In the midst of our current pandemic, it’s hard to think of anything else. The disease COVID-19 has taken the oxygen out of the air. It’s interesting to compare this epidemic with the other one that’s had so much attention in this neck of New York: the opioid epidemic. Given recent research into what are being called “deaths of despair,” deaths by drug overdose, alcohol abuse and suicide, a comparison sheds light on concerns that we’ll still be fighting upstate long after the coronavirus.
The coronavirus epidemic began far away, but quickly became global. The opioid epidemic, on the other hand, is not global — it’s an American problem. It started with drug companies underplaying the addictive nature of new, easily available prescriptions. It continued to grow with other illegally obtained drugs.
The coronavirus is highly contagious, and so far has hit urban areas worst. The opioid epidemic spread slowly and most persistently into rural and poor areas. The coronavirus is more dangerous for the elderly, while opioid fatalities have affected working-age adults 30 – 60 years disproportionately.
The opioid epidemic can affect anybody, but by far it hits the unemployed and uneducated most. It has taken more than a decade for victims and their families in the U.S. to begin to get enough help from public health officials and policy makers.
The statistics for suicides made two economists, Anne Case and Angus Deaton, take a close look what they saw as an astonishing rise of suicide among middle-aged whites. Their new book “Deaths of Despair and the Future of Capitalism,” demonstrates that deaths of all kinds were on the rise for this age cohort. While the world’s population has grown healthier and lived longer, men and women in the U.S. of working-age are dying at rates so high that they lowered life expectancy across the board for our country for three consecutive years.
In the past, this lower life expectancy trend had only occurred from pandemics like the flu epidemic of 1918 or world wars. Now, upon closer examination, Case and Deaton found that between 1999 and 2017 more than 600,000 Americans between the ages of forty-five and fifty-four died from “extra deaths” due to suicide and self-poisoning (drug over-doses and alcohol-related deaths). These are the deaths caused by despair.
Trying to understand why the American Dream was eluding so many at an age when Americans often have their best health and best economic footing, the economists looked for causes. Was it the opioid phenomenon? They conclude opioids didn’t cause the despair among the white working class, but fed upon people who were already at loose ends. It did affect the less educated, however, since only about 9 percent of opioid deaths in the past 25 years were Americans with college degrees. When other possible correlations were tracked — obesity, poverty, and income inequality — the patterns didn’t overlap. Similar numbers of troubling deaths showed up among all categories of weight. Rather surprisingly, patterns of poverty and inequality also didn’t correspond with patterns of death by region or race.
What does correspond strongly with the deaths of despair, according to Case and Deaton’s research, is the rate of employment in a given region: the greater the number of working-age people without jobs, the higher the rate of deaths of despair, whether it is drug overdoses, suicide, or alcohol-related liver disease.
We hear of low unemployment in very recent years, but many of these jobs are low paid, unstable, and less likely to have benefits. In the 1960s only 5 percent of men in their prime (ages 25 – 54) did not have jobs. By 2010 those without jobs grew to 20 percent. By 2018, after what’s called the “recovery “ from our 2008 recession, 14 percent still did not have jobs. Of that number, only 20 percent reported that they were looking for work, so 80 percent of these without jobs weren’t counted officially as unemployed.
Oswego is no stranger to poverty and underemployment. The city of Oswego and Oswego County Opportunities came out with a report in 2017 on area poverty entitled LIFT. It demonstrated many areas of concern related to poverty, including the fact that “Oswego County has suffered from a persistently higher unemployment rate than New York State and the United States for at least the past 15 years. Over the past eight years, Oswego County has averaged an unemployment rate a full two percentage points higher than New York state.”
The LIFT report details how lack of education has aggravated unemployment locally, stating Oswego “County and city residents with less than a high school degree are substantially less likely to be in the labor force Only 47 percent of city residents and 52 percent of county residents without a high school degree are in the labor force, as compared to 60 percent in the state and 61 percent in the nation.”
Among our older population, “57 percent of city and county adults between the ages of 55 and 64 are in the workforce, compared to 66 percent of older adults in the state and 64 percent in the nation.”
Since we know that there are fewer good jobs for those without college and without high school degrees, the low 2016 high school graduation rates for Oswego County and the state’s low-income students — 70 percent and 72 percent, respectively — are a serious concern. The lower yet rate of 59 percent for the city of Oswego’s low-income students is downright alarming.
In the past 50 years — all my adult lifetime — I’ve witnessed the deterioration of pay and changes in the structure of work for people without (and even some with) college education.
Wages have gone down, not just flattened. Jobs don’t last as long, and many are temporary or part-time without benefits.
The majority of American workers are valued less and less as companies seek cheap labor globally and put shareholders’ interests above the interest of their U.S. workers. Here in the wealthiest country, economic and social stress have grown relentlessly, creating a sector that has reasons to despair and be angry. Why is the increase in “deaths of despair” happening here far more than elsewhere?
Case and Deaton look at the usual suspects: the availability of drugs; the easy access and unusually high ownership of guns (which are used in over half of our suicides); automation and globalization; the loss of protections once won by labor unions; and corporations’ push for profit at the expense of wage earners. But they find another surprising factor: it’s that our health care system is so costly for employers that insurance premiums amount to “a perverse tax on hiring lower-skilled workers.”
Here’s how: The Kaiser Family Foundation tells us that the average health insurance policy for families costs employers $21,000, of which employers generally pay 70 percent. When a business hires a well-paid worker at $125,000, that worker’s health benefit adds less than 12 percent to the employer’s cost. If that business hires a low-paid worker for a salary of $25,000, the same health benefit costs the employer 58 percent more. Our health system incentivizes businesses not to hire low-skilled workers.
While wages for laborers have fallen, the cost of health benefits to employers has skyrocketed. The employer-based structure of our health care system works against hope for gainful employment among our working class. Until we change that system so that health care costs are paid by wage-based taxes, our system penalizes those who aren’t educated. Our economic and health policies are connected. They breed anger and hopelessness. The result is more suicides and drug and alcohol- related disease and deaths.
The U.S. is pouring dollars into clinics and programs to prevent suicide and cope with the opioid epidemic, and yet the rates of suicide and life-threatening addiction remain very high. The state and federal interventions against the opioid epidemic are valuable, but they only treat the symptoms. Despair is a public health crisis that needs state and federal attention along with our all-out efforts to deal with COVID-19. Americans have succeeded with many labor reforms before; we can do it again. The alarming number of deaths of despair needs everyone —public officials, our heath industry, and educators. Only better job opportunities, education and basic health care for everyone will solve this other epidemic.
Mary Loe lives in Oswego.