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Bi-Weekly Discussion - Is the Working Class Dying from Despair?

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Brian B.
Bi-Weekly Discussion - Is the Working Class Dying from Despair?

Details

We're currently hosting our discussions at Café Walnut, near the corner of 7th & Walnut in Olde City, just across the street from Washington Square Park. The cafe's entrance is below street level down some stairs, which can be confusing if it's your first time. Our group meets in the large room upstairs.

Since we're using the cafe's space, they ask that each person attending the meetup at least purchase a drink or snack. Please don't bring any food or drinks from outside.

The cafe is fairly easy to get to if you're using public transit. With SEPTA, take the Market-Frankford Line & get off at the 5th Street Station (corner of 5th & Market), and walk 2 blocks south on 5th and then turn right on Walnut Street and walk 2 blocks west. With PATCO, just get off at the 9th-10th & Locust stop and walk 3 blocks east & 1 block north. For those who are driving, parking in the neighborhood can be tough to find. If you can't find a spot on the street, I'd suggest parking in the Washington Square parking deck at 249 S 6th Street which is just a half block away.

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"DISEASES OF DESPAIR": EXPLAINING THE RISE IN MORTALITY AMONG WORKING CLASS AMERICANS

INTRODUCTION:

In our last meetup, we explored allegations that there's a "depression epidemic" in America and potential causes for it, including declining social capital & rising loneliness, economic problems & work stress, and sedentary lifestyle & poor diet. For those of you who didn't attend, it may be useful to briefly review the discussion outline:
https://www.meetup.com/Philadelphia-Political-Agnostics/events/wpjnnqyzdbwb/

In this meetup, we'll look at the effects of this depression epidemic, namely the rise in suicide, alcoholism, drug abuse & obesity and their negative effects on the mortality rate & life expectancy in America, particularly among the white working class & underclass.

Most people already knew that poorer Americans typically have a variety of social problems that shorten their life expectancy, but most assumed that conditions must be worse for blacks & Hispanics. Thus, it came as a surprise to many when the Princeton economists Anne Case & Angus Deaton reported in 2015 that mortality rates have been steadily declining for black & Hispanic Americans but have been rising over the past 2 decades for non-college educated white Americans. Non-college educated white Americans now have the highest mortality rate of any demographic during middle age (45-54 years old). In another paper in 2017, Case & Deaton proposed that this rising mortality is caused by a decline in social support & rising unemployment among working class whites, and they allege that the stress from this has caused a striking rise in what they call the "diseases of despair" - i.e. suicide, drug addiction & alcoholism.

The "diseases of despair" concept is useful because it gives us a way to think of the connections that link the various causes of rising mortality among working class white Americans, but as we'll see in our discussion, not all experts agree with Case & Deaton's analysis. Some experts say the rise in mortality only applies to working class white women, and others have pointed out that blacks still have higher fatality rates than whites overall. Some experts have pointed out that suicide & alcoholism don't contribute nearly as much to the mortality rise among whites as opioids & obesity, and they've argued that drug abuse & obesity are better conceptualized as "lifestyle diseases" not necessarily linked to despair.

Opinions are also split on the policy implications of these worrisome trends. Progressives tend to argue that the government must use a public health approach & essentially save people from themselves, while many libertarians & conservatives see this as too paternalistic and favor an approach that puts more emphasis on personal responsibility.

There's also a debate about the effects these social problems have had on the electoral process. Case & Deaton's study is often seen in the context of the 2016 election and Trump's surprising victory. Many pundits have alleged that Trump won in part because he was able to harness the despair of the white working class & turn it into populist anger. Some pundits among the "Never Trump" conservatives & Clinton Democrats poured scorn on "hillbillies" for supporting Trump, but

RELEVANT MATERIAL FROM PAST MEETUPS:

Aside from our previous discussion on the "depression epidemic", there's a few more past discussions that may be relevant to our current topic...

Our meetup on "Public Safety & Civil Liberties" from April of 2018 provided a philosophical framework for thinking about tradeoffs between public health & personal freedoms in the Intro section & Part 1:
https://www.meetup.com/Philadelphia-Political-Agnostics/events/249161091/

Back in January of 2018, we had a meetup entitled "The Economics of Happiness" that is relevant to this discussion. In particular, Part 5 of the outline dealt with the "happiness-suicide paradox" - the tendency of happier societies to also have higher rates of suicides - and this relates to Part 1 of this discussion:
https://www.meetup.com/Philadelphia-Political-Agnostics/events/gqxkvnyxcbcc/

In a meetup in July of 2017 entitled, "Sex, Demographics & Declinism" we talked about the declining marriage rate especially among blue collar workers, and how this is tied to the decline of blue collar wages in factory jobs.
https://www.meetup.com/Philadelphia-Political-Agnostics/events/241373059/

Back in June of 2017, we had a meetup entitled "Wage Stagnation, Poverty & Cost Disease". It looks like wages have not stagnated over the last 30-40 years as many pundits have alleged, but more of our income goes to pay for healthcare, higher education & housing costs all of which have risen, so it feels like wages have stagnated. The data we looked at shows that anti-poverty programs have helped two-parent families where one or both spouses work, but those trapped below the poverty level are typically one-parent households where the parent is either unemployed or works only part-time.
https://www.meetup.com/Philadelphia-Political-Agnostics/events/238805096/

In October of 2017, we had a meetup entitled "Deep Culture & The American Dream" where looked at various claims about a "culture of poverty" is trapping both lower-class urban blacks & lower-class rural whites in poverty, as well as counter-arguments that this amounts to blaming the victims of our “rigged economy":
https://www.meetup.com/Philadelphia-Political-Agnostics/events/zgmddnywnbcb/

Note that this meetup will be immediately preceded a Skeptics discussion on "drug panics" - i.e. moral panics about drug use - and conspiracy theories about the drug trade. These relate to Part 2 of this discussion, where we'll discuss the effects of the opioid epidemic.
https://www.meetup.com/Philly-Skeptics/events/ffkqkqyzfbwb/

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DIRECTIONS ON HOW TO PREPARE FOR OUR DISCUSSION:

The videos & articles you see linked below are intended to give you a basic overview of some of the major debates over rising mortality among the American working class, particularly middle-aged whites, as well as rises in suicide, alcoholism & opioid abuse. As usual, I certainly don't expect you to read all the articles & watch all the videos prior to attending our discussion. The easiest way to prepare for our discussion is to just watch the numbered videos linked under each section - the videos come to about about 48 minutes total. The articles marked with asterisks are just there to supply additional details. You can browse and look at whichever ones you want, but don't worry - we'll cover the stuff you missed in our discussion.

In terms of the discussion format, my general idea is that we'll address the topics in the order presented here. I figure we'll spend about 25 minutes on each section.

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I. AMERICA'S SUICIDE EPIDEMIC:

  • IS THE SUICIDE RATE IN THE U.S. RISING? IS IT NOW HIGH ENOUGH THAT IT DESERVES TO BE CALLED AN "EPIDEMIC" & A "PUBLIC HEALTH CRISIS"?

  • SHOULD SUICIDE RATES ABOVE A CERTAIN LEVEL BE SEEN AS AN INDICATOR OF A BROADER SOCIAL DYSFUNCTION?

  • IS THIN AIR MOSTLY RESPONSIBLE FOR THE "SUICIDE BELT" IN THE MOUNTAIN STATES, OR IS IT MORE CONNECTED TO DEMOGRAPHICS OR SOCIO-ECONOMIC CONDITIONS?

  • DOES AMERICA'S RELIGIOSITY DECREASE THE SUICIDE RATE?

  • HOW MANY SUICIDES ARE CAUSES BY DIVORCE & FAMILY BREAKUP?

  • WHY IS THE SUICIDE RATE HIGHER FOR WHITE PEOPLE THAN BLACK PEOPLE, DESPITE THE FACT THAT BLACK PEOPLE TEND TO HAVE LESS WEALTH & EXPERIENCE MORE DISCRIMINATION?

  • HOW CAN WE ACCOUNT FOR THE "SUICIDE-HAPPINESS PARADOX" - I.E. WHAT CAN WE DO TO DECREASE THE SUICIDE RATE IF INCREASES IN OVERALL SOCIETAL HAPPINESS TEND TO INCREASE IT?

  • HOW CAN WE RAISE AWARENESS ABOUT SUICIDE WITHOUT ENCOURAGING THE "WERTHER EFFECT"? SHOULD REPORTING & ARTISTIC DEPICTIONS OF SUICIDE BE CENSORED?

  • WOULD RESTRICTING ACCESS TO FIREARMS CUT THE SUICIDE RATE OR MERELY RESULT IN ALTERNATIVE METHODS?

1a) Seeker, "Why Do People Commit Suicide?" (video - 3:19 min.)
https://www.youtube.com/watch?v=dNgLrHGymYc

1b) Seeker, "Why More White Men Are Dying From Gun Suicides" (video - 4:48 min.)
https://www.youtube.com/watch?v=qWNDuPkr8CY

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II. ALCOHOLISM & DRUG ADDICTION AS "DISEASES OF DESPAIR"

  • WHAT'S THE LINK BETWEEN DEPRESSION AND ALCOHOLISM & DRUG ADDICTION - I.E. DOES DEPRESSION CAUSE DRUG & ALCOHOL ABUSE OR VICE-VERSA?

  • DOES UNEMPLOYMENT CAUSE DESPAIR WHICH LEADS TO SUBSTANCE ABUSE, OR DOES SUBSTANCE ABUSE LEAD TO JOB LOSS?

  • WHAT COULD BE BEHIND THE INCREASE IN CHRONIC PAIN THAT OFTEN LEADS TO LONG-TERM PRESCRIPTIONS FOR OPIOIDS?

  • IS THE OPIOID EPIDEMIC DRIVEN MORE BY SUPPLY OR DEMAND?

  • IS INCREASED DRINKING DUE TO DESPAIR?

  • ARE SUBSTANCE ABUSE & ADDICTION A DISEASE, A FORM OF MENTAL ILLNESS, A MORAL FAILING, A SOCIAL PROBLEM, OR SOME COMBINATION OF THE ABOVE?

2a) NY Times, "The Facts on America's Opioid Epidemic" (video - 2:02 min.)
https://www.youtube.com/watch?v=oHlaz0kQlRE

2b) NewsChannel 5, "Study finds high rates of opioid prescriptions could be linked to poor labor force" (video - 2:10 min.)
https://www.youtube.com/watch?v=S8Jnn-DXfwo

2c) Time, "Why Americans, Especially Women, Are Drinking More" (video - 1:57 min.)
https://www.youtube.com/watch?v=72q_oHcsSRQ

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III. OBESITY & SMOKING AS "LIFESTYLE DISEASES" & THEIR RELATION TO THE "DISEASES OF DESPAIR":

  • SHOULD OBESITY & SMOKING ALSO BE CLASSIFIED AS "DISEASES OF DESPAIR" DUE TO LINKS BETWEEN STRESS & OVEREATING & SMOKING?

  • WHY HAS OBESITY RISEN FASTER AMONG POOR PEOPLE? IS IT MORE LINKED TO LESS EXERCISE OR MORE CALORIES?

  • DO FOOD STAMPS CONTRIBUTE TO OBESITY AMONG THE POOR?

  • WHY ARE POOR WOMEN FATTER THAN POOR MEN?

  • WHY HASN'T THE SMOKING RATE FALLEN AS MUCH AMONG POOR & WORKING CLASS AMERICANS?

  • HOW MUCH DOES SMOKING & OBESITY CONTRIBUTE TO THE HIGHER WORKING CLASS MORTALITY RATE?

3a) HuffPost Live, "Do Food Stamps Make Poor People Fat?" (video - 2:12 min.)
https://www.youtube.com/watch?v=cDBaoyfRoZw

3b) David Pakman, "Smoking Now a Habit of the Poor & Working Class" (video - 3:19 min.)
https://www.youtube.com/watch?v=eNWBwaOOK4U

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IV. UNDERSTANDING REGIONAL DIFFERENCES & DEMOGRAPHIC TRENDS IN MORTALITY RATES:

  • DOES THE FACT THAT THE "SUICIDE BELT" IS IN THE MOUNTAIN STATES WHILE THE OPIOID EPIDEMIC IS WORST IN THE RUST BELT & OBESITY IS HIGHEST IN THE SOUTH MEAN THAT CULTURAL FACTORS LOOM LARGER THAN ECONOMIC DESPAIR?

  • WHY DO LOW-INCOME WHITES IN THE UPPER MIDWEST BUCK THE TREND & LIVE LONGER THAN MIDDLE-CLASS WHITES IN THE REST OF AMERICA?

  • IS THE APPARENT MORTALITY RISE IN NON-COLLEGE EDUCATED WHITES MOSTLY DUE TO SELECTION EFFECTS - I.E. AS COLLEGE ATTENDANCE RATES RISE, IS THIS A GROUP THAT'S INCREASINGLY DYSFUNCTIONAL?

  • ARE MORTALITY RATES LOWER AMONG BLACKS & HISPANICS COMPARED TO WORKING CLASS WHITES BECAUSE THEY'RE MORE USED TO ECONOMIC STRESS?

  • DO HISPANICS LIVE LONGER THAN WHITES DUE TO A BETTER DIET?

  • COULD UNREPORTED DEATHS BE MAKING BLACK & HISPANIC MORTALITY RATES APPEAR ARTIFICIALLY LOWER?

4a) Anne Case, "'Deaths of despair' are surging in white America" (video - 3:47 min.)
https://www.youtube.com/watch?v=56k4TCJvVZQ

4b) Michael Greger, "The Hispanic Paradox: Why Do Latinos Live Longer?" (video - 6:42 min.)
https://www.youtube.com/watch?v=NO91dfafzGQ

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V. POLITICAL IMPLICATIONS OF THE "DISEASES OF DESPAIR" & THE RISE IN WHITE WORKING CLASS MORTALITY:

  • DID INCREASED TRADE WITH CHINA CAUSE THE DEINDUSTRIALIZATION & UNEMPLOYMENT THAT PRECIPITATED THE "DISEASES OF DESPAIR"?

  • DID "ECONOMIC ANXIETY" & GOV'T NEGLECT OF THE WHITE WORKING CLASS'S PROBLEMS MOTIVATE THEM TO VOTE FOR TRUMP, OR WAS IT MOSTLY RACISM & XENOPHOBIA?

  • WAS BILL MAHER'S REMARK THAT "PILLBILLIES" ELECTED TRUMP RUDE BUT TRUE? IS OPIOID ADDICTION MORE COMMON IN POOR RURAL COUNTIES THAT VOTED FOR TRUMP IN 2016?

  • DOES WE NEED TO EMPATHIZE MORE WITH THE WORKING CLASS & ENACT SOCIAL PROGRAMS TO HELP THEM, OR IS IT UP TO THE WORKING CLASS TO EMBRACE PERSONAL RESPONSIBILITY & MOVE TO AREAS WHERE THE ECONOMY IS BETTER?

5a) PBS, "How the feeling of falling behind fuels deadly distress for white Americans" (video - 8:24 min.)
https://m.youtube.com/watch?v=INDs43eQRJA

5b) PBS, "Is economic anxiety fueling Trump and Sanders supporters?" (video - 8:31 min.)
https://www.youtube.com/watch?v=aQ9a4VNJTHw

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