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Journal Article

Citation

Cayley W. Fam. Med. 2021; 53(3): 232-233.

Copyright

(Copyright © 2021, Society of Teachers of Family Medicine)

DOI

10.22454/FamMed.2021.729703

PMID

unavailable

Abstract

Is capitalism in the United States an engine of general prosperity, or a racket for upward redistribution? In Deaths of Despair, Princeton economists Anne Case and Angus Deaton explore the relationships between economic inequality, health status, and increasing rates of death and suicide among middle-aged White Americans.

The authors (a husband and wife team) relate that the book "was born in a cabin in Montana in the summer of 2014" (p. 1). Their discovery that suicide rates in their rural summer retreat were four times greater than in their home on the East Coast prompted further research into increasing rates of pain and ill health among middle-aged White Americans, and increasing mortality from what they labeled "deaths of despair"--deaths from suicide, drug overdose, and alcoholism. They justify this combined outcome by arguing that all three types of death have in common an underlying degree of intentional or unintentional self-harm, which in most situations can be attributed to a lack of hope.

The book combines meticulous analysis of data with comprehensive historical and social analysis. Its four sections explore historical antecedents of today's economic conditions (Part I: Past as Prologue"), analysis of social data ("Part II: The Anatomy of the Battlefield"), economic realities ("Part III: What's the Economy Got to Do With It?"), and the nature of 21st century capitalism in the United States ("Part IV: Why Is Capitalism Failing So Many?").

Throughout the book, Case and Deaton return time and again to the argument that recent history in the United States has been particularly harsh to Whites without a bachelor's degree. This argument may sound insensitive after 2020 has thrust the realities of racism to greater prominence in our national conversation. However, Case and Deaton point out that while mortality disparities persist between Blacks and Whites, mortality rates for middle-aged Blacks have continued to improve yet mortality rate improvements for middle-aged Whites have stalled. Indeed, they argue that while racial disparities are diminishing for many outcomes, "class divisions are widening, at least if we think of class in terms of education" (p. 185).

Among the causes they identify for increasing deaths of despair among middle-aged Whites without a bachelor's degree are the decline of social and religious institutions, increasing disparity between rural and urban economies, the weakening of unions, and increased outsourcing of work...


Language: en

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