The Epidemic of DespairMarch/April 2020 93hopefully less a bellwether than a warning, an example for the rest o
the world o
what to avoid. On the other hand, there are genuine
reasons for concern. Already, deaths from drug overdose, alcohol,
and suicide are on the rise in Australia, Canada, Ireland, and the
United Kingdom. Although those countries have better health-care
systems, stronger safety nets, and better control o
opioids than the
United States, their less educated citizens also face the relentless
threats o
globalization, outsourcing, and automation that erode
working-class ways o life throughout the West and have helped fuel
the crisis o
deaths o
despair in the United States.AN AMERICAN MALADY
Mortality rates in the United States fell through the last three quar-
ters o
the twentieth century. But then, in the late 1990s, the progress
slowed—and soon went into reverse.
A major reason for the decline in life expectancy is increasing mor-
tality in midlife, between the ages o
25 and 64, when the most rapidly
rising causes o
death are accidental poisoning (nearly always from a
drug overdose), alcoholic liver disease, and suicide. Overdoses are the
most prevalent o
the three types o
deaths o
despair, killing 70,000
Americans in 2017 and more than 700,000 since 2000. The 2017 total
is more than the annual deaths from at its peak in 1995 and more
than the total number o
U.S. deaths in the Vietnam War; the total
since 2000 outstrips the number o
U.S. deaths in both world wars.
The U.S. suicide rate has risen by a third since 1999; there are now
more suicides than deaths on the roads each year, and there are two
and a hal
times as many suicides as murders. In 2017 alone, there
were 158,000 deaths o
despair, the equivalent o
three fully loaded
Boeing 737 jets falling out o
the sky every day for a year.
Younger birth cohorts—Americans born more recently—face a higher
risk o
dying from drugs, alcohol, or suicide at any given age than older
cohorts, and their deaths rise more rapidly with age than was the case for
earlier cohorts. This increase in mortality is similar for men and women,
although the base rates for women are lower; women are less likely to die
by suicide than men and less likely to overdose or to succumb to alcohol.
African Americans did not gure greatly in this trend until 2013;
the subsequent rise in their deaths is attributable in part to a sudden
slowdown in progress against heart disease and a rapid increase in
deaths from drugs laced with fentanyl, a deadly opioid that hit the13_Case_Deaton_Blues.indd 93 1/20/20 7:42 PM