An Epidemic of Hopelessness?
Explaining why research shows "more despair and worse health" in the US.
Posted Nov 12, 2015
A new study from Princeton University documents a dramatic increase in rates of death among the middle-aged. Professor Anne Case and her colleague, the Nobel laureate Angus Deaton, found that after decades of improvement—mortality had been declining consistently by about 2% a year—it actually increased by about half a percentage point every year from 1999 to 2013. This result startled everyone, not only because the long-term trends have been for improvement, but also because the researchers did find the expected improvement in each of the six other countries they examined (Australia, Canada, France, Germany, the UK, and Sweden). Only in the US was mortality increasing.
Equally surprising, the causes of the increase in deaths were not the usual suspects, such as heart disease. Instead, mortality is on the rise because of higher levels of suicide and greater numbers of drug and alcohol overdoses (along with alcohol-related liver disease). Thus, people are increasingly taking their own lives, or living with reckless disregard for their health and safety, such that they are more likely to die prematurely.
Further, and almost as troubling, the paper also documented higher rates of other maladies short of death—“declines in health, mental health, and ability to conduct activities of daily living.” Professor Case summarized the results for CNN by saying “more despair and worse health.” Overall, as Professor Ellen Meara observed, the study illustrates the sad reality that what we are observing is an “epidemic of hopelessness.”
Professor Case speculates that one reason why things seem so bleak for more people in the US is that all the other countries studied “have more social safety nets in terms of unemployment benefits and healthcare.” This is doubly likely since the worst outcomes were felt by those with the lowest levels of education, and thus lower income, job security, and access to medical care. The scholarly literature tends to support the conclusion that a weak social safety net is the cause of rising distress.
In a previous post, I reviewed a number of peer reviewed, nonpartisan, academic studies that found that overall levels of happiness were strongly driven by the generosity of the social safety net and, more generally, by the size and scope of government. That conclusion may not please conservatives, but it clearly suggests itself as an explanation for what Case and Deaton found: there is less “hopelessness” in countries that actively help people take care of themselves and their families through public policy.
What about in the United States though? Writing in the peer reviewed Journal of Politics, colleagues and I found that when looking across the American States, there was a strong causal connection between life satisfaction in the state and four political factors: the state’s level of “transfer payments” (meaning things like unemployment benefits or other income maintenance programs), an index of the level of economic regulation, a measure of how progressive state governments were, and a variable representing the extent to which the state had a history of rule by the Democratic Party. Thus, quality of life was higher when a state spent more on the social safety net, when it more aggressively regulated the economy in the interests of workers and consumers, when its government was progressive, and when it was controlled by Democrats. These results were obtained at the both the aggregate and individual-level (i.e. when studying either individuals or state level averages) and also when controlling for a range of other possible explanatory factors, again at both the individual-level (income, education, race, etc.) and the state-level (racial diversity, social capital, population, economic development, etc.).
So much for happiness. What about suicide? My colleague Patrick Flavin and I examined the connections between state policies and the suicide rate in a paper published in the peer reviewed journal Social Indicators Research. Using similar statistical methods—that is, estimating the impact of state policies on prevalence of suicide, while controlling for other relevant factors—we again find that policies typically labeled progressive reduced suicide.
While our main results depended upon relatively complex statistical models, the basic relationships lend themselves to easy graphical expression. Consider first how the safety net, as expressed through transfer payments, affects suicide. As graph (A) from the paper indicates, the pattern could hardly be clearer:
Similar results obtain when considering the impact of state spending on Medical benefits:
Clearly, in both cases, it is evident that suicide rates decline as the state spends more on income maintenance programs and more on medical care for its citizens. These relationships, it is worth repeating, are not lessened by simultaneously considering other factors known to predict suicide rates.
The same paper also considered the general level of the government’s commitment to progressive public policies in a wider sense, finding again that the more progressive policy was, the less was the suicide rate, controlling for other factors.
Seen in this light, the increase in “hopelessness” plaguing America can be seen as a symptom of low and generally declining levels of a commitment to public policies that help insulate people against the psychological burden of unemployment and/or financial insecurity. While the advent of a nascent system of near-universal healthcare offers some glimmer of promise, the general pattern has been that of the country moving away from, rather than toward, the kinds of policies that research suggests are most conducive to people leading positive and rewarding lives—or choosing to live at all.
The reality is thus that that the cause of our “epidemic of hopelessness” lies in our public policies. The problem—and implicitly the solution—can be found in an understated 2014 headline from the PBS News Hour: “Social safety net catching fewer of America’s neediest.”
You can find the full-text of both of my articles discussed in this post (among others) and read a chapter from my book The Political Economy of Human Happiness here.