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Everyone should be grateful to the Washington Post for following up – in heart-breaking detail – on one of the most tragic and important stories of our time: the mounting mortality crisis among working- and middle-class middle-aged white Americans. At the same time, the Post‘s findings raise as many questions as they answer, significantly complicating the story – and the challenge of reversing these dismaying trends.

This white mortality crisis, you’ll recall, first broke into the news last fall, when Princeton University economists Angus Deaton (the latest Nobel prize winner) and Anne Case published a report solidly documenting the trend and linking it to growing economic insecurity combined with ever more paltry pension plans. Deaton and Case noted pointedly that, although other high-income countries, especially in Europe, had also experienced financial crises, productivity slowdowns, and widening inequality, the worsening white death rates in the United States, which provides fewer social and retirement protections, were unique. The authors also suggested that declining economic expectations hit white Americans’ psyches especially hard, and that non-whites, whose expectations were never as high to start with, found harder times easier to cope with.

As observers – like yours truly – noted, the implications for American politics seemed profound. In particular, I wrote, the Deaton-Case results indicated that outsider Republican presidential candidate Donald Trump was more on-target than even he suspected when he kept complaining that America was getting “killed” by job- and wage-killing trade policies. And in fact, a strong relationship between rising white mortality and resurgent U.S. populism was made clear by the Post last month, when it found a high correlation between concentrations of the mortality problem and support for Trump.

Today’s report, however, adds crucial details indicating that other factors may be at work as well. One such finding: that “the most extreme changes in mortality have occurred among white women….” Women, after all, haven’t suffered nearly as much manufacturing job loss as men – whether it stems from trade policy mistakes or other causes (like factory automation). At the same time, since so many women have entered the U.S. workforce in recent decades – as manufacturing employment has faced more trade and technology pressure – they could well be affected indirectly by industrial job loss, as laid off manufacturing workers had to start competing for jobs in service sectors where women were more numerous.

Also muddying the picture is the big (and overlapping) rural-urban white health divide found by the Post (with “rural” including “small-town America”). In important ways, this geography of the white mortality crisis is consistent with the trade and manufacturing-centered interpretation. As is known by anyone who has traveled extensively around the “rust belt” or the American South, lots of factories have been and still are located in small towns and semi-rural areas, in part because land is cheap.

And reinforcement for this view is found on this map accompanying the Post article.

So many of the orange-brown and dark grey areas in the map on left — which signify counties and regions with the fastest rising white female mortality rates — are places like southern Michigan (think “auto industry”), northern Ohio (autos, steel, and industrial machinery), northwestern Indiana (steel), north central and western New York State (industrial machinery, heating and cooling equipment, railroad equipment, steel), and the Carolinas (where the plunge in textile and furniture jobs hasn’t nearly been offset by newer – often foreign – investments in sectors like aerospace, automotive, appliances, and electronics assembly). (The map on the right shows counties and region where white female mortality is falling.)

Nonetheless, so many of the biggest orange-brown stretches are regions dominated by other parts of the economy. Clearly, the coal industry’s woes bear lots of blame for the mortality crisis in Kentucky, southern Ohio, and West Virginia. And Nebraska, the eastern half of Utah, and the western half of Kansas have never been manufacturing strongholds (though Wichita has long been a major aerospace center).

The variety of local and regional economies involved shouldn’t be surprising. Anything as big as a mortality crisis in such a large segment of the population is bound to have multiple causes – and to resist talking-point-deep explanations and slapdash remedies. But that doesn’t mean the mainstreams of the two major parties shouldn’t be addressing the rapidly deteriorating health of so many Americans much more comprehensively and energetically.

 

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