With a long history of bipartisan support for corporate power and profit and continued systemic racism and neglect of basic needs, the United States is failing to provide basic resources and security to all its residents. These are the underlying causes of falling life expectancy, falling family formation, family stress, insecurity, and increasing mental distress, domestic violence and child abuse and deaths, including from drug use, alcoholism and suicide (deaths of despair). These are the catastrophic consequences. It is important to recognize the systemic causes and enter the fight for a new politics.
"We examine mortality differences between Americans adults with and without a four-year college degree over the period 1992 to 2021. Mortality patterns can provide evidence on how well society is functioning, information that goes beyond aggregate measures of material wellbeing. From 1992 to 2010, both educational groups saw falling mortality, but with greater improvements for the more educated; from 2010 to 2019, mortality continued to fall for those with a BA while rising for those without; during the COVID pandemic, mortality rose for both groups, but markedly more rapidly for the less educated. In consequence, the mortality gap between the two groups expanded in all three periods, leading to an 8.5-year difference in adult life expectancy by the end of 2021. There have been dramatic changes in patterns of mortality since 1992, but gaps rose consistently in each of thirteen broad classifications of cause of death. We document rising gaps in other wellbeing-relevant measures, background factors to the rising gap in mortality, including morbidity, social isolation, marriage, family income, and wealth.
"Death is particularly indicative of societal failure when it is not due to a widespread infectious disease—like COVID-19—or even to failures in the medical system, but to self-inflicted causes like suicide, alcoholism, or drug overdose. An examination of the mortality gaps between more and less educated Americans can tell us how the U.S. economy is performing, not just on average, but for the majority of its population, those without a college degree. The division by education is in many ways an alternative to discussions of income distribution, for example by looking at outcomes at selected percentiles, and is a useful supplement to analysis by race and ethnicity.
"We identify the causes of death that make the largest contribution to these widening gaps, particularly “deaths of despair”—from drug overdose, alcoholic liver disease, and suicide—as well as deaths from cancer, cardiovascular disease, chronic lower respiratory diseases, and diabetes. The differential mortality experiences of those with and without a college degree come not only from direct effects of education on individual health, for example through health behaviors or enhanced ability to deal with life, including the healthcare system, but also from broader social and economic forces in the communities where people work and live. Who does or does not complete a four-year degree is also likely to depend on health, a selection effect.
"Direct and indirect forces affect health. Among them are the increasingly difficult job situation for less-educated workers and the long-term negative impacts of a deteriorating labor market on their marriages and the communities in which they live. (The recent tight job market has improved matters but, as has happened in the past, the benefits may not last.) There is also an important recent literature on the negative effects on health of corporate-sponsored laws passed in Republican-controlled state legislatures—regarding minimum wages, right to work laws, pollution, guns, and tobacco taxes and controls—all of which are likely to differentially hurt working-class Americans.
"As we turn from death to life, and document the levels and trends in a range of outcomes for the more- and less-educated adult populations. Our underlying supposition is that the widening mortality gaps have their roots in differential life experiences between the two groups. Over a range of wellbeing-relevant outcomes, people with a college degree have fared better than those without. , We document the college divide in material wellbeing, morbidity, marriage and religiosity; in the last section of this paper, we update these estimates for marriage and for morbidity, including mental distress, as well as for family income and wealth. The post-1992 period saw major changes in mortality patterns, including those for cardiovascular disease mortality— whose longstanding decline came to a halt—and those for several cancers, where there have been many improvements. Mortality from deaths of despair grew markedly over this period."
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