Wednesday, Nov 11, 2015 02:58 AM PST
The decline and fall of White America: Inside the study that has shocked the public-health community
New research from Princeton has shown an all-but-unprecedented increase in mortality rates. Here's what to know
Topics: public health, Demographics, Health, Science, News, Politics News
(Credit: SuriyaPhoto via Shutterstock)A fascinating and disturbing paper from Princeton social scientists Anne Case and Angus Deaton reveals a shocking deterioration of health among what can be called, to echo Michael Harrington’s famous 1962 book on poverty, the Other White America.
The Other White America is made up of the approximately 55 million white non-Hispanic American adults who have no formal education beyond high school. This group compromises a little more than one third of all white non-Hispanics, and includes more than one in every five American adults. If it were an independent nation, the population of the OWA would be larger than the adult population of every European country other than Germany.
The deteriorating health of the Other White America is seen most clearly among its middle-aged residents. In a development that has almost no precedent in the public health statistics of advanced economies, the mortality rate for middle-aged whites with no more than a high school education actually increased by 22.3 percent between 1999 and 2013. This increase correlates closely with educational levels: Over this same time, the mortality rate of middle-aged whites with at least a BA degree fell by 24 percent, which is consistent with the rate of decline in mortality in the rest of the population, both in the United States and in other developed nations.
One aspect of the Case-Deaton study that has gone largely unnoticed is the extent to which it reveals an ongoing intensification of the so-called “Hispanic paradox.” The paradox is this: Normally, socio-economic status, as reflected in education levels and income, correlates well with health outcomes, as indeed it does among the whites in their study. American Hispanics have far less formal education, and make considerably less money, on average, than white Americans. Middle-aged white Americans are three times more likely to have college degrees than middle-aged Hispanics, and are 55 percent more likely to have graduated from high school. Median household income for whites is 46 percent higher than it is for Hispanics.
Despite these differences, which would ordinarily produce far better health outcomes for the more educated and wealthier group, American Hispanics now have longer life expectancies than whites. Indeed, the Case-Deaton study found that, among middle-aged Americans, this gap is growing at a fast pace, as mortality rates among Hispanics continue to drop rapidly, while they are actually rising among whites. The result is that mortality rates for middle-aged whites are now 54 percent higher than for Hispanics.
An even more startling contrast can be found between the mortality rates of Hispanics, and of whites with no more than a high school education. Since approximately 80 percent of middle-aged Hispanics never went to college, the educational credentials of this group largely overlap with those of white Americans with high school degrees or less. Yet the middle-aged members of the Other White America now have a mortality rate that is an astonishing 173 percent higher than that of their Hispanic peers.
What could account for such astounding disparities? Case and Deaton found that most of the increased mortality rates among middle-aged residents of the Other White America could be accounted for by just three interrelated factors: drug and alcohol overdoses, suicide, and chronic liver diseases that are usually a product of long-term alcohol abuse. (These factors are closely related in that the line between deaths formally classified as suicide and other forms of self-destruction can be quite fuzzy).
