Anne Case and Angus Deaton96
ticularly badly, and its long-standing increase in life expectancy has
plateaued. These dolorous trends, in the United Kingdom as in much
o the rest o northern Europe, come mostly from increased mortal-
ity—or slowdowns in the decrease o mortality—among the elderly.
This trend is in sharp contrast to what has happened in the United
States, where the biggest increase in mortality from all causes has
been among middle-aged people vulnerable to both the rise in deaths
o despair and the slowdown in progress against heart disease. Those
over 65 in the United States have not been aected much, although
there are signs now that the youngest people still considered elderly—
those between 65 and 69—are beginning to experience increases in
mortality from drugs, alcohol, and suicide.WORKINGCLASS ELEGY
What is causing deaths o despair in the United States, and can those
causes translate to other countries, either now or in the future? There
has been a long-term, slow-moving undermining o the white working
class in the United States. Falling wages and a dearth o good jobs have
weakened the basic institutions o working-class life, including mar-
riage, churchgoing, and community. The decline in marriage has con-
tributed signicantly to the epidemic o despair among those with less
than a four-year college degree: marriage rates among that group at
age 40 declined by 50 percent between 1980 and 2018. With lower
wages, fewer poorly educated men are considered marriageable, and
this has given rise to a pattern o serial cohabitation—when individu-
als live with a number o partners in succession without ever getting
married—with the majority o less educated white mothers having
children out o wedlock and with many fathers in midlife separated
from their children, living without the benets o a stable and suppor-
tive family life. These trends among less educated Americans—declines
in wages, the quality and number o jobs, marriage, and community
life—are central in instilling despair, spurring suicide and other self-
inicted harms, such as alcohol and drug abuse.
The Great Recession that began after the nancial crisis o 2008 has
caused much pain in the United States and elsewhere. But it did not
spark the epidemic o deaths among the U.S. working class. Even
though the recession worsened the conditions o many people’s lives
and stoked anger and division in both the United States and Europe, it
was not an immediate cause o deaths o despair. These deaths were13_Case_Deaton.indd 96 1/20/20 5:03 PM