The Value Gap is a MarketWatch interview series with business leaders, academics, policymakers and activists on reducing racial and social inequalities.
Last year, Nobel Prize winner Angus Deaton and his wife Anne Case, both emeritus professors at Princeton University, published “Deaths of Despair,” a much-acclaimed book that delved into why the mortality rate among non-Hispanic white Americans without a college degree has been rising, undoing a century of progress.
They recently released new research that looked at the data through the end of 2019 and into the pandemic and how “deaths of despair” have spread among other groups as well. Their grim finding: For white Americans aged 25-74 who don’t have a college degree, the alcohol-related mortality rate rose 41%, mortality from drugs soared 71% and the suicide rate climbed by 17% between 2013 and 2019. Some of those trends continued into the pandemic.
MarketWatch spoke with Deaton to find out why he and Case believe a college education has become “a matter of life and death.” The interview has been edited for length and clarity.
MarketWatch: Over the past decade, you have been studying “deaths of despair” among blue-collar, non-college-educated Americans. That’s a term your wife and collaborator Anne Case coined. Would you please define it and discuss the trends you have seen up to the beginning of the pandemic?
Deaton: We found there were three causes of death that were rising quite rapidly. One of them was drug overdoses. Another one was suicide. And the third one was alcoholic liver disease. And perhaps the most stunning thing about that increase in deaths was that it was almost entirely confined to people without a four-year college degree.
So, the real important cutoff here is between having a bachelor’s degree and not. When we first wrote about it in 2015, it was confined to white non-Hispanics, but after about 2013, it moved into the African-American community, too.
MarketWatch: Mortality among African-Americans is higher in a lot of different ways. But you’ve also seen the gap between African-Americans who have college degrees and those who don’t.
Deaton: There’s a gap between African-Americans and white non-Hispanics wherever you look. And it’s true for people with a BA and for people who don’t have a BA. But it’s been closing at the same time that the gaps between people with and without a BA have been expanding for both Blacks and whites.
So the biggest gaps now are between people who do and do not have a BA. The gaps between whites and Blacks have been narrowing, though that slowed down over the last few years. And it will slow down a good deal more during COVID.
MarketWatch: You said in your paper that these trends are unique to the United States. You don’t really see them in any other developed country, is that correct?
Deaton: That’s right.
MarketWatch: So this is not just for deaths of despair, but for other kinds of conditions as well, like cardiovascular disease?
Deaton: Right. We’ve been talking about all-cause mortality.
Cardiovascular disease, which is a much bigger killer than pretty much anything else and has been the main driving force of mortality reductions in the last quarter of the 20th century, has really begun to stall out. For people without a BA it has begun to rise.
MarketWatch: So through the end of 2019, you saw these patterns developing over the previous decade?
Deaton: Yes. Starting in the early to mid-90s, the approval of OxyContin was a marker to some extent, and things really took off after that. 2019 was a little bit better than 2018. But [the first few months of] 2020 look much worse.
MarketWatch: COVID started hitting the Northeast heavily around last March. And we’re about a year and a half into the pandemic. How has that affected the trends that you’ve studied?
Deaton: We know bits and pieces, but we don’t have access to the complete set of death records. The last year for which we have that was 2019.
But if you look at the deaths of despair, I mean, that became sort of a political football, because Alex Azar, who was Secretary of Health and Human Services, and President Trump himself had said that lockdowns would be a disaster because thousands and thousands of people would be killing themselves.
MarketWatch: The president actually said more people would die of suicide than of COVID if we didn’t end the lockdowns.
Deaton: From the evidence we have, it’s pretty clear that the suicides that President Trump predicted have not happened; in fact, suicides went down in 2020 compared with 2019. And that seems to happen in pretty much all the countries for which we have data. [A study] in the Lancet showed reductions in suicide in the first six months of the pandemic in 21 countries.
[On the other hand], drug overdoses in the U.S. have risen rapidly during the pandemic. But they were rising very rapidly in December, January, February of 2020, before anyone had ever heard of the pandemic.
MarketWatch: We’ll get back to drugs in a bit. According to the Georgetown Center on Education and the Workforce, a four-year college graduate earns on average 84% more over a lifetime than someone who has only a high school diploma. But you write that a college degree has become “a matter of life and death.” Is it that grim?
Deaton: We already talked about the fact that death rates are going up for people without a BA and going down for people with a BA. That sounds like a matter of life and death to me. But it’s also true that if you fail your BA, they don’t take you out and shoot you.
So I think that statement is correct and also, that the college premium has become enormous. And again, the troublesome thing is not so much the people at the top are doing really well, but the median wage for men without a BA has fallen for 50 years.
MarketWatch: But there are quite a few people who don’t have BAs who are doing really well. I mean, try to get a plumber or electrician or a landscaper these days.
Deaton: That would be great. I’m very happy [if wages are] rising, which they haven’t done for a really long time.
MarketWatch: And the jobs the Labor Department projects will be the fastest-growing over the next 10 years include quite a few like solar photovoltaic installers or occupational therapy assistants—plumbers and electrician are always in demand—that don’t require college degrees, and they pay pretty well.
Deaton: Well, I noticed the CEO of Merck said they’re going to expand their hiring of people without a college degree, so it may be not just the plumbers you’re talking about, but lots of other jobs, for instance, in coding, computer work, and also some other things which currently require BAs.
And we are talking about averages here. Journalists tend to do this all the time; they’ll say, “Well, these people say that GDP is going up, but my uncle Fred, his income went down last year, so they’re wrong.” Well, we shouldn’t be going there. Average means it’s not true for everybody.
MarketWatch: OK. You and Anne Case also write in your paper that these rising deaths of despair among people who don’t have a four-year college degree show that our economy and society are “not delivering for the majority of Americans.” Is that because most Americans are not college-educated?
Deaton: Yes. Two-thirds of them do not have a college degree. It’s an outrage. It’s not just like there’s a few people who didn’t do very well. It’s the two-thirds of the population that don’t have a college degree and it’s unnecessary.
I mean, in a better world, we could arrange our jobs and education system very differently. Look at the Netherlands or Germany, for instance. There are lots of routes to respect and dignity and meaningful work. It’s not all getting the BA. A lot of [German workers] have apprenticeships. There’s great pride in that. The BA has become a condition for dignified work and self-esteem. That’s terrible; that’s not what a BA is for.
MarketWatch: What has changed in America since the 1970s that has led to this horrible situation in so many parts of the country of drug addiction, suicide, and early death?
Deaton: The real bad guys are the people who are pushing drugs, sometimes illegally and sometimes legally. That was one of the great scandals in the U.S., that essentially heroin with an FDA label on (it’s called OxyContin) was pumped out in enormous numbers and individual members of Congress, as we described in “Deaths of Despair,” blocked enforcement efforts to stop this.
These are very well-financed people getting rich by addicting the population. The Sackler family alone made its $13 billion [fortune primarily from OxyContin]. Other countries do not allow that. They use OxyContin in Germany and Britain and France, but it is not pumped out into the general population like that.
But on the other hand, Anne and I would argue that there was just a lot of pain out there, there was a lot of despair, there was a lot of unhappiness, which made fertile ground for evildoers to come in and unleash this wave of addiction and death.
So, what are the underlying things that have made life so difficult over the last 50 years for people without a BA? The obvious candidates are globalization and automation and the lack of good jobs with good corporations for less-educated people. Now, globalization and automation can’t explain that by themselves, because you have those in every country in the world and you don’t get deaths of despair in those other countries.
But the big story, which is what Anne and I write about in our book, is the incredible cost of healthcare coupled with the way it’s funded. One dollar in five in America goes to supporting this obscenely swollen industry. And then we’re financing most of it off less-educated workers. That premium per family is now over $20,000 a year. If you take that over a 2,000-hour work year, it’s $10 an hour that has to be met by the firm. And it either has to come out of profits or out of wages. And that destroys jobs.
Also, there are very few corporations anymore that hire their own food-service workers, their own transport staff, cleaners, or janitorial staff. Those jobs used to be inside large corporations. And there was always a possibility that the janitor could become the CEO, or more realistically, the janitors were part of the firm and that helped give their lives meaning. All that is gone.
MarketWatch: You mentioned in your book the work of William Julius Wilson, who studied what happened to the Black community on the South Side of Chicago when the steel mills shut down. The social breakdown that followed (including declining marriage rates and increased drug use) also happened 20 years later in non-college-educated white working-class communities.
Deaton: Absolutely. When we went to the White House after I won the Nobel Prize, President Obama suggested to us that we explore exactly that parallel, which we did in a whole chapter in the book.
When these jobs go away, it destroys social life and communities come apart and people don’t go to church anymore. It sounds just like what William Julius Wilson described. It is.
MarketWatch: So how is this all connected with politics? You write in so many words that the Democratic Party divorced non-college-educated, blue-collar whites.
Deaton: Absolutely. We’re not the first to say that. After 1968, the Democrats turned themselves into a party of the educated elite and minorities. And Republicans have been more and more representing these less-educated people. Of course, Republicans are also very dependent on financing from corporations and from the rich, and that alliance doesn’t work very well. And so you have maybe half the population just being shut out of politics altogether, whose voice is not heard in Washington.
MarketWatch: So why did so many gravitate toward a Republican Party and Trump who stand for policies that for the most part don’t help them?
Deaton: Because for them, the Democrats are much, much worse.
MarketWatch: Why? Because they help minorities?
Deaton: Well, there is this unpleasant racist part of this, which is that many less-educated whites see Blacks as threatening their way of life and their jobs–
MarketWatch: And immigrants, too.
Deaton: And they see the Democrats on the side of those people and they want that to stop. It was also during the Clinton administration that NAFTA was signed, and [when China was about to enter the World Trade Organization,] Clinton made this wonderful speech where he said, “If you believe in a future of greater openness and freedom for the people of China, you ought to be for this agreement. If you believe in a future of greater prosperity for the American people, you certainly should be for this agreement.”
And they just watched their industries, their jobs being destroyed on the Democrats’ watch. So, I don’t think they particularly favor the Republicans, but they see them as just way better. And the condescension that came out of the election campaign of Hillary Clinton, for instance. If I hadn’t disliked Trump so much–
MarketWatch: The “deplorables” comment?
Deaton: It’s awful. These are good people and they’re having a really rough time.
MarketWatch: So, what’s the answer? I mean if the votes were there in Congress to pass big change?
Deaton: If we had any other healthcare system in the world, that would cut our costs in half [and] liberate an enormous amount of jobs and job opportunities that we used to have that are not there anymore. So, that’s the single most important thing. And it’s not because we want to extend healthcare or give vision care or dental care to everybody. That’s not the point.
The point is just getting costs under control. I really, really believe in the market. But the market cannot deliver healthcare, right? We try and all we do is create a mess of rent-seeking and upward redistribution and this catastrophic healthcare system that hides behind free-market ideology.
MarketWatch: Would it be something like the National Health Service in Britain? Or Canada’s system?
Deaton: Well, you don’t have to go that far. And I know the term socialized medicine really bothers people. You don’t have to have the doctors working for the government, which is what happens with the NHS. But the French don’t do that. The Swiss don’t do that. The Swiss have the second-most-expensive healthcare system in the world. And the difference between the Swiss and the Americans is 6% of GDP, right? So, they’re a third cheaper than we are. That’s 125% of the total amount we spend on the military.
MarketWatch: How about child care?
Deaton: Well, I’m very much in favor of the child tax credit, [which] reduced child poverty in the year it’s been in place by 50%. We have pretty good studies saying that childhood poverty is really bad for people.
MarketWatch: Any final thoughts?
Deaton: I’m not very optimistic. It’s really very hard to see how we get out of this now.
MarketWatch: And the politics seems to be getting worse, not better.
Deaton: That’s what I meant, really.