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Speaker 1: I kind of feel like we talked about a lot

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Speaker 1: of you know, depressing and alarming things on this show.

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Speaker 1: We're not We're not happy of bunch, are we? They

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Speaker 1: called the dismal science for a reason, though I can

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Speaker 1: they do? They do? Hi, and welcome back to Bloomberg Benchmark,

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Speaker 1: a show about the inner workings of the global economy.

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Speaker 1: I'm Tori Stillwell and economics reporter for Bloomberg News, and

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Speaker 1: I'm recording today out of our DC newsroom, and I'm

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Speaker 1: joined by my co host, Akio, our Benchmark editor in

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Speaker 1: San Francisco. Hey Hockey, Hey Tory. How's it going Pretty good?

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Speaker 1: Pretty good? Although I don't know today's topic is on

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Speaker 1: the morbid side, I would say I kind of feel

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Speaker 1: like we talked about a lot of depressing and alarming

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Speaker 1: things on this show. We're not happy of bunch, are we?

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Speaker 1: They called the dismal science for a reason, though I

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Speaker 1: can they do? They do? Well? You know, I promise

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Speaker 1: to all our listeners, I promised at the show. However

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Speaker 1: depressing and alarming it's going to be, It's also going

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Speaker 1: to be totally interesting and reveting too. Let's dig in. So,

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Speaker 1: the National Center of Health Statistics came out with a

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Speaker 1: report recently that looked at US suicide rates for different

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Speaker 1: races and ages from nineteen nine to fourteen, so the

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Speaker 1: last fifteen years or so, and all around it was

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Speaker 1: a pretty bleak picture, right. So the report showed that

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Speaker 1: suicide rates age adjusted in America was gosh, twenty four

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Speaker 1: percent higher in fourteen than it was in nine. Suicides

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Speaker 1: went up for men and for women in every single

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Speaker 1: age group under seventy five, and during that time frame,

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Speaker 1: the suicide rate for white females ages forty five to

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Speaker 1: sixty four rose eight percent and was three to four

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Speaker 1: times higher than for females in other racial and ethnic groups.

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Speaker 1: In fact, meanwhile, here black males, actually we're the only

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Speaker 1: racial and ethnic group of either sex to have a

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Speaker 1: lower suicide rate in compared to nine. So what does

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Speaker 1: this all have to do with economics? For that, we're

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Speaker 1: going to need an economist with us. Is in case,

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Speaker 1: a professor of economics and public affairs at Princeton. She's

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Speaker 1: done some amazing work on the rise of both mortality

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Speaker 1: and morbidity among white Americans in the twenty one century.

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Speaker 1: And you actually might remember her co author on this

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Speaker 1: work from one of our very first episodes. His name's

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Speaker 1: Angus Deaton. He is not only the winner of the

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Speaker 1: Nobel Prize for Economics, but is also Anne's husband. And

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Speaker 1: thank you so much for joining us today. That's my

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Speaker 1: pleasure to be with you. So and we talked about

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Speaker 1: suicides a little bit earlier in this show, but your

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Speaker 1: work dealt with more than just that, just looking at

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Speaker 1: morbidity and more stality broadly in midlife for white Americans.

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Speaker 1: Could you just boiled your research down to a sentence

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Speaker 1: or two? What was the gist of what you and

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Speaker 1: ang Is found when we looked both at morbidity and mortality.

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Speaker 1: The mortality increases that we saw among people in midlife

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Speaker 1: white non Hispanics and midlife we're being driven by what

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Speaker 1: we call deaths of despair, so drug overdose suicide, alcohol

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Speaker 1: related liver deaths. And underneath that layer of mortality, we

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Speaker 1: found a lot of what we call morbidity, so poor

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Speaker 1: health among whites and middle age, poor mental health, a

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Speaker 1: lot of pain, a lot of difficulty with activities of

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Speaker 1: daily living, reports that they're unable to work. And so

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Speaker 1: when you put that together, it paints a picture of

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Speaker 1: some despair among especially working class whites in America. And

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Speaker 1: I think what was really striking about your research was

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Speaker 1: that that wasn't always the case that these mortality rates,

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Speaker 1: they were going down for white Americans until the late nineties,

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Speaker 1: and then after that they started taking back up. That

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Speaker 1: isn't what we saw in other advanced countries in Europe, right,

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Speaker 1: That's exactly right that in the US, after almost a

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Speaker 1: century of uninterrupted progress when it came to lower mortality

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Speaker 1: rates both among people in middle age and in older ages,

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Speaker 1: suddenly in the late nineteen nineties we saw that kind

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Speaker 1: of progress stopped dead and for people in some age

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Speaker 1: groups actually begin to reverse and go in the wrong

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Speaker 1: direction altogether. Whereas in name your favorite European country, mortality

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Speaker 1: rates in middle age continue to fall at about two

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Speaker 1: percent a year, which is what was happening in the

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Speaker 1: US until the late nineteen nineties. So that is really

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Speaker 1: one of the underlying questions. Why did the US leave

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Speaker 1: the herd? So what made us differ? And have you

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Speaker 1: found the answer to that question. We are hard at work.

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Speaker 1: We're back in the weeds right now looking for answers.

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Speaker 1: Of course, everyone we talked to on every politician you

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Speaker 1: hear no see answer but what do they say it? Uh.

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Speaker 1: It depends on who's doing the talking. So it can

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Speaker 1: be anything from the fact that jobs that were good

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Speaker 1: jobs in the US left the country they were sent to, say,

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Speaker 1: to Cambodia or to Vietnam. It could be some politicians

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Speaker 1: think that it's Obamacare backfiring on itself, although this crisis

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Speaker 1: began way before the Obama administration. Uh. Some people think

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Speaker 1: it's just that America is not great anymore, and that

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Speaker 1: once America is great again, people will uh stop killing

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Speaker 1: themselves in such large numbers, slowly with drugs and alcohol

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Speaker 1: or quickly with a gun. So and can you walk

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Speaker 1: us through I guess the health side of this then?

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Speaker 1: What is leading people to, uh, I guess, use more

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Speaker 1: drugs or to kill themselves as a mental illnesses? What

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Speaker 1: sort of health factors I guess are behind this increase

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Speaker 1: in mortality and morbidity with middle aged whites, well Tory.

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Speaker 1: At this point it's really speculation. But on the morbidity side,

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Speaker 1: when things that we can actually measure, it certainly is

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Speaker 1: the case that people's mental health has suffered in the

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Speaker 1: last fifteen years. So every year the National Health Interview

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Speaker 1: Survey asks a very large nationally representative group of people

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Speaker 1: about their mental health and UM they could. They score

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Speaker 1: the answers, and year on year from through fourteen, the

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Speaker 1: scores have gotten worse on average for people in whites

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Speaker 1: and middle age. People's reports of say sciatica, of chronic

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Speaker 1: joint pain, of neck pain, of face pain, all of

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Speaker 1: those markers of pain have increased as well, and when

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Speaker 1: asked about activities of daily living, a significantly higher number

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Speaker 1: report that they have difficulties socializing with friends. Now we

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Speaker 1: know pain and social isolation are both triggers for suicide,

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Speaker 1: for example, and those things have risen um in tandem

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Speaker 1: over the last fifteen years. Now, what's under that? That's

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Speaker 1: what we're at work trying to unearth. Is it the

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Speaker 1: case that we are just much more socially isolated and

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Speaker 1: that puts people at risk? I mean, that might be

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Speaker 1: something that's different between the US and say, our sister

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Speaker 1: countries in Europe, And we don't know the role yet

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Speaker 1: that is played by stronger social safety nets which the Europeans,

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Speaker 1: the Canadians, the Australians have relative to the US. We

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Speaker 1: don't know the role yet of having access universally to healthcare.

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Speaker 1: Those are roles that those play still don't really need

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Speaker 1: to be investigated. And and and then a different avenue is

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Speaker 1: to look at what's happened to the American employment patterns,

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Speaker 1: since this is a crisis that's really hit people with

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Speaker 1: a high school degree or less, and those are people

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Speaker 1: in the US who used to be able to get

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Speaker 1: with a high school degree, a good job, a job

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Speaker 1: with on the job training, which may be very important,

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Speaker 1: a job where they could move up with that training,

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Speaker 1: and that those jobs are gone, those jobs aren't coming back.

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Speaker 1: Those jobs would have had benefits, those jobs would have

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Speaker 1: had healthcare. And it may not just only be the

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Speaker 1: loss of those jobs that have left the country, but

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Speaker 1: when say a manufacturing center closes down, the local tax

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Speaker 1: base implodes the local schools who can't support themselves as well.

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Speaker 1: So it may be that working class people look at

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Speaker 1: their children and think that their children and are not

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Speaker 1: going to have the same kind of um promising avenues

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Speaker 1: that they themselves thought they might have. So there may

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Speaker 1: be an intergenerational part of this as well, of people

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Speaker 1: not knowing whether or not the future looks any brighter

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Speaker 1: for their own children. And that's that's I mean, that's

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Speaker 1: so fascinating one on your first point, that we could

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Speaker 1: talk about social isolation in an age where things like

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Speaker 1: Facebook and Twitter and Instagram and all these new things

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Speaker 1: are supposed to be bringing us closer to people and

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Speaker 1: helping connect us to people all over the world. And

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Speaker 1: so I just think it's fascinating that isolation is still

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Speaker 1: an issue. Perhaps I think it really is an issue,

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Speaker 1: even in the age of Facebook. We know that divorce

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Speaker 1: rates may have something to do with this. If if

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Speaker 1: people are divorcing at higher rates than they may spend

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Speaker 1: more time alone, that's still to be invest deicated. It's

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Speaker 1: also possible that people may look at each other's Facebook

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Speaker 1: pages where they see here I am on my fabulous

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Speaker 1: vacation and my life is fabulous, whereas underneath that there

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Speaker 1: may be all a much bigger story, not all of

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Speaker 1: it looks as bright and sunny as is portrayed on Facebook.

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Speaker 1: And so whether these people feel socially isolated, or whether

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Speaker 1: they feel like they lost a sense of purpose in

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Speaker 1: their lives um or are financially struggling because they lost

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Speaker 1: their job, you know, the idea is that maybe they're

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Speaker 1: turning to alcohol or drugs in their despair, and they

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Speaker 1: end up dying a premature death right, Well, that is

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Speaker 1: that is certainly one of the stories that one can tell.

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Speaker 1: Now whether or not that those are really the underlying drivers.

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Speaker 1: We we have a lot of work to do, looking

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Speaker 1: small geographic area by small geographic area in the US

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Speaker 1: to try to see whether or not the data are

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Speaker 1: consistent with that story. And we should know more a

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Speaker 1: lot more about that once we actually do the work.

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Speaker 1: And so now we're actually in the process of doing

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Speaker 1: the work, and that's going to take some time. Well,

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Speaker 1: we're going to take a quick break and when we

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Speaker 1: come back, we will have much more to talk about,

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Speaker 1: including why and this is a question I'm particularly interested in,

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Speaker 1: why aren't we seeing similar trends in non white communities.

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Speaker 1: So we're going to talk a little bit about that

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Speaker 1: and hopefully more about some of these economic reasons behind

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Speaker 1: the increases that we're seeing after this break, so maybe

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Speaker 1: zooming out a little bit before we kind of go

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Speaker 1: into the why and the consequences a little bit more.

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Speaker 1: This is an amazing statistic for our listener. So if

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Speaker 1: mortality rates for white Americans contin hinue to decline that

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Speaker 1: way that they were up to the late nineties, half

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Speaker 1: a million deaths could have been avoided between nine and

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Speaker 1: two thousand and thirteen, almost five hundred thousands, So that's

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Speaker 1: basically equivalent to the number of Americans who have died

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Speaker 1: from AIDS. Whatever is causing this, and isn't it fair

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Speaker 1: to call this an epidemic depends on how you want

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Speaker 1: to use the word epidemic. It certainly is something that's

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Speaker 1: widespread in every state in middle age. On average, people

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Speaker 1: in whites and middle age are reporting themselves in worse

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Speaker 1: health than they did fifteen years ago. In all census regions,

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Speaker 1: the suicide rates are up, and all all census regions,

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Speaker 1: the the reports of social isolation are up. So it

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Speaker 1: is certainly happening throughout the country. So if you want

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Speaker 1: to call it an epidemic using that as your definition,

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Speaker 1: then it is kind of a very quiet epidemic. And

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Speaker 1: actually the five hundred thousand number, we want to back

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Speaker 1: off of that a little bit because some of those

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Speaker 1: um some of those deaths are probably due to the

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Speaker 1: fact that it took women longer to stop smoking than

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Speaker 1: it took men. Women took it up later and they

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Speaker 1: stopped later. So in the US, some of those deaths

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Speaker 1: are actually probably due to cancer and heart disease related

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Speaker 1: to cigarette smoking. That's still working its way out. But

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Speaker 1: if you just some the numbers of people who died

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Speaker 1: in this century in the New century from suicide, from

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Speaker 1: drug overdose, from alcohol related liver mortality, if the rates

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Speaker 1: of those deaths had stayed at what they had been,

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Speaker 1: say in then in the period between two thousand and

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Speaker 1: two thousand and fourteen, about three hundred thousand people aged

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Speaker 1: thirty five to fifty nine would not have died of

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Speaker 1: the deaths of despair. So it's the same order of

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Speaker 1: magnitude as the number of people who died and have

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Speaker 1: A little a little bit lower, but same order of magnitude.

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Speaker 1: Although the AIDS crisis got a lot of attention, whereas

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Speaker 1: this really has been a very quiet, if you want

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Speaker 1: to call it epidemic, a very quiet epidemic. And so

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Speaker 1: far our discussion has been about white, middle aged Americans.

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Speaker 1: Why aren't we seeing um I guess problems or increases

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Speaker 1: in mortality and morbidity at the same magnitude for other races.

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Speaker 1: That is a terrific question. Happily, the mortality rates for

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Speaker 1: African Americans in middle age is falling even quicker than

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Speaker 1: it is in among our European counterparts. And mortality rates

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Speaker 1: for Hispanics is falling at exactly the same rate as

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Speaker 1: our European counterparts. So it's about two point six percent

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Speaker 1: per yor for blacks and about two percent a year

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Speaker 1: for Hispanics. And why is it the case that this

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Speaker 1: big cloud has not landed on their heads? So we

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Speaker 1: we can again, we can speculate at this point, we

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Speaker 1: don't have any firm answers. Part of the drug overdoses

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Speaker 1: come from the availability of prescription opioids, which started in

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Speaker 1: the mid nine nineties and gain speed and gained speed

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Speaker 1: with the introduction of drugs like oxy cotton. And there's

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Speaker 1: a small literature that suggests that African Americans were discriminated

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Speaker 1: against if they presented with the same level of pain,

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Speaker 1: doctors were less likely to prescribe them heavy duty opioids

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Speaker 1: than they would be if a white presented with the

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Speaker 1: same level of pain. So so while that kind of discrimination,

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Speaker 1: there's no room for the kind of discrimination. But at

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Speaker 1: the same time, that may be one of the explanations

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Speaker 1: for why the opioid part of this did not land

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Speaker 1: on the heads of African Americans. It's also the case

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Speaker 1: that pharmacies in the inner cities UH, some of them

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Speaker 1: don't want to actually stock opioids because it makes them

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Speaker 1: a target for people to come and steal the opioids,

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Speaker 1: which in some communities have actually become a currency of

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Speaker 1: sorts that you can actually trade things for drugs as

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Speaker 1: if the drugs were money. We think of the opioids,

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Speaker 1: we think we hear being angesty and my co author

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Speaker 1: and I as being one of the proximate causes for

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Speaker 1: this epidemic. But it's just approximate cause, like what causes

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Speaker 1: people to reach for those drugs? They're available, but they're

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Speaker 1: available in Canada as well. Why is it that in

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Speaker 1: the US it's really become such a killer, and why

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Speaker 1: has it become such a killer for whites? We don't

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Speaker 1: really have an answer. So African Americans and Hispanics, are

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Speaker 1: they reporting the I guess the same amount of pain

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Speaker 1: or the similar increases in pain or is that different

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Speaker 1: as well? So there's been no decrease, no decline in

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Speaker 1: UH self reported health among African Americans. There has been

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Speaker 1: a small increase in reports of pain, UH not as

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Speaker 1: large as seen in the UM white non Hispanic community.

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Speaker 1: But no, but but certainly there has been an increase,

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Speaker 1: but they're the deaths of despair for African Americans, meaning drugs, suicide,

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Speaker 1: alcohol have been falling for people in their thirties. It's

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Speaker 1: been constant for people in their forties into their early fifties,

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Speaker 1: So that we don't see the same dramatic increase that

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Speaker 1: we've been seeing from age thirty to age fifty nine

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Speaker 1: in the white community. And and if I understand that,

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Speaker 1: if I understood the data are correctly in your in

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Speaker 1: your study, Hispanic and Black Americans actually are less likely

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Speaker 1: to die at middle age and white people are at

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Speaker 1: this point. Is that right? No? No, So the mortality

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Speaker 1: rates for African Americans is still higher than UM it

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Speaker 1: is for white non Hispanics. Hispanics actually have lower mortality

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Speaker 1: rates than UM than much wealthier white non Hispanics. UM.

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Speaker 1: That's another puzzle for demographers. Why it is that it's

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Speaker 1: called the Hispanic paradox. Why it is that Hispanics actually

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Speaker 1: do have much better reported health and have lower mortality

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Speaker 1: rates and higher life expectancy rates than whites. But among

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Speaker 1: African Americans, while there's been real progress. Uh, there is

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Speaker 1: still a gap between black and white mortality, with blacks

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Speaker 1: having higher mortality than whites. It's but it has been

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Speaker 1: falling and the gap has been closing. Unfortunately, part of

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Speaker 1: the gap closing has come from the fact that white

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Speaker 1: mortality rights have increased. I mean, you want everybody to

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Speaker 1: get to the frontier. You don't want it the gap

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Speaker 1: to close because you know, whites are are doing worse

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Speaker 1: than they had been doing. You want to see everybody

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Speaker 1: doing better. Right you know, Let's let's say, come November,

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Speaker 1: whoever becomes the president, she or he calls you up

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Speaker 1: and says, look, I've seen your paper. There's a clear

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Speaker 1: crisis among middle age white Americans right now. What should

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Speaker 1: I do? What would your policy advice be? That is such?

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Speaker 1: That is such a multilayered question, and until we really

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Speaker 1: find our way back out of the weeds and have

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Speaker 1: a better sense of how much of this is about

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Speaker 1: job loss, how much of this is about social connection,

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Speaker 1: It's it would be hard for me, and of course

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Speaker 1: I'm an academic, so it's hard for me to say

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Speaker 1: I have the answer and this is what it is,

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Speaker 1: and this is what your policy should look like, but

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Speaker 1: I think economists in general are true believers in education.

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Speaker 1: And one of the things that happened but between the

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Speaker 1: late nineteen seventies and today is that the premium and

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Speaker 1: the labor market forgetting a college degree went from about

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Speaker 1: higher pay for people with a college degree to something

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Speaker 1: like above what people with a high school degree could earn.

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Speaker 1: So part of these people in middle age now came

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Speaker 1: of age in the late nineteen seventies and we're making

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Speaker 1: decisions about the course of their lives before they had

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Speaker 1: any reason to understand that there was going to be

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Speaker 1: this wedge that was going to be driven between their

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Speaker 1: earnings and the earnings of people who went on to

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Speaker 1: get more education. So I I think also watching the

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Speaker 1: quality of public schools a road is very bad for UH,

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Speaker 1: the morale of people and throughout the country, and so

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Speaker 1: I think actually shoring up our schools would be a

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Speaker 1: long run approach to this problem. A short run answer

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Speaker 1: is going to be as much as there's pushback against it.

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Speaker 1: I'm with the c d C and in saying that

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Speaker 1: doctors should probably have to have some education UH specific

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Speaker 1: to prescribing these really heavy duty opioids. The A M

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Speaker 1: A is against it, but I think that given that

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Speaker 1: we are currently prescribing enough prescription painkillers to medicate every

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Speaker 1: adult America kind of around the clock for a month,

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Speaker 1: we are prescribing enough that we probably need to make

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Speaker 1: sure we know what we're doing. Yeah, it's it's amazing

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Speaker 1: to hear you talk about this because it sounds like

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Speaker 1: these economic factors that are increasing white middle aged mortality

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Speaker 1: and morbidity are are the same ones that are fueling

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Speaker 1: a lot of the rhetoric that we're seeing in this

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Speaker 1: election season. So, um, it's I think this is a

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Speaker 1: really important trend to keep an eye on in terms

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Speaker 1: of for for I guess that and momentum there as well. Yeah,

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Speaker 1: there was a really interesting article in the Washington Post, uh,

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Speaker 1: and during this primary season where they took states and

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Speaker 1: broke the states down into their counties and looked at

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Speaker 1: the primary results and saw really clear pattern that in

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Speaker 1: the counties where the death rates in middle age were higher,

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Speaker 1: the Trump votes were much stronger. So I thought that was, um,

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Speaker 1: quite quite interesting. I think both on the on the

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Speaker 1: right with Donald Trump and on the left with Bernie Sanders, Uh,

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Speaker 1: there is a real sense of community that feels like

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Speaker 1: they haven't been heard for a very long time, and

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Speaker 1: part of that comes out in these data on how

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Speaker 1: they're reporting their health and on mortality. Wow, that's a

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Speaker 1: lot to think about, um, And maybe to avoid ending

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Speaker 1: on such a dark note, UM, maybe I can ask

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Speaker 1: a lighter question to wrap this all up. What's it?

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Speaker 1: There are a lot of economists, I think, who where

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Speaker 1: the wife and the husband worked together on research. What's

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Speaker 1: it like to do research with your husband? It's it's terrific.

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Speaker 1: I mean, it's not that we don't have enough to

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Speaker 1: talk about without talking about work, but it's really nice

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Speaker 1: to to work with someone who shares the same kind

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Speaker 1: of passion for the work that I have. So I'm

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Speaker 1: just I'm lucky enough also to be married to someone

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Speaker 1: who just won the Nobel Prize, which has had the

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Speaker 1: effect of sprinkling fairy dust on our lives. And um,

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Speaker 1: that has been a really terrific experience. So, UM, I

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Speaker 1: it's not for everybody. I think for some people it's

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Speaker 1: really nice to be able to leave things at the office.

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Speaker 1: We never leave things at the office, which certainly, you

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Speaker 1: know you can you can imagine the downsides of that,

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Speaker 1: but it's also incredibly exciting to just always feel like

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Speaker 1: they're we have At any point, we could be saying, oh,

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Speaker 1: I have this idea about what this might be, and

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Speaker 1: then share it and then you know, uh, I think

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Speaker 1: about ways to dig into it. Yeah, that's terrific. Well,

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Speaker 1: and thank you so much for joining us today. It was.

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Speaker 1: It was great speaking with you, really my pleasure. Thanks

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Speaker 1: a lot, and thanks to you all for listening. Benchmark

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Speaker 1: will be back next week and until then, you can

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Speaker 1: find us on the Bloomberg Terminal and Bloomberg dot com,

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Speaker 1: as well as on iTunes, pocket Cast, and Stitcher. While

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Speaker 1: you're there, take a minute to rate and review the

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Speaker 1: show so more listeners can find us and let us

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Speaker 1: know what you thought of the show. You can talk

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Speaker 1: to us and follow us on Twitter at seven and

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Speaker 1: that Tory stillwell. And for our listeners who aren't on Twitter,

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Speaker 1: you can also email our producer alec at a McCabe

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Speaker 1: m c c a b e at Bloomberg dot net.

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Speaker 1: See you next week