April 7, 2021 - 11:23am

Before Covid, there was another epidemic — the opioid epidemic.

In fact, as Anne Case and Angus Deaton of Princeton University have shown, the problem isn’t only the fatalities caused by opioid misuse, but also other forms of drug overdose, suicide and alcohol-related liver disease.

Described by Case and Deaton as “deaths of despair”, these scourges have had a measurable impact on mortality trends in America. Indeed, the problem was serious enough to send a century-long trend of ever-increasing lifespans into reverse.

It is not an equally distributed phenomenon. The rise in deaths of despair is overwhelmingly concentrated among poorer Americans. The size of this effect is shown in new research from Case and Deaton published in the Proceedings of the National Academy of Sciences.

The authors analyse figures for “expected years of life from 25 to 75”. In a population where everyone died aged 25, the expected years of life would be zero. If, on the other hand, everyone reached their 75th birthday then the figure would be 50. 

In the following chart, we see a long-term increase in expected years of life that peaks in the early 2010s and then, disturbingly, starts to decline. That’s bad enough, but the authors then present separate figures for people who have a four year degree (shown on the chart as “BA or more”) and for those who don’t (“No BA”):

Expected years of life from 25 to 75 by BA status. Credit: Proceedings of the National Academy of Sciences

As you can see, the whole of the decline is concentrated among the less educated part of the population. Among graduates, expected years of life continues on an upward trend. In other words, class-based inequalities are widening.

But what about racial inequalities? In another chart, the authors show separate trends for black and white Americans (also broken-down by education and sex):

Expected years of life from 25 to 75 by race, ethnicity, and sex.

This shows that racial inequalities certainly exist — with black Americans at a disadvantage to their white counterparts. However, the racial gap has narrowed considerably for both men and women over the last three decades — in clear contrast the widening class gap. That’s an irony given just how intensely focused US politics is on race right now. 

Of course, lifespan isn’t the only measure of inequality. Nor does any recent improvement in racial justice erase centuries of slavery, segregation and racism. 

Nevertheless, on this most basic measure of well-being, the class gap (as signified by level of formal education) is now much bigger than the race gap. As the authors put it: “those with a college diploma are more alike one another irrespective of race than they are like those of the same race who do not have a BA.”

It’s clear that something has gone very badly wrong for working-class Americans of whatever race. While Covid-19 is likely to bury this underlying trend under a flood of excess deaths, it doesn’t mean that America’s social emergency has gone away.

Peter Franklin is Associate Editor of UnHerd. He was previously a policy advisor and speechwriter on environmental and social issues.