Case and Deaton Examine Rising Mortality Rates, Part 1

Deaths of Despair

Anne Case and Angus Deaton. 2020. Deaths of Despair and the Future of Capitalism. Princeton: Princeton University Press. (Part 2)

Review by Stephen W. Hiemstra

Even before the corona virus pandemic, life has been difficult for many Americans. For those without a college degree, real incomes have been flat or declining since around 1980. In recent years, we have seen multiple years of declining life expectancy and record levels of suicide, drug overdoses, and opioid deaths. Adding insult to injury, mainstream politicians of both parties have mostly ignored these problems. When I heard about Anne Case and Angus Deaton’s book, Deaths of Despair and the Future of Capitalism, I immediately ordered a copy.


When it is reported that life expectancy has been declining in the United States in recent years, the implication is that death (or mortality) rates are rising. Case and Deaton write:

“Deaths from alcoholic liver disease were rising rapidly too so that the fastest-rising death rates were from three causes: suicides, drug overdoses, and alcoholic liver disease…deaths of despair…The book is about these deaths and about the people who are dying.” (2)

These deaths of despair are preventable, not happening in other industrialized countries, and primarily among middle-aged white, non-Hispanic men (4)—the ones commonly described in popular culture as those benefitting from “white” privilege, which has vaporized in this generation (5). Case Deaton observe:

“The widening gap between those with and without a bachelor’s degree is not only in death, but also in quality of life; those without a degree are seeing increases in their levels of pain, ill heath, and serious mental distress, and declines in their ability to work and to socialize. The gap is also widening in earnings, in family stability, and in community. A four-year degree has become the key marker of social status.” (3)

In part one of this review, I will offer an overview and focus on changes affecting individuals. In part two I will discuss the economic environment that brought about these outcomes.

Background and Organization

Anne Case and Angus Deaton are economists emeriti of the faculty of Princeton University. Deaton won the Nobel Prize for economics in 2015.

Deaths of Despair and the Future of Capitalism is written in sixteen chapters divided into four papers:


  1. The Calm before the Storm
  2. Things Come Apart
  3. Deaths of Despair


  1. The Lives and Deaths of the More (or Less) Educated
  2. Black and White Deaths
  3. The Health of the Living
  4. The Misery and Mystery of Pain
  5. Suicide, Drugs, and Alcohol
  6. Opioids


  1. False Trails: Poverty, Income, and the Great Recession
  2. Growing Apart at Work
  3. Widening Gaps at Home


  1. How American Healthcare is Undermining Lives
  2. Capitalism, Immigrants, Robots, and China
  3. Firms, Consumers, and Workers
  4. What to Do? (vii)

These chapters are preceded by a preface and introduction, and followed by Acknowledgments, Notes, and an index.

Dimming Prospects

A key motivator for writing about deaths of despair starts with a stark economic reality:

“After correction for inflation, the median wages of American men have been stagnant for half a century; for white men without a four- degree, median earnings lost 13 percent of their purchasing power between between 1979 and 2017…. Since the end of the Great Recession, between January 2010 and January 2019 nearly sixteen million new jobs were created, but fewer than three million were for those without a four-year degree. Only fifty-five thousand were for those with only a high school degree.” (7)

The easy summary of this problem is to observe that less educated white American men are substantially less able to participate in the American dream of having a good paying job, a family, a house, medical and pension benefits. Here are talking about 38 percent of the working-age population (4).  Case and Deaton observe:

“Our story of deaths of despair; of pain; of addiction, alcoholism, and suicide; of worse jobs with lower wages; of declining marriage; and of declining religion is mostly a story of non-Hispanic white Americans without a four-year degree.” (4)

Less money, less connection, less religion, less life-expectancy. Without a job, white men are simply shamed as losers. This shame and guilt is currently being turned inward, but the authors note that this is likely soon to turn outward into violence (14). The current political climate suggests that this later outcome is not far off.


Anne Case and Deaton’s Deaths of Despair and the Future of Capitalism provides a detailed look into the disturbing problem of declining life expectancy in America. While in the past poor economic performance has usually been attributed to the entry of poorly educated immigrants, racism, or a multicycle of poverty, the authors point to growing class distinctions correlated with college graduation, an oligopolistic corporate structure, and changing trends in the workforce. Deaths of despair uniquely affect non-Hispanic, white American men. Blue-collar European men face the same economic reality, but have a healthcare plan and have a longer life-expectancy.

This book is well written and documented. It should be required reading for those studying economics and cultural trends, especially presidential candidates.

Case and Deaton Examine Rising Mortality Rates, Part 1

Also see:

Nouwen: Make Space for Self, Others, and God 

Vanhoozer: How Do We Understand the Bible? Part 1 

Books, Films, and Ministry

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