A new study published in the Journal of Epidemiology and Public Health (hat tip reader ma) gives more granular insight into the triggers of so-called deaths of despair, as in the AIDS-level rise of deaths of the middle aged with high-school-only educations. We’ve embedded the study at the end of this post; the data supplement is here.
The article uses a large data set of United AutoWorkers at GM in Michigan, with workers hired as far back as 1938, including mortality information. The authors scrubbed the data to focus those who joined after 1970 in three plants, one in Detroit, one 50 miles west of Detroit, and one in a more rural area. All plants were downsizing prior to their closures in 2012, 2010, and 2014 respectively. Women were excluded because there were so few suicide and overdose deaths among them.
The authors describe the contract terms that suggest that job departures before the age of 55 were likely to be involuntary. They found that employees who stopped working were 16 times as likely to die of suicide or overdose as ones who stayed employed. The odds of death were highest among workers in rural areas, likely due to the difficulty of finding a new job:
Of the three study plants, Plant 2 had the highest incidence rate of suicide in this study. This plant was located at the site of Willow Run, a factory in southeastern Michigan renowned for the mass production of fighter planes during World War II….By 1970, it employed 10 000 workers making automatic transmissions. Plant 2 closed in 2010 as part of GM’s bankruptcy proceedings. In 1970, the population of the surrounding township was 30 000; today it is 20 000.
Nearly all the drug deaths occurred at Plant 2 in runup to its closure. This would also have been during the financial crisis, which could have hit older workers with investments.1
The authors also push back mildly on the popular notion that deaths of despair are a white phenomenon. The plant in Detroit, which did have a lower suicide rate, was where nearly all the African Americans work. Angus Case and Anne Deaton speculated that the higher death rates among lesser educated whites was due to Hispanics and blacks having stronger family/informal social safety nets. That may be conflated by the fact that working class Hispanics and blacks are more concentrated in cities that rural areas, so the quiet impoverishment of rural America would hit older, not well educated whites, who by virtue of being in the most disadvantaged communities, would suffer the most. From the paper:
Case and Deaton were the first to note rising midlife mortality rates among Caucasian, non-Hispanic Americans aged from 35 to 54 with a high school education or less. They identified drug overdose, suicide and alcohol-related liver disease mortality as the causes of the increase and attributed these ‘deaths of despair’ to reduced economic opportunity among less educated adults.
Increases in these ‘deaths of despair’ have since been identified across multiple race and ethnic groups and geographic contexts. Rising mortality rates have been reported for US African Americans, Hispanics, Asians and Pacific Islanders, 25–64 years of age, with drug overdoses the leading cause of the recent increases in all these subpopulations. Reversing decades of steady decline in all-cause mortality for African Americans and Caucasians, these disturbing shifts are particularly pronounced for midlife individuals without a bachelor’s degree. Suicide rates have also increased by 33% since 2000, with the steepest increase for Caucasian men. Though the rise has been less dramatic for suicide than for overdose, it emerged in 2016 as the fourth leading cause of death among adults, aged 35–54. Rural counties had consistently higher suicide rates than metropolitan counties.
The authors take as a given that the “China shock” after its WTO entry in the early 2000s was a crippling blow to US manufacturers already in decline. And just as that policy (as well as NAFTA and successful anti-union efforts) decimated blue-collar workers, studies of variation in state policies suggests that higher minimum wages and earned income tax credits would reduce suicides (but not overdose deaths).
The Detroit Free Press spoke to the UAW about the study:
UAW President Rory Gamble has three words of advice for his family and his union brothers and sisters who are contemplating an early job exit: Don’t do it.
Gamble has been around long enough to see what happens when workers exit a job ahead of retirement age without a “defined path” for the future and the financial acumen to stay solvent.
“They get hit with major disappointment when that package money runs out,” Gamble told the Free Press. “Reality sets in and they lose their health care and that leads to declining health, declining mental health and then you combine that with the mental shock and here we are, we get high incidents of folks committing suicide and dying early.”
Gamble has a growing concern over the high rates of suicide and overdoses among union members. That’s why he said he will encourage his successor to push the Detroit Three automakers, in the 2023 contract negotiations, to provide for added services such as extended mental health and financial counseling benefits as part of any early incentive plans the companies offer union members to leave the job.
“We need to craft language that provides firm support going forward, that helps folks moving forward and helps their transitions,” said Gamble, who has no plans to seek reelection after his term expires in 2022. “I see us doing that, given the numbers.”
The problem, as readers know all too well, on America’s present trajectory with Covid-19, a lot of people are or face the real risk of being out of work, with few ready prospects for re-employment. $1200 checks are better than nothing but they won’t go far. With entire sectors of the economy facing auto-industry level downsizings, on a much more compressed timeframe, desperation will lead to high costs: more deaths, more divorces, more violence at home, more crime. And tellingly, the official fixation is on more policing rather than more jobs and social support.
1 If you pooh pooh the idea, you are showing your class bias. Workers with good paying manufacturing jobs in areas with modest costs of living could accumulate a lot of savings; I know of paper mill workers with ~ $1 million in retirement and savings accounts.