Deaths of Despair and the Future of Capitalism

"This book fits in the category of ‘very important economics books’, which the FT prize has identified and brought out right from the start. Angus Deaton won the Nobel Prize in economics and Anne Case is a very respected empirical economist. They’re looking at something that’s at the very core of Trumpism, the plight of white working-class Americans in the early 21st century. They’ve done a lot of digging into the data for rising suicide rates and deaths from drugs overdoses and alcohol abuse —the ‘deaths of despair’ of the title—and how and why those have gone up. It’s essentially a book about some of the human economic pain that lay behind Trump’s success. They lay the blame very strongly on the US healthcare system, particularly the way in which opioid prescription has turned into an epidemic of addiction. They also try to propose some answers that might be turned into policy. With the presidential election this year, this is a book that’s been taken up very strongly as one of the data points, if you like, for explaining what’s going on behind the extraordinary divisiveness and inequality in the United States. It’s US-specific analysis, but one that has wider implications for the way in which we think about economic and cultural divisions around the world. The book very clearly and starkly illustrates the problems in the US. Ed Luce—our Washington-based commentator, who has himself written books about the state of the US— reviewed the book for us. He took issue with the idea that discrimination against whites has become as big a problem as discrimination against Blacks and other minorities, which is what the authors say more than half of white working-class Americans believe. His view is that there is much more to the alienation of the white working class than racial envy (I’m citing Ed because I have not travelled as widely in the US as he has). “They’re looking at something that’s at the very core of Trumpism, the plight of white working-class Americans in the early 21st century” So there is some speculation in the book, an element of controversy. They’re not just using the empirical data. But, arguably, that’s what makes it a more interesting book. It’s not simply a list of the charts that they might have put out to their students and followers among economists. It is an attempt to shape and direct policy and insert that into the presidential campaigns. Yes, though I think there are elements in the policy part of the book that don’t look big enough, given the scale of the problems that they describe. Obviously, they’re working within a US system but, from the outside, a lot of the policy prescriptions that even candidates that are supposedly left-of-centre come up with look rather pallid. Also, I don’t think there’s much in their policy prescriptions that looks at the cultural elements that seem to me, as a non-economist, to be so important when you’re looking at the mudslinging that’s been going on between the two halves of the US political environment."

"It’s a really important book. It pulls together the work that they’ve been doing for a number of years now, looking at the fact that, for the first time, life expectancy in the US is falling, and falling very unequally. They have identified this phenomenon of white high-school dropouts who are falling victim to deaths of despair—suicides, opioids and other overdoses, and alcoholism. By bringing together all of this evidence, they have put a spotlight on the phenomenon. “The ‘beyond-GDP’ debate has definitely got an extra boost as a result of what’s been happening this year” It’s linked, obviously, to broader questions about the economic future of certain places in the United States, where the economic purpose seems to have evaporated as a result of all the changes in the economy. It’s also linked to the role of education and the way that the rewards to skills have continued going up, with skilled people congregating in big cities and the diverging fortunes of people in different places. There are lots of potential explanations for broad social trends like this. They don’t try to identify in any detail which ones in particular are the most important. But I think the key thing that they have highlighted that’s new is the education gap. If you’ve got a four-year college degree, things are getting better, and if you have dropped out of high school, things are getting worse, to the extent that such people are dying younger. US life expectancy has been diverging from other rich countries since the mid-1990s, but it’s only since 2015 that it’s actually been declining in absolute terms. For this to happen in an advanced country that claims to be one of the richest in the world is absolutely staggering. There aren’t easy solutions. Complex phenomena never admit of one simple thing that you can do. I think that takes us back to this broader debate about how to equip people for a massively changing economy, something that I think policymakers everywhere have failed in. And, because the US has no universal health care and people therefore fall between the gaps in terms of care, it manifests itself in this total failure of capitalism. If capitalism doesn’t give us progress over time, what’s the point of it?"