RSF: Beyond Deaths of Despair

The term “deaths of despair” was coined in 2015 by economists Anne Case and Angus Deaton to describe the increasing mortality rate for White Americans without college degrees due to drug over-doses, suicide, and alcoholic liver disease. These deaths were attributed to the despondency experienced by the White working class, who were left behind by changes in the American economy. However, the mortality picture has changed since then. Mortality rates are now rising among both Black and White Americans without a college degree. Nearly all major causes of death are increasing more, or decreasing less, for people without college degrees. The educational gap in mortality has become so severe that, in 2021, adult life expectancy was more than eight years higher among college graduates. In this double issue of RSF, Case, Deaton, sociologist Andrew J. Cherlin, and an interdisciplinary group of contributors move beyond the concept of “deaths of despair” to explore the widening educational gap in mortality. 

Issue 5 provides new perspectives on the education gap in mortality as well as new viewpoints on the non-college population. Christopher L. Foote and colleagues show that much of the educational gap in mortality may be due to smoking. One of the most popular explanations for the growing mortality gap is that college unlocks better job opportunities. However, Sam Arenberg and Sam Stripling find that what may matter for longer life expectancy is not so much having a “good” job as having a job at all, as high school dropouts with jobs have lower mortality rates than college graduates without them. Victor Tan Chen and colleagues reveal that people with opioid use disorders experience “precarity chains”: overlapping, connected hazards that combine to put people at increased risk of substance abuse.

Issue 6 also gives new viewpoints on the non-college population and examines geographic and international variation in mortality. Grace Landrum-Hall and colleagues discover that men with health issues repeatedly enter and exit the formal labor force—referred to as “churning”—owing to inflexible employer policies and insufficient income support program policies. Jennifer Karas Montez and col-leagues show that rural areas and small cities have seen increases in mortality, while large urban areas have seen decreases. Iliya Gutin and colleagues find that the educational gap in health and well-being is typically larger in the US than in Britain. This may be because education in the US—and the resulting higher salaries—allows for more access to health-promoting resources.

This double issue of RSF provides fascinating insights into the stark and alarming mortality gap between those with and without a college degree in the US.