Why poor white Americans are dying of despair

Poor white Americans are dying of despair. And racism is to blame.

A recent social science paper found that middle-aged non-Hispanic white Americans (ages 45-54) experienced a large increase in total mortality between 1998 and 2013. If the mortality rate had instead continued falling on its previous trend, it would have prevented nearly half a million deaths over that 15-year period.

A mortality increase like this is basically unheard of in the developed world — be it Sweden, France, Australia, Korea, or Japan, continuing economic growth has meant corresponding decreases in mortality. That normal downward trend also holds for other demographic groups in the United States. African-Americans still experience an absolute mortality rate higher than whites, but their rate still fell sharply over the study period — meaning the ratio between black and white mortality rates shrank from 2.09 to 1.40 between 1998 and 2013. Meanwhile, U.S. Hispanics were near whites in 1998, but have since fallen far below (keeping almost exactly even with Great Britain's rate, as it happens).

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The increase in white deaths is entirely concentrated among people with a high school degree or less, a good proxy for poverty. Meanwhile, mortality rates have continued to decline among whites with any college attendance.

What's behind the increase in poor white deaths? Well, they are dying not of disease, but of suicide, chronic alcohol abuse, and especially drug overdoses. As Paul Krugman writes, it resembles "the collapse in Russian life expectancy after the fall of communism."

Why? American poverty is increasingly brutal. Male wages at the bottom fifth of the income ladder, for instance, have fallen by over 30 percent since the late 1960s, and inequality has exploded. These days, those in the top 1 percent capture virtually all economic growth.

Other countries have responded to similar trends by building a strong welfare state: universal health care, free education and college, disability and unemployment insurance, maternity leave, a child allowance, paid vacation, and so on. With economic growth plugging along, there is more social product to fund generous services — thus ensuring that just about everyone has at least a decent standard of living. That is behind the broadly improving mortality rates in other nations.

But America has been extremely stingy about putting welfare where it's really needed. Fifty years after we got insurance coverage to the elderly and most of the poor, we just barely got a halfway-decent framework for covering everyone else who didn't have it (which still needs a ton of work). Direct cash aid to the poor was basically killed under Bill Clinton. And we are nearly alone in the world in providing no maternity leave or child allowance. (It's important to note that we do spend about as much as sensible countries on welfare, it's just that a huge portion of it is funneled straight to the rich through tax expenditures.) As a result, the white American poor — like Dylann Roof's friends — are economically insecure and deeply alienated from mainstream society.

Why didn't America build the economic structures that would ensure economic growth was broadly shared? There are many reasons, but perhaps the biggest one is racism. Research shows that American voters are less likely to support a generous welfare state because of racist attitudes; historical studies demonstrate that the New Deal was politically acceptable only insofar as it excluded blacks.

Ta-Nehisi Coates has emphasized that white supremacy is a positive interest. White people weren't tricked into their lousy welfare state; it was what they wanted. Better to keep blacks at the very bottom of the social castes than risk joining them in last place, even if that would be a better absolute position.

But we can see today that there are concrete and unintended side effects to this preference. Whether poor whites are individually racist or not, racism is literally killing them.

Martin Luther King spoke to this point, in his final sermon before he was assassinated. He related how once when he was in jail in Birmingham, he debated the white prison guards about segregation. But eventually the subject turned to the guards' own lives (and it's really worth listening to):

When King said the same forces keeping down African-Americans are also hurting poor whites, he obviously didn't mean they experience the same racism. What he meant, I think, was that racism is the ultimate force behind a constellation of other proximate oppressions — lack of health insurance, bad schools, low wages, unemployment, and so forth — but when a white person is poor, they experience many of those same problems.

Obviously the situations of poor whites and blacks were not identical back in 1968. Today as well, poor whites are less likely than poor blacks to be imprisoned, killed by the police, die early, and so on.

But poor whites are still getting ground into mulch in this country — and it's getting worse over time. Jim Crow is long dead; the real social advantages to simple whiteness (as opposed to somewhat less brutalization) are eroding over time. At this rate, in another decade or so poor whites will be about even with blacks on mortality, and might even catch them in imprisonment. Last place is coming up to meet them, whether they like it or not.

As King might say, if they knew what was good for them, poor whites would join hands with their black brothers and sisters, and help build a society that provides a decent standard of living for everyone, without exception.