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ANNE CASE is Alexander Stewart 1886 Professor of Economics and Public Aairs Emerita
at Princeton University, where she is Director of the Research Program in Development
Studies.
ANGUS DEATON is Dwight D. Eisenhower Professor of Economics and International Aairs
Emeritus at Princeton University. He was awarded the Nobel Prize in Economics in 2015.
They are the authors of the forthcoming book Deaths of Despair and the Future of Capitalism.The Epidemic of Despair
Will America’s Mortality Crisis Spread to
the Rest o the World?
Anne Case and Angus Deaton
S
ince the mid-1990s, the United States has been suering from
an epidemic o “deaths o despair”—a term we coined in 2015 to
describe fatalities caused by drug overdose, alcoholic liver dis-
ease, or suicide. The inexorable increase in these deaths, together with
a slowdown and reversal in the long-standing reduction in deaths
from heart disease, led to an astonishing development: life expectancy
at birth for Americans declined for three consecutive years, from 2015
through 2017, something that had not happened since the inuenza
pandemic at the end o World War I.
In the twentieth century, the United States led the way in reducing
mortality rates and raising life expectancy. Many important health
improvements—such as the decline in mortality from heart disease as
a result o reductions in smoking and the increased use o antihyper-
tensives and the decrease in infant mortality rates because o the de-
velopment o neonatal intensive care units—originated in the United
States and precipitated mortality reductions elsewhere as knowledge,
medicines, and techniques spread.
Now, the United States may be leading Western nations in the
opposite direction. Might American deaths o despair spread to
other developed countries? On the one hand, perhaps not. Parsing
the data shows just how uniquely bleak the situation is in the United
States. When it comes to deaths o despair, the United States is