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Another Epidemic Rises



This second epidemic is not of disease, like COVID-19, but of despair–within a certain demographic of American men.

As I said in my last post, the main thing we’ve wanted to do since the beginning of the COVID-19 crisis is to get back to normal. I had no idea, however, that there is a “new” normal afoot. It is one we may want to check, not return to. And I learned about it from an article a friend shared that appeared in The New Yorker. The title is “The Blight,” and it was written by Atul Gawande.

Atul Gawande

The title refers to an epidemic of despair that may be far more deadly than the COVID-19 virus if it continues. And this is a matter of special interest to Gawande because, in addition to being a wonderful writer, he is a surgeon whose MD is from the Harvard School of Medicine. He learned about the epidemic from the book Deaths of Despair and the Future of Capitalism by two married Princeton economists, Ann Case and Angus Deaton. (Angus is also a Nobel Prize winner.)


The bulk of Gawande’s article traces the research that took Ann and Angus to their conclusion about the evolution of the new normal. The catalyst was Ann’s curiosity about the economic impact of the kind of chronic pain from which she suffered in her back. She had already become known for her research on the connections between health and economic patterns. In 2014, she took a new tack with the question whether chronic pain had diminished in the United States over the last few decades. Much to her surprise, in spite of labor-saving technologies and advanced medical treatment, it had actually increased–and especially among people in their 50s. Some one hundred million Americans suffer from it.

Soon Angus joined in the research to find the links that would explain why.  One after another, they discovered the following details:

  • Communities with higher rates of chronic pain also had higher rates of suicide.
  • Chronic pain and suicides had risen significantly among middle-aged, non-Hispanic white Americans, but not among black or Hispanic Americans.
  • Not only suicides but also all forms of death were rising among middle-aged whites.
  • All forms of death included death by drug overdose and alcohol-related liver disease as well as suicide.
  • The highest death rates from suicide, drug overdoses and alcohol-related disease were occurring among working-age white men and women who did not have college degrees.

At one point, the combination of the above factors had proven so devastating that for three years the life expectancy for all Americans fell. And from 1999 to 2017, more than 600,000 deaths more than the demographically predicted number occurred among people age 45 to 54.


The economists coined the term “deaths of despair” for deaths caused by suicide, drug overdoses, and alcoholism. As their work progressed, they learned that although the incidence of such deaths was concentrated among working age white men with no college degree, there was no connection with poverty. There was, however, a close connection with joblessness.

Now for the statistics. Apparently the upward trend of deaths of despair began in the late 60s. At this time, 95% of men of prime working age (25 to 54) had jobs. By 2010, only 80% did. As the economy recovered from  the Great Recession, that figure rose a little to 86%. Per capita economic growth that had averaged between two and three percent a year after World War II has sunk to less than 1.5 percent during the last decade. And consider these points:

  • Among men with no college education, median wages have flattened since 1979.
  • Work is harder for the less educated to find and is less stable.
  • Work hours are more uncertain, and employment is of shorter duration.
  • Employment often takes the form of gig work, temporary contractual work, or just day labor.
  • Employment is less likely to come with benefits.

Now let’s look at the subject of benefits. We all know that the cost of healthcare has soared, and the best way to get insurance is through an employing corporation. Gawande cites a study showing that earnings for laborers fell 21% between 1970 and 2016. However, including benefits, compensation rose 68%. That looks good, but Gawande says that “increases in health-care costs devoured take-home pay.” At the same time, opportunities to work were dropping as corporations strove to replace laborers with automation or to seek cheaper labor overseas.


As a result of all of the above, the white working-age labor force began to “succumb to despair,” as Gawande puts it, and many men stopped looking for work. The response has not been compassionate. The argument goes, as Gawande puts it, that “People are taking the lazy way out of responsibilities. . . and so they choose alcohol, drugs, and welfare and disability checks over a commitment to hard work, family, and community. And now they are paying the price for their hedonism and decadence–with addiction, emptiness, and suicide.”

Unfortunately, prior to the publication of the book by Ann and Angus, there had been no major effort to analyze and address the decline of the working class. Now it is clear that something has “gone profoundly wrong with the American Dream,” as Gawande says. Our response so far has been to focus on the development of addiction-treatment centers and suicide-prevention programs rather than digging down among the roots of the problem. One result is a palpable anger stirring among the white men who are rapidly losing financial ground, status, and health. CORVID-19 will wreak more devastation, and there will be consequences.

Ann Case and Angus Deaton

My personal perspective now intrudes. These working-class white men who feel devalued are men we all have encountered or know as friends and neighbors, and their specialized skills have proved very valuable time and time again. They know how to design things, build things, repair things, fix things, and create order and efficiency for those of us who are kind of clueless in this regard. We need them, and we’re probably going to need them a lot more if it takes longer than we hope to constrain the COVID-19 pandemic. Beyond recovery, I think we need to figure out how to create a respected and generously compensated space for them in our economy.


As with the premiere of the Crip Camp documentary, the timing of publication of the Deaths of Despair and the Future of Capitalism relative to our pandemic will bring special attention to their subject matter, and this is fortuitous. As I mentioned in my earlier blog, America quarantined is also a time for America to think. And the question on countless fronts is how we can return to an “improved” normal.

But maybe I’m addressing the wrong readers. Can some of you pass this on to your grandchildren? Just kidding. Like Ann Case and Angus Deaton, I think we all have time enough left to do a few good things for the collective.









One Response to “Another Epidemic Rises”

  1. Les Fenter

    “Like Ann Case and Angus Deaton, I think we all have time enough left to do a few good things for the collective.”

    I believe many men find purpose in their jobs, moreover, careers. Have seen so many of my contemporaries retire then return to workforce in same or different capacity. Yeah, yeah, we suggest a hobby. That just does not satisfy the need I’m referring to. Unless coupled with philanthropy, a hobby is only temporarily satisfying. Yes, it’s nice to be recognized among your peers for your good hobby work. (I’ve been recognized multiple times for my carvings. Don’t get me wrong, it feels good when it happens and the plaques are nice on the wall.) But true satisfaction comes when one makes a difference. That’s what your lasts statement offers.
    Yeah. I’d like to help my older guys get a grip. My philanthropy in recent times has been my Middle School mentoring. And it is VERY satisfying. Perhaps I will find a way to get back to that. That is what I call getting closer to the root cause. If we can help others discover their potentials, won’t that help them reach for it?