Now They Get It: Health, Class, and Economic Restructuring

In the past few months, many commentators have responded to a recent study that shows increasing death rates among middle-aged white Americans. Some have suggested that the increase is the consequence of material poverty resulting from economic restructuring and the neoliberal agenda over the last several decades.

Globalization, trade liberalization, deregulation, privatization, and reductions in the welfare state have not only led to downsizing in many industries, they have also reduced wages and benefits, contributing to growing economic inequality. The nature of many jobs has also changed. Work has been intensified, hours have become increasingly irregular, and workers face anxieties about the loss of their jobs and electronic monitoring of their work. These changes leave workers feeling vulnerable and stressed, and that together with anti-union laws and poorly enforced labor laws limit their ability to fight back. As someone who taught courses in Occupational Safety and Health for many years, I am all too aware that these workplace stresses and the limits of workers’ agency are associated with increases in cardiovascular disease, physical and mental disorders, and acute injuries. In other words, while research has focused on increasing mortality rates, changes in work also contribute to increased health problems, which may, in turn, explain the increases in alcoholism and drug abuse that Anne Case and Angus Deaton see as key factors in the rising death rates.

Workplace stress and insecurity are among the “hidden injuries of class” that compound material poverty. As people adapt to changes in and the loss of work, they become more isolated, and, too often, lose their sense of community and self worth. Worse, they internalize insecurity, blaming themselves for problems at work or for not being able to find a decent job or support their families. That people blame themselves should not surprise us, given the persistent ideal of the American Dream, which promises that individual effort will pay off in upward mobility. No wonder people who have lost jobs or who are working hard but still struggling economically see their challenges as a moral failure or character flaw.

For anyone who has studied the social costs of deindustrialization, none of this is news. In the 1980s, Harvey Brenner determined that for every one percent increase in unemployment there were 650 homicides, 3300 admissions to state mental hospitals, 500 deaths by cirrhosis of the liver, 20,000 deaths by suicide. Other studies focused on displaced workers in the late twentieth century showed increases in incarceration, insomnia, headaches, smoking, child and spousal abuse and stomach disorders, not to mention suicide and drug and alcohol abuse. In many ways, the current research shows not a new trend but rather the long-term impact of economic restructuring and neoliberalism on workers’ lives.

What is new is that these patterns no longer seem to apply primarily to the working class. While Case and Deaton note that poorer and less-educated white people had even higher mortality rates, their study suggests that the pattern also applies to the middle class. This may be what most surprised commentators, for whom the report offered dramatic evidence of an important change in American culture. As Paul Krugman suggested, “We’ve seen this kind of thing in other times and places – for example, in the plunging life expectancy that afflicted Russia after the fall of Communism. But it is a shock to see it, even in an attenuated form, in America.” Krugman and others asked how this could happen. In an interview with Vox, Deaton commented that the middle-aged white people in his study had “lost the narrative of their lives.” While this certainly applies for many in the working class, as Sherry Linkon noted in November, it is also true for growing numbers of middle-class Americans who may have been even more invested in the American Dream.

Also new is the racial pattern. In the 1970s and 80s, death rates for African Americans rose, but in recent decades, they have fallen as the rates for whites have risen. Andrew Cherlin suggests that the difference could be explained by people’s perceptions of how they are doing compared with others like them. As Cherlin writes, “It’s likely that many non-college-educated whites are comparing themselves to a generation that had more opportunities than they have, whereas many blacks and Hispanics are comparing themselves to a generation that had fewer opportunities.” Put simply, if white working-class people see themselves as losing ground, they may be more likely to consider suicide or engage in self-destructive behaviors.

The impact of economic restructuring on material poverty and health has a long history. In the last 40 years, increases in poverty and the declines in the health of the working class were rationalized as “acceptable” losses associated with major economic change. But what has changed is the demographic landscape. No longer are mortality and morbidity issues associated primarily with the working-class and African Americans. Now, job loss and economic insecurity are impacting the middle class and whites.

I’m reminded of an old adage: when poverty comes in the door, love goes out the window. As middle-class whites increasingly experience the kind of economic insecurity that became normal for so many working-class people years ago, some are losing not just love but also their health and even their lives.

John Russo