Anne Case and Angus Deaton
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streets in 2013. Until then, the epidemic o deaths o despair was
largely con¥ned to white non-Hispanic Americans.
The increase in deaths o despair has been almost exclusively among
Americans without a four-year college degree. A bachelor’s degree ap-
pears to be a shield against whatever is driving the increase in deaths
from drugs, alcohol, and suicide. The proportion o the midlife popu-
lation with an undergraduate degree has changed little in recent years,
so any possible changes in the type o people who graduate from col-
lege are not what’s shaping this pattern. It was long believed that sui-
cide was an aÊiction o the more educated. The suicide rates for the
more and less educated in the United States are virtually identical for
people born before 1945, but they diverge markedly by education for
those born later in the century: for Americans born in 1970, for ex-
ample, the suicide rate for non-college graduates is more than twice
that o college graduates. About two-thirds o white non-Hispanic
Americans do not have a bachelor’s degree, 42 percent o the adult
population, and it is this group that is most at risk o deaths o despair.ACROSS THE POND
The United States is not entirely alone in seeing a rise in deaths o
despair. These three categories o death are, o course, present every-
where, but most rich countries show no upward trend. The exceptions
are the English-speaking countries, which all show some increase
since 2000, although their mortality rates from deaths o despair re-
main much lower than those o the United States. No other country
has seen parallel increases in all three kinds o deaths o despair, nor
are their rates o such deaths close to those in the United States.
The United Kingdom oers an informative case. Deaths o despair
in England and Wales have risen steadily since 1990. There was a
large upsurge in alcohol-related liver mortality in the 1990s and early
years o this century, but that has subsided in recent years. Suicide
rates have risen since 2000, but most o the growth in deaths o de-
spair comes from drug overdoses. Deaths o despair are now more
common in midlife than deaths from heart disease, long a major killer.
But despite those unfortunate trends, the mortality rate from deaths
o despair in England and Wales is still less than hal o the rate in the
United States. (One black spot in the United Kingdom as a whole is
Scotland, where, thanks to illegal drug use, the rate o deaths from
drug overdose is almost at the U.S. level.)