Posts Tagged ‘mortality’

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Special mention

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mortality

We don’t need Louisiana Detective Rodie Sanchez coming out of retirement to solve the crime against the members of the working-class currently being committed in the United States.

We already know many of the details of the crime. We also know the identities of both the victims and the serial killer. The only real mystery is, what’s the country going to do about it?

The investigation itself is being painstakingly carried out by Anne Case and Agnus Deaton (pdf). They show, with abundant statistics, that mortality trends in the United States run counter to those in other rich countries, where they have been steadily declining for decades.

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The headlines, of course, have been about one group—middle-age white non-Hispanics with a high-school degree or less—whose mortality rates, especially those attributed to “deaths of despair” (drug overdoses, suicides, and alcohol-related liver mortality), increased from 1998 through 2015.* The focus in on that group for a number of reasons, including the fact that increasing rates for them (as against blacks and nonwhite Hispanics) have all but erased the racial gap in mortality among non-college-educated Americans—and, of course, because of the prominence of “white working-class” voters in explanations of Donald Trump’s electoral victory.

But we also need to go beyond the headlines and understand that, while rates for different ethnic and racial groups in the United States have moved in opposite directions in recent decades, the rates for working-class blacks and Hispanics are still very high—and, in recent years (as can be seen, in the case of blacks, in the chart at the top of the post), they’ve also begun to rise.

That’s the real crime story. All three groups within the American working-class—whites, blacks, and Hispanics—are being killed at abnormally high rates compared to the populations of other rich countries.

And the serial killer? Case and Deaton have a much more difficult time working in this area. That’s because they follow the headlines and emphasize the differences in the long-term trend rates and lose sight of the larger picture. So, they discount the role played by income inequality and, instead, endorse Charles Murray’s story about the decline in traditional American virtues among working-class whites (which I wrote about back in 2012).

The fact is, the labor-market factors identified by Case and Deaton—which have negatively affected whites, blacks, and Hispanics with a high-school degree or less—have become more severe as inequality has soared and the social safety net ripped apart in the United States from the early 1970s onward. The upward trend for whites and the narrowing of the racial gap, as significant as they are, shouldn’t hide from view the more general problem (as I wrote about in 2015) of a large and growing gap between the life expectancies (for both men and women) of those at the top and bottom of the distribution of income in the United States.

American TV is currently captivating viewers with stories of people accused of committing horrific acts. It’s time, however, to focus on the story of an economic system that has created its own killing fields.

 

*Mortality increases for whites in midlife have also been paralleled by morbidity increases, including deteriorations in self-reported physical and mental health, and rising reports of chronic pain.

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One of the consequences of the unhealthy healthcare system in the United States (not to mention the obscene level of inequality) is a very high maternal mortality rate—higher than in all other OECD countries except Mexico.

According to the authors of a new study published in Obstetrics & Gynecology (pdf),

Despite the United Nations Millennium Development Goal for a 75% reduction in maternal mortality from 1990 to 2015, the reported (unadjusted) U.S. maternal mortality rate more than doubled from 2000 to 2014. As we have shown, most of the reported increase in maternal mortality rates from 2000 to 2014 was the result of improved ascertainment of maternal deaths. However, combined data for 48 states and the District of Columbia showed an increase in the estimated maternal mortality rate from 18.8 in 2000 to 23.8 in 2014, a 26.6% increase. Notably, the smaller increase seen in the adjusted data appears to be a result of earlier estimates of the U.S. national rate being substantially underreported. Clearly at a time when the World Health Organization reports that 157 of 183 countries studied had decreases in maternal mortality between 2000 and 2013, the U.S. maternal mortality rate is moving in the wrong direction. Among 31 Organization for Economic Cooperation and Development countries reporting maternal mortality data, the United States would rank 30th, ahead of only Mexico. . .

the maternal mortality rate for 48 states and Washington, DC, from 2000 to 2014 was higher than previously reported, is increasing, and places the United States far behind other industrialized nations. There is a need to redouble efforts to prevent maternal deaths and improve maternity care for the 4 million U.S. women giving birth each year.

The U.S. maternal mortality rate is clearly moving in the wrong direction—and it will continue to do so unless and until Americans do something to transform the healthcare system and solve the problem of inequality.

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The historical trend in health and mortality in the United States has mostly been a story of health improvements, medical triumphs, and longer lives. For example, in 1950 the death rate per 100,000 Americans was 1,446. By 2014 the rate had fallen to exactly half that—to 723.

But that seems to be changing. The preliminary 2015 numbers from the Centers for Disease Control and Prevention show a bump up to 729.5. It’s the first time in a decade that the mortality rate actually rose.

Experts said the current rise was surprising.

“We are not accustomed to seeing death rates increase on a national scale,” said Andrew Fenelon, a researcher at the C.D.C. who did not work on the paper. “We’ve seen increases in mortality for some groups, but it is quite rare to see it for the whole population.”

He added that it would drag the United States further behind its European peers: “Many countries in Europe are witnessing declines in mortality, so the gap between the U.S. and other countries is growing.”

If these preliminary numbers are confirmed, then the end of the downward trend in the mortality rate is an indicator of much larger problems—not only in the healthcare system, but in the wider society.

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A new study by Barry Bosworth, Gary Burtless, and Kan Zhang (pdf, as discussed here) reveals that (looking at mid-career earnings) the life expectancy gap between those at the top and bottom of the distribution is growing.

For example (from the bottom half of the chart above), for 50-year old women in the top one-tenth of the income distribution, women born in 1940 could expect to live almost 6.4 years longer than women in the same position in the income distribution who were born in 1920. For 50-year old women in the bottom one-tenth of the income distribution, they found no improvement at all in life expectancy.

Longevity trends among low-income men were not much better: Men at the bottom saw only a small improvement in their life expectancy (of 1.7 years) compared to a much large increase for men at the top (8.7 years). So, the life-expectancy gap between low-income and high-income men increased just as fast as it did between low- and high-income women.

This growing gap in life expectancy has lots of different implications, such as the long-presumed progressivity of Social Security payouts (since low-wage contributors receive monthly checks that are a higher percentage of the monthly wages they earn during their careers than high-income participants). But, according to this and similar studies, we’re learning that the growing mortality differences between rich and poor are offsetting the redistributive tilt in Social Security’s benefit formula.

Perhaps even more important, the mortality gap is challenging our long-held expectation that successive generations live longer than the generations that preceded them. For the past three decades, however, improvements in average life spans at the bottom of the income distribution have been negligible while those at the top continue to grow.

What this finding suggests is that it’s not just income and wealth but life itself that has grown starkly more unequal in the United States.

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While we’re on the topic of capitalism and mortality, there’s another new study, discussed by Ana Swanson, that shows are jobs are literally killing us.

The data show that people with less education are much more likely to end up in jobs with more unhealthy workplace practices that cut down on one’s life span. People with the highest educational attainment were less affected by workplace stress than people with the least education, the study says.

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Our jobs are killing us—and more of us with harder jobs and fewer years of education—because of long hours and shift work, the lack of health insurance and paid time off, and job insecurity.

If capitalism is creating the kinds of workplace conditions that lower workers’ life expectancy, then perhaps it’s time to create other kinds of jobs, outside of capitalism.

We have years of life to gain.