Monday, November 28, 2016

The White Man's Burden: Drugs, Drinking, Suicides Up Since 2000

More nonsense has been written about white nationalism/supremacy in the wake of Donald Trump’s election than anyone should have to read. So, it is a pleasure to find some actual data analysis on the role of the non-college educated white citizen in the success of the Trump candidacy, especially versus Mitt Romney’s failed 2012 campaign.

The Economist has determined health status explains the Trump vote better than being a non-college educated white citizen does. The sicker you are, the more likely you are to have voted for Trump. Non-college educated whites are also likely to be sicker, so the two variables are not independent. Nevertheless:

Although we could not find a single factor whose explanatory power was greater than that of non-college whites, we did identify a group of them that did so collectively: an index of public-health statistics. The Institute for Health Metrics and Evaluation at the University of Washington has compiled county-level data on life expectancy and the prevalence of obesity, diabetes, heavy drinking and regular physical activity (or lack thereof). Together, these variables explain 43% of Mr. Trump’s gains over Mr. Romney, just edging out the 41% accounted for by the share of non-college whites.

(“Illness as an Indicator,” The Economist, November 19, 2016, available at

Okay, so let’s get this straight: Obamacare had been signed in 2010, but did not provide subsidized benefits until 2014. The people who should have been most grateful for Obamacare rejected it in the 2016 election, more than they had in 2012. (Romney also ran against Obamacare.) The Economist column also cited a 2015 paper by Nobel-award winning economist Angus Deaton, which shows significant deterioration in health metrics among middle-aged, non-college educated whites since around the turn of the millennium:

Fig. 1 shows a cessation and reversal of the decline in midlife mortality for US white non-Hispanics after 1998. From 1978 to 1998, the mortality rate for US whites aged 45–54 fell by 2% per year on average, which matched the average rate of decline in the six countries shown, and the average over all other industrialized countries. After 1998, other rich countries’ mortality rates continued to decline by 2% a year. In contrast, US white non-Hispanic mortality rose by half a percent a year. No other rich country saw a similar turnaround. 
The mortality reversal was confined to white non-Hispanics; Hispanic Americans had mortality declines indistinguishable from the British (1.8% per year), and black non-Hispanic mortality for ages 45–54 declined by 2.6% per year over the period.

(Anne Case & Angus Deaton, “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century,” Proceedings of the National Academy of Sciences, vol. 112, no. 49, December 8, 2015, pp. 15078-15083.)

As I noted previously, there has been a significant increase in government dependency for health care since 1997, and that shift from job-based benefits might have had a negative impact on this population. However, the crisis among middle-aged, non-college educated whites is not directly to do with the health system. Drinking, drug abuse, and suicides all increased significantly in the last two decades.

Whether President Trump’s plan to “Make America Great Again” will restore the previously positive 20th century trend of mortality improvement for non-college educated whites is a question that will be examined carefully in the years to come.

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