stronger sense of identity.
posted by AlexiaSky at 12:14 AM on November 3, 2015 [52 favorites]


I think it is worth mentioning that the entitlement and despair I mention as a possible driving force of this rise is embedded in liberal and conservative White people alike. Voting Blue does not give a White person a pass from the effects of White supremacy.
posted by schroedinger at 12:24 AM on November 3, 2015 [6 favorites]


The final paragraph of the paper is sobering (no pun intended):

A serious concern is that those currently in midlife will age into Medicare in worse health than the currently elderly. This is not automatic; if the epidemic is brought under control, its survivors may have a healthy old age. However, addictions are hard to treat and pain is hard to control, so those currently in midlife may be a “lost generation” whose future is less bright than those who preceded them.

In Australia, which is evidently doing comparatively well on this front, each state spends about a third of its budget on health care. So everyone is really afraid of the doomsday ahead when the baby boomers start hitting the end of their lifespan. The data here would suggest that, in the US, it will be worse. There will be a protracted period of disability (both baby boomers and their children) which will be a compounding problem because paying for the medical services will lead to further economic disadvantage in society thereby driving further health problems.

Thanks for posting.
posted by kisch mokusch at 1:29 AM on November 3, 2015 [3 favorites]


AdamCSnider - I'd be interested in seeing whether there's a similar phenomenon in Great Britain, for example

Not The UK as a whole, but in Scotland there certainly is. I recently attended a talk by the previous Chief Medical Officer of Scotland, where he painted a similar picture of mortality for men under the age of 44 due primarily to "diseases of despair." The graph in this link shows that in Scotland this has manifested as a levelling off of improvement for this group while everyone else has carried on getting better. The net result now is that mortality rates for this group in Scotland are around 30% higher than in England and Wales, controlling for poverty rates.
posted by Jakey at 2:16 AM on November 3, 2015 [8 favorites]


The Scottish example is fascinating because of the argument that the drop isn't solely caused by economic deprivation (since there is comparable economic deprivation in places in England). But I was depressed by the conclusion that we should focus on investment in the early years - isn't there something that can be done for existing adults who are at risk of early death for this reason? Investment in local communities, counselling, addiction treatment centres, jobs?
posted by Aravis76 at 2:23 AM on November 3, 2015 [2 favorites]


From 1978 to 1998, the mortality rate for US whites aged 45–54 fell by 2% per year on average, which matched the average rate of decline in the six countries shown, and the average over all other industrialized countries. After 1998, other rich countries’ mortality rates continued to decline by 2% a year. In contrast, US white non-Hispanic mortality rose by half a percent a year. No other rich country saw a similar turnaround. The mortality reversal was confined to white non-Hispanics; Hispanic Americans had mortality declines indistinguishable from the British (1.8% per year), and black non-Hispanic mortality for ages 45–54 declined by 2.6% per year over the period.
So it's painted as uniquely American in the article, although I have a hunch that if you separated Scotland from the rest of the UK you'd see Jakey is right.
posted by alasdair at 2:27 AM on November 3, 2015


In the talk I attended, there was also some additional data shown that correlated poor societal outcomes with inequality rather than absolute income. This seems to be true across countries of varying GDP/capita. I'm not sure how that maps onto the Scotland/ England divide though.
posted by Jakey at 3:20 AM on November 3, 2015


I know the UK is often half-way between EU and US, but on this I don't think the UK situation is remotely comparable. In the UK the welfare state is intact, if less generous, and workers' rights are not a complete fiction, though they may have been qualified.

whole regions were basically removed from the national economy during Thatcherism.

I mean we'll always hate the bastard bastard demon Thatcher, however long ago it was, but hold on to the distinction between rhetoric and reality there.
posted by Segundus at 3:24 AM on November 3, 2015 [1 favorite]


I'd be interested in seeing whether there's a similar phenomenon in Great Britain, for example

The suicide rate is increasing in the UK with it being the biggest killer of men between 20 and 49. Owen Jones did an article / great video on it earlier in the year
posted by fearfulsymmetry at 3:30 AM on November 3, 2015


Not The UK as a whole, but in Scotland there certainly is.

No, not in Scotland as a whole which that kind of implied. The Jekyll/Hyde aspect of Scottish society is ever present, there are plenty of pockets of health and privilege and plenty of pockets of near third-world levels of ill-health and drug abuse. And as in America, the complacent well off want nothing to do with, let alone help, the poor.
posted by epo at 4:25 AM on November 3, 2015


Actually, I think we should point out a very important demographic fact- "middle aged" people are all members of Generation X now.

And so:

You're taught you're the strongest, the best, the ideal. You're taught you're entitled to have it all. The world is your oyster. Then you hit middle-age, you see your youth receding and your career opportunities gone. The future looks bleaker every day. Maybe you blame others--indulge in blaming racism, sexism, the collapse of the USA. Or maybe you blame yourself.

This isn't necessarily true. It may have been true of the baby boomers, yeah. But not us. For Generation X, more often than not, the narrative can also go more like this -

You were left to grow up more or less on your own as a latchkey kid. You maybe were told you were entitled to have it all, but you weren't really given a road map for how to get it all. In fact, it felt more like you were being told you should have it all, and that you would be found less-than if you didn't.

So you were pushed into trying to get things, without being told how to achieve them, even though secretly you weren't sure you wanted all that much anyway - I mean, your parents were trying madly to "get it all" and didn't seem that happy, especially since they never spent time with you and had to work all the time to get it - and even worse, they were hanging on to everything anyway so you couldn't get the finite resources even if you wanted them.

And then three recessions hit - one in the late 90's, one after 9/11, and one in 2008 - and that chipped away at what little you were able to get. So you have even less than you started with, and that feeds into the narrative you've been sold, which is that you should have it all by now, but look, you don't, what's wrong with you?

And the generation after you is actually getting all the breaks that could have helped you out - staying on your parents' health insurance to the age of 26? Talk of waiving student loans? That would have been a huge help to you when you were in your 20's, but no one was talking about giving that to you. No, you were supposed to try to scramble for it on your own, and you were a loser if you didn't get it.

That is the mindset many of us in Generation X are taking into our middle ages, and that is when we're getting hit with the receding youth and vanishing career opportunities.

So it may not be "I was told I could have it all but I don't and now I'm lashing out" in all cases; in many cases, it may be "I was told I had to do it all on my own but people kept on stacking the deck against me and kicking me when I was down and now I've had it." And the suicides may be "I was kicked when I was down for so long and I've had enough".
posted by EmpressCallipygos at 4:40 AM on November 3, 2015 [122 favorites]


What about the world around them makes middle-aged white men with limited education feel worthless? It may or may not just be the economic situation.

But the way that it is hitting men with high school or less education strongly suggests it is the economy.

Men - particularly traditional men - place a lot of self worth on providing for themselves and their families. But the recent recessions have hit people with less education much harder than those with more education. In 2009, for example, the unemployment rate for people with degrees was about 5-6%, while it was in double digits for people with with only high school, and even higher for those who didn't have a high school diploma.
posted by jb at 4:45 AM on November 3, 2015 [10 favorites]


You're taught you're the strongest, the best, the ideal. You're taught you're entitled to have it all. The world is your oyster.

Is this what lower-income people without college educations have traditionally been taught? It doesn't really ring true to me.
posted by oliverburkeman at 4:46 AM on November 3, 2015 [10 favorites]


But the way that it is hitting men with high school or less education strongly suggests it is the economy.
I thought the article said it was hitting men and women equally?
posted by ArbitraryAndCapricious at 4:51 AM on November 3, 2015 [3 favorites]


As far as I can tell the article doesn't make any distinction: it says that "drugs, alcohol and suicides had risen for middle-aged white men and women across all educational backgrounds", but that doesn't have to mean equally. For example, suicides are predominantly male. I'd be curious to see whether there's a gender breakdown. Time to dive into the report.
posted by Grangousier at 5:09 AM on November 3, 2015


From the article (second page, second column, second paragraph):

The change in all-cause mortality for white non-Hispanics 45–54 is largely accounted for by an increasing death rate from external causes, mostly increases in drug and alcohol poisonings and in suicide. (Patterns are similar for men and women when analyzed separately.)

posted by kisch mokusch at 5:15 AM on November 3, 2015 [1 favorite]


I've made this point before but it bears repeating. I worked at Samaritans as a counselor for a while. The training included the sobering fact that suicidality is comorbid with overuse of alcohol and other drugs, prescription and otherwise. People do kill themselves sober, but it's a lot easier to take that huge and final step if you're messed up. Liver problems? A lot less likely if you're not actively drinking a lot of alcohol or overusing certain drugs.

If I were a triage nurse or doctor, the equivalent of patching the aorta on this public health problem would be to acknowledge and treat the addictions and dependencies first AND to prevent new addictions.

Our fucked society that some people like to call "the economy" because it sounds temporary? I'm sure that feeds heavily into people picking up or continuing with substances, but economic hard times don't have to be a death sentence. One deals with difficult circumstances better if one's head is clear. Don't let the rich bully-bastards push you into hurting yourself.

If you or one of your loved ones has a problem with alcohol or drugs, help is out there. Getting that help could save a life.

And please think twice before accepting or filling that script for opiates, unless you just had major surgery or you have terminal cancer. Many people are going down a really dark road just because they filled that initial script... and then kept refilling. Ibuprofen is an effective drug for relief of minor to moderate pain.
posted by Sheydem-tants at 5:17 AM on November 3, 2015 [12 favorites]


Actually, I think we should point out a very important demographic fact- "middle aged" people are all members of Generation X now.

They are now, but this about 49-54 year olds from since 1998, so people born in the years between 1944 and 1966. We're talking about a few Gen Xers and a lot of Baby Boomers, mixed together.
posted by Bulgaroktonos at 5:18 AM on November 3, 2015 [8 favorites]


This is about rate of change, not absolute numbers, so an uptick in the (relatively low) suicide rate for women would register here, I think. And it's probably worth noting that the mortality rate for black Americans in this age group continues to be higher than that for white, non-Hispanic Americans. It's just that it's declining for black Americans and increasing for white Americans. From the graph in the report, it looks like Hispanic Americans in this age group have had lower mortality than white, non-Hispanic Americans for a long time, and their mortality continues to decline, which is kind of interesting.
posted by ArbitraryAndCapricious at 5:25 AM on November 3, 2015 [3 favorites]


They ran the same story over at Ars Technica and, within about 20 posts, the thread was treated to some ripe MRM grar. It was pretty predictable, I guess. Still disappointing.

I can sympathize with the findings of the article. I'm pretty solidly in the leading edge of that age group experiencing the suicide spike. I've always felt we were always having the rug pulled-out from under us as we tried to keep-up with a rapidly changing world. As if, just as we managed to figure-out the rules of, primarily, the economy, someone imposes new rules. Lather, rinse, repeat. The upshot being that you never quite seem to be able to gather enough of a hedge against the future.

Then, all of a sudden, you find yourself in the future. The rules are still changing but now your ability to keep up financially is being eroded. Your age is now a drawback. And, if you're like me, you're watching your own parents' situations in nursing homes and the like, and it scares the shit out of you. It also doesn't help that so many political leaders seem hell-bent on killing-off the safety net that your parents are relying on, and you now see you will need as well.

If you live that long, of course.

So....
posted by Thorzdad at 5:28 AM on November 3, 2015 [24 favorites]


Bear in mind, also, that death is only a small indicator of the larger issue behind each of the trends.

Increases in death by suicide would suggest an increased prevalence of clinical depression (certainly together with the other data this interpretation seems quite reasonable). The lower rates of successful suicide between men and women are irrelevant. It just means the multiplier is larger for women (i.e. there are more depressed women per suicide than men).

Ditto for liver disease and "poisonings". Not everyone who takes drugs dies of an overdose, and for every death due to alcohol-induced cirrhosis there are probably a few thousand people abusing alcohol in some way that cause a lot of harm both socially and physically but not death.

So as worrying as the mortality rates are, it is the underlying (and substantially larger) morbidity trends that are truly alarming.
posted by kisch mokusch at 5:43 AM on November 3, 2015 [1 favorite]


If the study holds water, then it's a pretty devastating reflection on how the economic aquifer has been diverted over the course of these people's lives, mostly to benefit the very richest. (We heard again this week about the hollowed middle in consumer products: it's either artisanal single-origin chocolate or crappy sub-Hersheys stuff.)

That is something I see more and more all the time, from retailers targeting the poor succeeding while retailers whose market is the middle class struggle, to what products I can find when I go shopping. Whether food or consumer goods, the choice is cheap and terribly crappy, or well built but very expensive.

The New York Times article on this study is really blunt about the class aspect as well:
The analysis by Dr. Deaton and Dr. Case may offer the most rigorous evidence to date of both the causes and implications of a development that has been puzzling demographers in recent years: the declining health and fortunes of poorly educated American whites. In middle age, they are dying at such a high rate that they are increasing the death rate for the entire group of middle-aged white Americans, Dr. Deaton and Dr. Case found.

... The effect was largely confined to people with a high school education or less. In that group, death rates rose by 22 percent while they actually fell for those with a college education.
There are a lot of poor, middle-aged Americans living with chronic pain and with severe economic stress, and with zero prospects of their situation improving. Of course they drink and use pain pills. I probably would as well if I was stuck in that situation with almost no safety net and no viable plan to change things.

That this is big enough to cause a measurable public health impact gives me some slight hope that we might finally start reversing some of the public policies that have created this situation, and return to the policies of most of the twentieth century that increased safety nets and redistributed some economic gains to people in the middle class and below.
posted by Dip Flash at 5:45 AM on November 3, 2015 [12 favorites]


I'm surprised that acetaminophen wasn't mentioned as a potential factor in the liver disease:

"A classic paper by the Acute Liver Failure Study Group was published in 2005. This group looked at the cases of liver failure that were occurring in the United States and found that acetaminophen was responsible for at least 40% of them, and as many as one third of the deaths."

The FDA has taken some steps to limit acetaminophen doses in the past few years, but too little too late for many people.
posted by RobotVoodooPower at 5:54 AM on November 3, 2015 [14 favorites]


Having reading Joe Bageant recently. This unfortunately follows. His descriptions of the physical condition of most of friends and neighbours was appalling. Overworked with chronic pain using alcohol and drugs to get through the day.
posted by KaizenSoze at 6:04 AM on November 3, 2015 [2 favorites]


I might add that having your GenX/Millennial/whatevs children still living with you (or otherwise economically tied to you, i.e. co-signer on school loans, or having Parent Plus loans) doesn't help your mental state, either.
posted by Thorzdad at 6:18 AM on November 3, 2015 [1 favorite]


Ibuprofen is an effective drug for relief of minor to moderate pain.

Glad to hear that's the case for you, Sheydem-tants, because it isn't for everyone. Signed, your migraineur friend with a ton of experience on this particular issue.
posted by bitter-girl.com at 6:30 AM on November 3, 2015 [14 favorites]


And please think twice before accepting or filling that script for opiates

I think you'd better present a pretty rigorous comparison of the rates of opioid addiction vs. rates of untreated pain (especially among women) before making a statement that seemingly-rash.
posted by straight at 7:00 AM on November 3, 2015 [23 favorites]


You're taught you're the strongest, the best, the ideal. You're taught you're entitled to have it all. The world is your oyster.

Is this what lower-income people without college educations have traditionally been taught?

Even if isn't an oyster for them, personally or directly, at any given moment, American exceptionalist ideas (around e.g. meritocracy, etc. etc., which are promulgated everywhere, through media, schools) teach everyone that it could be, that it's their native right, just by virtue of being American.

It's probably possible to rationalize contradictions between a belief in a particular vision of a just world and reality for only so long before reality forces a heartbreaking dissonance. Or maybe it doesn't, even then; maybe those who've strongly internalized this idea need it all the more the worse off they get, and interpret their distance from it as a personal failure.
posted by cotton dress sock at 7:01 AM on November 3, 2015 [4 favorites]


There's a right-wing line about how poor Americans are the richest poor people in the world. That's bullshit. It's possible to be really fucking poor in the US: living in a trailer, queuing up in darkness for charity healthcare, eating what the food banks can provide. But you might have a flat-screen TV or a cellphone, so that doesn't count apparently.

Poor Americans are "rich" in ways that ultimately don't matter at all (although indoor plumbing is pretty great where available).

You're taught you're the strongest, the best, the ideal. You're taught you're entitled to have it all. The world is your oyster.

Is this what lower-income people without college educations have traditionally been taught? It doesn't really ring true to me.


Not really, no, but it's what a certain kind of modern left-leaning person believes they have been taught.
posted by Steely-eyed Missile Man at 7:33 AM on November 3, 2015 [9 favorites]


Even if you're doing ok now, that feeling of insecurity eats at you. One crisis, or several, and your family can end up on the street. It's so brutal. Sure, there's extended family, but they're struggling just as hard and don't always have help to give. And if your crisis ends up being a disability, well there's no getting back on your feet then; you're permanently a dependent, or else alone in dire poverty.

We can't enjoy whatever success we're currently having, because none of us feel secure that it won't be taken away from us. Savings and 401ks are pitiful next to the costs of decades of medical care, food and housing; Social Security doesn't kick in till you're old enough, and it's too little, and there are so many trying to take even that away.

If things got bad enough, and you saw yourself being one of the things that was dragging your loved ones down, or being alone with no way for things to get better, it's absolutely understandable why you'd choose suicide. No one wants to be homeless, or drag their family into homelessness. No one wants to rot in a crappy nursing home for years.

Next to the fact that you can, in this country, actually starve in the street or die for lack of healthcare, drug addictions seem almost trivial.
posted by emjaybee at 7:34 AM on November 3, 2015 [32 favorites]


And please think twice before accepting or filling that script for opiates, unless you just had major surgery or you have terminal cancer. Many people are going down a really dark road just because they filled that initial script... and then kept refilling. Ibuprofen is an effective drug for relief of minor to moderate pain.

This is terrible advise. No one should follow it, with maybe the exception of people with a history of addiction to opiates. Pain management is not a fucking moral hazard.
posted by Lentrohamsanin at 7:39 AM on November 3, 2015 [47 favorites]


This study really hits home for me; it absolutely describes the condition of my rural midwestern parents. They bounced from low-skill industry to low-skill industry (although my father detoured into learning to code, and then left that behind after a few years because he felt like an outsider in an office environment and got into long-haul trucking) and slowly descended into substance abuse and untreated depression. My mother ended up committing suicide a couple of years ago; my father's just a roving toxic waste dump of anger and frustration.

I could see their situations getting more and more hopeless for a long time; the entire small-town Nebraska world they inhabited was full of stories just like theirs. I don't know about the rest of the country, but I know the midwest is full of large pockets where leaving is difficult but staying in place means grappling with a bleak and awful existence with no opportunity.
posted by the phlegmatic king at 7:39 AM on November 3, 2015 [23 favorites]


Pain management is not a fucking moral hazard.

But there are still places where the default approach to healthcare is to hand out painkillers and anti-depressants because what else are you going to do. This is not diminishing the value of painkillers and anti-depressants where needed, but noting the role of indifferent doctors who'll refill prescriptions for an easy life, and self-medication with hoarded and traded pills.
posted by holgate at 7:47 AM on November 3, 2015 [3 favorites]


For real, phlegmatic. My mom was wrecked by a divorce at 40, has hopped office jobs, got laid off, got into a job training program and is starting another career at 53. She has diabetes and doesn't have the energy to exercise (can't blame her as neither do I), and a back corner of my brain is fucking terrified of what happens if/when she's not able to work because god knows I don't have the money to take care of her without crippling myself too.
posted by nakedmolerats at 7:55 AM on November 3, 2015 [8 favorites]


Sheydem-tants said: And please think twice before accepting or filling that script for opiates, unless you just had major surgery or you have terminal cancer. Many people are going down a really dark road just because they filled that initial script... and then kept refilling. Ibuprofen is an effective drug for relief of minor to moderate pain.


This is absolute nonsense, spouted by someone who is not a doctor. Please ignore this ridiculous moralizing bullshit as the utter absurdity that it is.

And holgate, with the new opiate laws, nobody is just handing out opiates willynilly anymore. People with MS and scoliosis and rheumatoid arthritis and a ton of other conditions now have to jump through such ridiculous hoops to get their meds refilled it's crazy pants.
posted by SecretAgentSockpuppet at 8:28 AM on November 3, 2015 [25 favorites]


Not really, no, but it's what a certain kind of modern left-leaning person believes they have been taught.

I'm not arguing every poor person grows up literally reciting in school "The world is my oyster, and I am the best." But every day our culture delivers the message to all Americans:
  1. The USA is the best and most free country and Americans are the best and most free.
  2. If you work hard enough you can do anything and be anything you want. Because of freedom.
  3. If you don't have a lot of material wealth then you are a lazy person who has not worked hard enough and have failed at life.
A POC will figure out fairly early in life via racism that the above statements are not entirely true. The system is a racket and one cannot blindly trust that good intentions and hard work will pay off in riches and a good life. In a fucked up way you are set up for disappointment.

White people don't get that forewarning. This means any given White person is set up for an existential crisis when they hit middle age and realize that their hard work and struggle has not paid off in an awesome, comfortable life. How do you reconcile the reality of your situation with the fact that America is a free, amazing country with riches available to anyone who works hard? Perhaps somebody is cheating: stealing all those riches and destroying America (immigrants, Black people, queers?). Or perhaps you are a failure at life.

I think there is also something to be said that the changing demographics of the USA and the slight hits to White privilege that have occurred in the past decade or two have left White people with the feeling that they are under attack. This can also contribute to feelings of anger and despair.
posted by schroedinger at 8:28 AM on November 3, 2015 [24 favorites]


Also, if people are assuming that this rise is among conservative-identified White people, it is because middle-aged White people with a high school degree or lower lean overwhelmingly conservative.
posted by schroedinger at 8:33 AM on November 3, 2015 [3 favorites]


Middle class white people get that message. Poor white people certainly do not.
posted by Steely-eyed Missile Man at 8:34 AM on November 3, 2015 [4 favorites]


My late thirties, out of work for two years now, blue collar, white, hardcore right wing, neighbor just attempted suicide last night. So this article hits rather disturbingly, and literally, close to home. He's in the ER now and may or may not recover.

Just a few weeks ago he shared his belief that Obamacare was bad, specifically because it had mental health care provisions. I suppose he was regurgitating something he heard on hate radio. He told me that the best thing would be for crazy people to kill themselves and save money thereby.

I can't help but think that, for some of the people in his situation, the constant drumbeat of hate radio was at least a minor contributing factor in their suicide attempts. Being told, basically, that you are worthless for many hours a day can't be good for a person.
posted by sotonohito at 8:35 AM on November 3, 2015 [42 favorites]


I actually find terms like "middle-class" and "poor" to be confusing in this context. I think that the people I know who fall into this category (white, not making a lot of money, less than a college education) would consider themselves middle class. They may even have grown up middle class and have been middle class at some point in the past.
posted by ArbitraryAndCapricious at 8:39 AM on November 3, 2015 [14 favorites]


the constant drumbeat of hate radio was at least a minor contributing factor in their suicide attempts

This, and the grim flood of disaster, murder, and war news being piped to them by the 24 hour a day cable news cycle.

But talk radio, wow, some of my (working class) relatives have some very strong ideas based on what they hear all day long with the radio ranting at them while they work. This is no mere Orwellian "Two Minutes Hate" -- it's a solid block day-long ranting anger.
posted by aught at 8:54 AM on November 3, 2015 [21 favorites]


I think that the people I know who fall into this category (white, not making a lot of money, less than a college education) would consider themselves middle class.

This is certainly true, based on the people I know or am related to who fall into the category. NO ONE considers themselves "poor" or "lower" class - those are insults nearly on a par with racial or ethnic insults.
posted by aught at 8:58 AM on November 3, 2015 [3 favorites]


I sometimes say talk radio is like pornography for the pleasure of hating your enemies. But then I worry that I use the internet for the same thing.
posted by straight at 9:01 AM on November 3, 2015 [10 favorites]


The case for raising the alcohol tax, in one paragraph

I think I 51% disagree with the conclusion but it deserves to be here.
posted by phearlez at 9:02 AM on November 3, 2015


Middle class white people get that message. Poor white people certainly do not.

They both consume the same mass media, which frequently works in images and messages of "self-made" successes and the perennial memes that "anyone who works hard succeeds in America" and "all it takes is a positive attitude to get what you want." Human interest stories on the news, pop songs, Hollywood movies, workplace training sessions - they all reinforce this core American mythology.
posted by aught at 9:03 AM on November 3, 2015 [4 favorites]


My late thirties, out of work for two years now, blue collar, white, hardcore right wing, neighbor just attempted suicide last night. So this article hits rather disturbingly, and literally, close to home. He's in the ER now and may or may not recover.

Just a few weeks ago he shared his belief that Obamacare was bad, specifically because it had mental health care provisions. I suppose he was regurgitating something he heard on hate radio. He told me that the best thing would be for crazy people to kill themselves and save money thereby.

I can't help but think that, for some of the people in his situation, the constant drumbeat of hate radio was at least a minor contributing factor in their suicide attempts. Being told, basically, that you are worthless for many hours a day can't be good for a person.


And now I see the situation where blatant hypocrisy is the preferable outcome. The logical conclusion of two minutes' hate, brought to you by advertising.
posted by Strudel at 9:03 AM on November 3, 2015 [4 favorites]


I don't think the internet compares to talk radio, primarily because it's a written medium and lots of people find reading and writing distasteful.

Plus, talk radio has so many colorful ~personalities~ and helpful pointers to lifestyle purchases like gold bricks, testosterone pills, and weight-loss smoothies.

It'd be interesting to see a study of health implications of talk radio advertising (bottom-shelf products for the gullible) and products advertised during super-mainstream network news (medium-shelf products for the gullible, but with fewer non-FDA-approved supplements).
posted by witchen at 9:05 AM on November 3, 2015 [3 favorites]


I hear alot of 'I worked my whole life why can't I get disability? ' the answer is these people didn't pay social security (constriction jobs paying cash, under the table work) so all they are eligible for is whatever the SSI amount is (this year it is 733 a month) and are never eligible for medicare.
So not only do they have severe health problems, they have to navigate a very difficult and splintered health care system.
posted by AlexiaSky at 9:06 AM on November 3, 2015 [9 favorites]


> Poor Americans are "rich" in ways that ultimately don't matter at all (although indoor plumbing is pretty great where available).

Freedom from cholera, polio, uninspected meat and access to medical care don't matter? Even if a trip to the ER because you don't get preventative care "ruins" your life due to debt, you're not dead.

I agree that we shouldn't support politicians that harp on this point to claim that we don't need more social services, but Katrina-level events happen every year in Bangladesh.
posted by morganw at 9:08 AM on November 3, 2015 [7 favorites]


What's even sadder are the people fueled by propaganda who are taught to hate and distrust the very people trying to help them! "Damn LIEberals and Obama lovers trying to improve my quality life, they're communists!"

The power of cognitive technology like public relations isn't respected enough, I think.
posted by gehenna_lion at 9:09 AM on November 3, 2015 [7 favorites]


Middle class white people get that message. Poor white people certainly do not.

White people ages 45-54 with less than a high school education lean overwhelmingly conservative, as seen in the link I posted. Older conservatives are more likely to see America as the greatest country. Conservatives are less likely to think aid to the poor helps, less likely to think POC have it worse than White people, and are more likely to believe in income mobility in the USA. If polls are any indication, they are getting that message.
posted by schroedinger at 9:13 AM on November 3, 2015




As 'cost saving measures and to restrict unessicary medical care', individuals on medicaid are required to part Copays to get medication and see their doctors.
Frequently they run out of money and can't pay the minimal (in this state anyway co pays are dollar or two) and go without medication or evaluation. Add the restrictive laws that make opiate users come in monthly to get a new script.
Many of these men have terrible injuries from day labor or construction jobs. People falling off roofs, back injuries from lifting heavy things, work accidents that just never were reported. As a day laboror, there is no workman's compensation, just a brief goodbye and are on your own.
posted by AlexiaSky at 9:15 AM on November 3, 2015 [3 favorites]


Strudel: "HIV/AIDS was treatable with increasingly sophisticated technical/scientific means. There could be a routinely employed vaccine soon. We may have a vaccine for ebola within the decade (the most recent outbreak proved to be a huge, if tragic opportunity for R&D).

As a rule, we've always been better at technical fixes than solutions that require actual sacrifice, political will, and long-term thinking.
"

The AIDS epidemic became as bad as it did, because of a profound lack of sacrifice, political will, and long-term thinking in the 1980s. Fighting AIDS was far more complex than inventing a pill, and we were making headway long before effective treatments were developed (and those treatments wouldn't have become a reality if we hadn't first started taking the epidemic seriously).
posted by schmod at 9:17 AM on November 3, 2015 [2 favorites]


I feel like I'm living in the middle of this story. I'm about to turn 39. In the past year, one friend a few years older than me died suddenly and unexpectedly of heart disease. Three other friends my age completed suicide (none of them knew each other). It's gotten to where going on Facebook means either learning of another death or reading posts mourning the recently dead.
posted by hydropsyche at 9:24 AM on November 3, 2015 [3 favorites]


Socioeconomic privilege is one of the most impactful types of privilege, and we shouldn't ever forget it.
posted by Drinky Die at 9:33 AM on November 3, 2015 [8 favorites]


This is not at all surprising to me. I mentioned in the "white people now give a shit about heroin deaths" thread that I lost an uncle to suicide this summer. His situation was pretty much boilerplate for these times: a 59 year old man with no post-secondary education, a blue collar job as a truck driver, a work injury for which he was prescribed opioids, then a layoff... and blammo, down the spiral he went. He slid into addiction, couldn't get another job, lost his car, his home, ended up on the streets and then in shelters, would get a very shaky toehold via social services and would start pulling himself up out of the hole and then some tiny ball would get dropped in the bureaucracy and he'd lose services or be set back in some way and he'd have to start all over again, reapplying for food stamps, for housing help... no wonder he felt like suicide was his only option.

Clearly our focus on obesity as the biggest public health issue is some fucking bullshit, y'all. How do we fix this? What do I do? Who do I harangue? What do we even fix first?
posted by palomar at 9:44 AM on November 3, 2015 [17 favorites]


If anyone reading this is finding themselves in a low place, feeling like things are hopeless or like hurting yourself is your only option - know that it isn't, there are other options and ways to get through it and come back from it. Please reach out and talk to someone you know about this, or get in touch with a Mefite or the mods (email mods at metafilter.com anytime 24/7), or call a hotline.

The hotline in the US is: 1-800-273-8255 (TALK). They also have an online crisis chat line. You can call or chat them even if you're not immediately suicidal, if you need to talk to somebody; don't overthink it, just reach out. Information for other countries is at the ThereIsHelp page on the MetaFilter wiki.

Other people have been in the same spot, and come back from it -- you matter, and there is hope.
posted by LobsterMitten at 9:52 AM on November 3, 2015 [25 favorites]


And please think twice before accepting or filling that script for opiates, unless you just had major surgery or you have terminal cancer. Many people are going down a really dark road just because they filled that initial script... and then kept refilling. Ibuprofen is an effective drug for relief of minor to moderate pain.

And if ibuprofen doesn't work, please ask you primary care doctor for prescription medication, even opiates, because *no one* deserves to endure a life of chronic, unrelenting, debilitating pain when some relief is so easily* within reach.

*for some values of 'easy'. everyone, everywhere seems to like stigmatizing pain meds, and making it harder and harder to obtain them.
posted by j_curiouser at 9:56 AM on November 3, 2015 [8 favorites]


It seems to me that a lot of white people are also severely lacking a sense of any kind of community. They've been just prosperous enough in the past to get out of whatever town they come from to go god knows where and find themselves with no family around to lean on when times are tough and without any real sense of belonging. This, at least, seems to be the case in my extended family, where some people are doing better than others but since the mid 1980s at least every single one would apparently rather drop dead than live within 1000 miles of each other.
posted by Jess the Mess at 10:10 AM on November 3, 2015 [20 favorites]


One important thing about people is that it's often the derivative that matters as much as the absolute level. As this chart of income changes by age group shows -- or especially this one that zooms in on 45-54 (both from here) -- the 45-54 age group has seen its real income fall an astonishing amount in the last 15 years. Regardless of what ideology they subscribe to, that's a pretty crushing experience over a very large chunk of your working life. And that's just for the age-group in toto -- while the worst-off have seen smaller declines (because there is less room to fall), the white working class has seen falls even steeper than this. It's no wonder that it leads to pain, depression, alcohol, and suicide. One silver lining of this study is that showing such a clear health correlate to the income decline gives a bit more ammunition to those who have been trying to draw attention to this ongoing socioeconomic disaster.
posted by chortly at 10:51 AM on November 3, 2015 [6 favorites]


Right up top: We're automating whole careers out of existence without a thought about what these folks are going to do with themselves.

This far down the thread and no mention yet of a guaranteed minimum basic income?

Because like it or not, if a robot can do 90% of your job for cheaper, the robot wins every time. We've shown - by voting with our feet - that we'll even deal with the aggravation of s-l-o-w-l-y repeating our information to automated voice systems over and over again instead of competent receptionists. ("A real live human answers your call on the first ring" is literally part of the sales pitch for some premium credit cards.)

So yes, robots are coming, and the vast majority of moderately-skilled jobs are going away. (And even some highly skilled ones are inevitably on the chopping block. Unlike your radiologist, a pattern matching robot never tires out or has a bad day or loses focus because their kid is sick.)

But this transition will generate an enormous social surplus of wealth - the question is whether that can be distributed with some modicum of equity, or whether (or for how long) we will be willing to tolerate our current levels of inequality.

"Bread and circuses", "religion is the opiate of the masses" - obviously nothing here is a new concept. But I don't have much hope that we will deal with it in a better fashion this time around, either.
posted by RedOrGreen at 11:18 AM on November 3, 2015 [17 favorites]


...how many years to the Putin of the US, then?

You can (not) see the Putin of the US on the back of the dollar bill. The top of the pyramid is invisible (not missing) ... but the Eye is not.
posted by Twang at 11:25 AM on November 3, 2015 [2 favorites]


“This is no mere Orwellian "Two Minutes Hate" -- it's a solid block day-long ranting anger.”

Left-wing radio as well now. I liked local (chicago) lefty radio. But it's getting to be the same format. Gotta sell gold, yeah? Although at least there was a period where there was useful information, or some information at the core. Right wing radio was always angrily talking about what someone else talked about other people talked about.


“And the suicides may be "I was kicked when I was down for so long and I've had enough"
This.
“Epidemic of despair” is probably the most accurate term I’ve heard for this.
Particularly among veterans.
Money quote: “Veteran suicide numbers have gone up in recent years with much of the attention focused on veterans of the wars in Iraq and Afghanistan killing themselves. However, almost seven out of 10 veterans who have committed suicide were over the age of 50, according to a Department of Veterans Affairs study.”

I talk to a lot of vets, other people, sometimes in dire straits. I don’t know how to tell some people not to kill themselves. I don’t. The causes of their depression aren’t just being in war, it’s the lack of health care, the lack of opportunity, the bleak future.
For someone who’s worked all their life and is looking at wasting away in a state nursing home, that’s got to be horrible. For someone who’s seen pain and death, quick, slow, whatever, you have more of an idea of what you’re in for. That’s enough to drive anyone mad.

Even Audie Murphy, probably as close to Captain America type brave as anyone can be, was very seriously looking at checking out early when he had money problems.
So the “there is hope” thing….I think you can bring yourself internally back from anything. But if your external circumstances don’t change, if they force you back into despair, I don’t know what any service is going to do for you to change that.

And that’s the big problem. Many, many people feel stranded, betrayed and abandoned, and I think they’re right. Addiction is a symptom of the problem, not the problem.
It is very convenient an issue though. Perhaps a ‘War on Prescription Drugs.’

Sorry to sound so cynical, but unless we change the circumstances of peoples’ lives, they will get up and get up and get up one more time they get knocked down. Until they don’t.

Because the deck is stacked against so many people and because (veterans in particular are so lionized in public) and so abandoned as soon as the lights are off or there’s real money or change at stake. God knows, we got to elect a job-creating beltway outsider that can keep us safe who’s gonna cut taxes right?

I dunno. All we have is each other. You’d think we’d be able to get it done. At some point the pain is going surpass the suspension of disbelief and things can explode.
And social explosions mess everyone up. Even those with the best intentions. Robespierre started public education, opposed the war with Austria, was 'incorruptable' etc. Didn't end well though.
I suppose Marie Antoinette saw it coming too but…”There is nothing new except what has been forgotten.”
Probably too late then.
posted by Smedleyman at 11:27 AM on November 3, 2015 [10 favorites]


(Postscript to comment: people have been yelling about these trends for a long time now. Here, at random, is Paul Krugman in 2012, the Economist in 2013, and this long read from Kevin Drum in 2013.)
posted by RedOrGreen at 11:30 AM on November 3, 2015 [2 favorites]


Addiction is a symptom of the problem, not the problem.

I always think of Rat Park (in comic form)
posted by the man of twists and turns at 11:31 AM on November 3, 2015 [8 favorites]


One silver lining of this study is that showing such a clear health correlate to the income decline gives a bit more ammunition to those who have been trying to draw attention to this ongoing socioeconomic disaster.

It's not being ignored by accident, it's being ignored on purpose, so what good will additional information do?
posted by aramaic at 11:41 AM on November 3, 2015 [3 favorites]


hydropsyche: I feel like I'm living in the middle of this story. I'm about to turn 39. In the past year, one friend a few years older than me died suddenly and unexpectedly of heart disease. Three other friends my age completed suicide (none of them knew each other). It's gotten to where going on Facebook means either learning of another death or reading posts mourning the recently dead.

Ditto. I'm about to turn 40, and there is a stark, stark difference between how my American friends are doing (made the first 20 years of my life, for the most part) and how my French colleagues and friends are doing (met during the second half of my life).

I grew up in a hugely blue-collar area in Oregon; my high school was one of the last in the state to still offer things like auto mechanics, woodworking, and drafting courses for kids who only wanted/needed their HS degree. Yes, we absolutely grew up thinking we were exceptional. Being blue collar and able to live a stable life was considered something to be proud of as an American. I remember it very clearly; in large part because my grandfathers went from growing up as dirt poor (the very reason that expression exists) immigrant farmers to having excellent lives as construction foremen. Still though, most of my friends got their college degrees and went into what seemed promising jobs 20 years ago, 10 years ago. And yet. I've lost count of the friends and acquaintances lost to heroin overdoses, heart disease, cancers left untreated for too long. At least twenty. Then there's what almost seems like the rite of passage of homelessness for my single mother friends that is absolutely panic-inducing. And if you want to get really anecdotal, teachers lost to and teacher friends affected by two fucking mass shootings now.

In France I'm part of a somewhat different cohort, but that very difference is in and of itself a reason things haven't regressed. I still know quite a few tradespeople, due to owning a place and also working for a year on the IT side of an insurance program that covers construction workers. I'm in IT, where 90% of my colleagues have 5-year degrees and the other 10% have at least 3-year degrees. Because in France, public education is still valued more than in the States (not saying it's perfect, not by far, but it is still held as a value, whereas in the States it's being attacked on all sides; I have dozens of US and French public teacher friends). About the same number of cancers, but only one that lead to death. No drug overdoses. No one lost to heart disease yet. About a dozen colleagues whose cholesterol levels are carefully watched with their GPs. We're still having a rough time of it as our salaries have been effectively, though unofficially, frozen for 5 years now. But "rough" still means healthcare. I know dozens of people who have been fired, others who have quit; single mothers raising kids included. No one has become homeless.

Smedleyman: At some point the pain is going surpass the suspension of disbelief and things can explode. And social explosions mess everyone up. Even those with the best intentions.

Quoted for truth.
posted by fraula at 11:48 AM on November 3, 2015 [21 favorites]


This NYTimes article focuses on the rise of suicide in rural areas: Small Towns Face Rising Suicide Rates
The C.D.C. reported last year that Wyoming has the highest suicide rate in the nation, almost 30 deaths per 100,000 people in 2012, far above the national average of 12.6 per 100,000. Not far behind were Alaska, Montana, New Mexico and Utah, all states where isolation can be common. The village of Hooper Bay, Alaska, recently recorded four suicides in two weeks.
posted by Secret Life of Gravy at 12:22 PM on November 3, 2015 [2 favorites]


literally the only thing that could leave me feeling long-term safe would be the knowledge that I could successfully live on the street if I had to. Unfortunately, my survival skills/general canniness are poor enough for me to not be even close to sure of that. I wish I could find a class in "urban camping" or "squatting for beginners" or somesuch, something that would teach me the skills I'd need to live in the Bay Area without money or formal, state-endorsed shelter if I got Ellis Act'ed out of my rent controlled apartment.

Capitalism is trying its damnedest to mimic the laws of thermodynamics: you can't win, you can't tie, and you can't even stop playing the game.
posted by You Can't Tip a Buick at 12:48 PM on November 3, 2015 [8 favorites]


the answer is these people didn't pay social security (constriction jobs paying cash, under the table work) so all they are eligible for is whatever the SSI amount is (this year it is 733 a month) and are never eligible for medicare.

I've got several relatives who worked long stretches under-the-table and will be facing this kind of thing. (And one of them had a really hard time buying a house because of lack of income history.) At the time, of course, these guys crowed about how smart they were to be beating the system and not paying that bastard Uncle Sam his pound of flesh like all us suckers. Sigh.
posted by aught at 1:18 PM on November 3, 2015 [6 favorites]


I wish I could find a class in "urban camping" or "squatting for beginners" or somesuch, something that would teach me the skills I'd need to live in the Bay Area without money

The Bay Area is IMO one of the best places to learn those skills. There aren't any classes for (hopefully) obvious reasons but you can learn a few things if you meet up with the right people. It takes a significant amount of time to network though, and if you aren't already in a situation to need those skills, they don't have much patience for tourists.

See also: People's Park, Homes Not Jails, Food Not Bombs and your friendly neighborhood infoshop.
posted by Feyala at 1:43 PM on November 3, 2015 [4 favorites]




one of the things I really hoped for out of the Occupy movement was a practical exchange of ideas, tactics, and skills between the activist community and the people who've banded together to establish tent cities after being denied access to state-sanctioned housing. I don't think that really happened — but I wasn't involved in Occupy, other than showing up for a few GAs.

Nevertheless, insofar as it's possible, we must learn how to live rough. Living rough can't be a solution to anything, since it's radically more available to people like me (tallish white-het-cis-man with no kids, good health, and great hair) than it is to most people, but nevertheless it must be a tool in our toolkits.
posted by You Can't Tip a Buick at 3:22 PM on November 3, 2015 [1 favorite]


I don't know who this "we" is, but where I live the average low temperature in January is 14 degrees Fahrenheit, and it's really not possible to live outside in the winter. The suggestion would come off as both misguided and obnoxious, to be honest.
posted by ArbitraryAndCapricious at 3:42 PM on November 3, 2015 [7 favorites]


yeah, point taken. I forget sometimes that most of this continent isn't as temperate as the west coast is — it's probably not surprising that the best organized/most successful/most politically influential tent cities in America are in California, Oregon, and Washington.
posted by You Can't Tip a Buick at 3:53 PM on November 3, 2015


Yeah, camping/roughing it through 90-120 days of 100F+ degree weather each year in Texas (38 Celsius) is not happening for me, either, ArbitraryAndCapricious.
posted by Unicorn on the cob at 3:54 PM on November 3, 2015 [3 favorites]


Clearly our focus on obesity as the biggest public health issue is some fucking bullshit, y'all.

Surely it's a coincidence that some of the biggest drivers in American discretionary consumer spending are clothing and food?
posted by sobell at 4:45 PM on November 3, 2015


Well the study didn't say these people were eating or dressing themselves to death so I don' t know what food and clothing have to do with anything.
posted by Elementary Penguin at 5:24 PM on November 3, 2015 [2 favorites]


I see that the good people of Kentucky (well, 30% of registered voters) just chose a new governor who pledged to shut down the state's ACA exchange and withdraw from Medicaid expansion, depriving about 9% of the state's population of health insurance at the stroke of a pen.

Many of the most ardent conservative voters will have come from the poorest parts of the state. I'd joke about the easy availability of bourbon but those eastern Appalachian counties are mostly dry. At least they have moonshine, weed and heroin.
posted by holgate at 7:48 PM on November 3, 2015 [2 favorites]


Having thought about this for a little while this evening, I wonder how much of this is attributable to 9/11? Even for people not directly affected, the events of that day left a, "generation lost in space, with no time left to start again," to borrow a phrase from Don McLean. People who were near 30 in 2001 are reaching their mid-40s now.
posted by ob1quixote at 10:06 PM on November 3, 2015


People who were near 30 in 2001 are reaching their mid-40s now.

Yeah. And in 2001 a lot of us were just finally getting to our feet after the burst of the dot-com bubble in the late 90's.

Gen-X got shafted, yo.
posted by EmpressCallipygos at 4:48 AM on November 4, 2015 [2 favorites]


Again: this trend started in 1998. I don't think it's about 9/11, and I also don't think it's just about Gen X.
posted by ArbitraryAndCapricious at 5:03 AM on November 4, 2015 [4 favorites]


Surely it's a coincidence that some of the biggest drivers in American discretionary consumer spending are clothing and food?

Clothing and food are both extraordinarily cheap by historical standards and are not what is driving bankruptcies and economic insecurity.
posted by Dip Flash at 5:46 AM on November 4, 2015 [2 favorites]


I'm curious : What is expensive by historical standards? At the provider end, almost everything has grown cheaper, even healthcare, although insurance providers keep the costs high.

Inflation out pacing wages? If so, the maybe food is not historically cheap. I suppose banking services must extract more from corporations now, and definitely extract more from government, but that mostly depresses wages and increases inequality. Inequality itself increases housing costs as landlords prefer to leave flats vacant to gambol on finding a renter who'll pay more rent, but that's part of inflation really.

As an aside, I've never understood how Americans pay so much for services like mobile phones, internet, cable, etc.
posted by jeffburdges at 6:29 AM on November 4, 2015


ft writeup, fwiw...
White, middle-aged, uneducated and dying

there is a stark, stark difference between how my American friends are doing (made the first 20 years of my life, for the most part) and how my French colleagues and friends are doing (met during the second half of my life)

also btw...
America's labour market is not working - "In 2014, 12 per cent — close to one in eight — of US men between the ages of 25 and 54 were neither in work nor looking for it. This was very close to the Italian ratio and far higher than in other members of the group of seven leading high-income countries: in the UK, it was 8 per cent; in Germany and France 7 per cent; and in Japan a mere 4 per cent... does the declining participation of prime-aged adults matter? Yes, it must: it matters if many believe they cannot earn enough in the labour market to support a family; and it matters if mothers lose their connection to the labour market. The relentless decline in the proportion of prime-aged US adults in the labour market indicates a significant dysfunction. It deserves attention and analysis. But it also merits action."
posted by kliuless at 6:40 AM on November 4, 2015 [1 favorite]


I've never understood how Americans pay so much for services like mobile phones, internet, cable, etc.

Local monopolies, technical constraints that make changing mobile provider difficult, etc.

But it's also a reflection of how the US is really fucking big, and that size exerts its own pressure. If you grow up in one of those small towns in sparsely-populated counties and don't have much education, you're less likely to move far -- and definitely less likely to move by choice than necessity. (Signing up for the military is a kind of hardcore GTFO move.) You're always going to be personally car-dependent or rely upon people who drive, likely to be reliant upon convenience stores and Dollar General, some distance from the nearest big supermarket (probably a Walmart) and everything is just plain strung out.

KaizenSoze linked to a piece on Joe Bageant upthread. Bageant noted that Americans had lived that kind of strung-out subsistence for decades, but that external forces after WW2 -- cheap food trucked in along the new interstates, large-scale farms squeezing out smallholders -- turned dirt-poor smallholders into assembly workers at the chicken-slaughterer. His argument was that you can live that kind of strung-out life if you're self-dependent (either individually or as a small community) but once you're beholden to others, you're fucked.

I think NAFTA in 1994 probably a big marker here, not so much as a cause but as a reflection of how the economy had already changed for adults without college educations.
posted by holgate at 6:54 AM on November 4, 2015 [2 favorites]


It's not just middle-aged whites - Kevin Drum
posted by wittgenstein at 9:09 AM on November 4, 2015


I sometimes say talk radio is like pornography for the pleasure of hating your enemies. But then I worry that I use the internet for the same thing.

Agreed. Talk radio is like pornography for the pleasure of hating your enemies ... for people who don't go to internet forums!
posted by theorique at 9:32 AM on November 4, 2015


Hi. I'm 42, gen x, fairly educated and suicide is lame so I guess I'm going to have to try working myself to death while being mostly homeless home free.

I'm posting this from a hammock, a phone, and a solar powered battery charger.

So far it isn't that bad. I'm lucky that I'm in good health, that I have a deep lack of appreciation for consuming or acquiring things I don't actually need, and apparently I have good camping skills accrued after years of being some kind of modern nomad. This year I've camped in weather down to about 0 F where it was REALLY hard to get out of my sleeping bag and go to work at 0 dark 30, but it helps that work involves hot coffee and food.

I have no kids, no real institutionalized debt, no pets or other dependents - no credit, either - and I'm pretty consistently thankful for being a slacker and not buying into either the standard nor deluxe versions of the American Dream, because it has left me mobile, supple, younger than my peers and more flexible in general.

Because unfortunately I'm probably the new American Dream and middle class. I'm mobile. I have free time. I'm not on food stamps or public aid. I have a little bit of discretionary income, which, not-ironically, is either spent at the local bar or having someone else make me a sandwich for once, or on new camping gear to replace the bits that keep wearing out.

You probably have no idea what its like to have a $50 headlamp break in the middle of a gusty rainstorm and trying to find all the little bits of copper that fell out of the broken switch in the dark and wet, but I can assure you it is thrilling and highly engaging. I did find all of the parts, but still had to go buy a new fancy $50 headlamp, because fuck giant wood spiders in your hammock, that's why.

Also, I kind of hate deer. They look and act like food. Dumb, skittish food on stilts. I've secretly taken to chasing them around in the dark as, uh, practice for the future. They seem to be startled about being chased around by a hungry monkey for the first time in decades.

Anyway, I figure I'm getting a head start on my new skill sets. By the time y'all have to flee the cities like I did, I will be more than ready to take to Alaska or the deep Olympics, where I fully expect to be welcomed into the Sasquatch forest cities of the Hoh as a curiosity and genetic missing link.

That or I will have accrued enough solar panels that I can start a tidy business offering USB power to refugees at handsome prices per mAh.

See you soon!
posted by loquacious at 9:56 AM on November 4, 2015 [16 favorites]




That is.... well, okay, one thing that you really want to know about PNAS, where the study wound up, is that PNAS has two routes of acceptance for papers: the ordinary "direct submission" track, where most people submit papers and which is very selective, and also the "contributed" track, which has a much more lax acceptance rate and is actually quite easy to publish from. Of course, to submit a paper to PNAS on that cushy contributed track, you must be a National Academy of Science member... which, incidentally, Angus Deaton is. Glancing more closely at the paper itself, it does look like it was accepted along that track ("...contributed by Angus Deaton"...).

So the fact that this piece kept getting rejected by other prestigious journals but accepted by PNAS, which is itself normally a rigorous and generally well respected journal, is.... tricky. After all, that respectable reputation is built on the selectiveness of its direct submission track, not the contributor track--and even though only NAS members can sponsor contributor track submissions, well, Nobel Prize winners have been known to subscribe to some pretty barmy ideas before. What's to say this work isn't another one? So that WaPo piece does not really inspire as much of a "hahaha those journals are suckers" reaction as that piece seems to think I should have. Instead, I just went "wait, what did JAMA and NEJM catch? I should evaluate this work much more closely and not let PNAS' name sway my opinions on the peer-reviewed validity of its methods and conclusions!"
posted by sciatrix at 12:44 PM on November 4, 2015 [6 favorites]


Agree with the problems associated with "track 2" submissions, but it is worth noting that the JAMA and NEJM submissions look to have been rejected by the editors without giving it a chance for peer review. So I don't think it's a case of the more prestigious journals "catching" something that PNAS didn't.

The linked article also writes this:

The two economists subsequently prepared their work for PNAS, and went through the laborious process of peer review and revision. “We were very concerned that we’d be scooped by someone else,” Deaton said.

In the meantime, Deaton won the Nobel Prize in Economic Sciences.


Which suggests that it both went through peer review and that Deaton was not a Novel laureate at the time of submission. The original article writes that it was reviewed by David Cutler, Jon Skinner, and David Weir, so the reviewers were evidently satisfied enough both with the paper and their job of evaluating it to name themselves publicly.

That being said, there were other journals they could've tried. There is definitely an element of "taking the easy way" with this paper.
posted by kisch mokusch at 12:57 PM on November 4, 2015 [3 favorites]


The Urban Institute ran a similar study focused on women earlier in the year with similar findings.
posted by holgate at 1:37 PM on November 4, 2015 [1 favorite]


sciatrix: wait, what did JAMA and NEJM catch?

I bet - with no special knowledge - that the paper didn't meet the publication guidelines for NEJM or JAMA. Those are medical journals, and using the WP analogy, "The house is burning!" is alarming and all, but isn't a reasonable contribution to the Journal of Fire Prevention and Combat. I could see an editor saying "This is very interesting but not a good fit here" and rejecting it out of hand, and it sure sounds like that's all that happened.

To me this is not a major red flag of any sort.
posted by RedOrGreen at 3:15 PM on November 4, 2015 [5 favorites]




Thanks for linking that, hydropsyche.

I missed that story when it was posted previously. Interestingly that thread contains this prophetic comment from, hobo gitano de queretaro, “I'm voting for heartbreak and abandonment! By life, obviously. It's the same thing that's killing all the unemployable white men. When there's no reason to go on, people don't.”
posted by ob1quixote at 6:33 PM on November 7, 2015




I actually read that when it came out in 2013. And then promptly forgot and when it was posted on Facebook by the SPLC yesterday, I thought it was new. It's a pretty compelling case study of what is happening.
posted by hydropsyche at 3:01 AM on November 8, 2015


More Krugman.
posted by sneebler at 7:27 AM on November 9, 2015 [1 favorite]


Jess the Mess: It seems to me that a lot of white people are also severely lacking a sense of any kind of community.

Is that part of the difference between the White and Hispanic groups? Also it seems like a lot of poor Hispanic people in the US are still working to send money home to relatives in Central America - maybe that gives them a sense of duty to a larger future?
posted by sneebler at 7:35 AM on November 9, 2015 [1 favorite]


A while back, a sociologist did a study of a lethal heatwave in Chicago and found that black people had a much higher death rate than Latino people who lived in very similar low-income neighborhoods. His conclusion, if I recall correctly, was that Latinos tended to have stronger social networks, which meant that elderly people were more likely to have someone to check in on them and notice that they weren't doing well. For similar reasons, men had a much higher death rate than women. So yeah, I think that could be part of it.
posted by ArbitraryAndCapricious at 8:53 AM on November 9, 2015 [2 favorites]


How Class Kills, A.W. Gaffney, Jacobin
posted by the man of twists and turns at 7:36 PM on November 9, 2015 [1 favorite]




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