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Deaths of Despair and the Future of Capitalism Hardcover – Illustrated, March 17, 2020

by Anne Case (Author), Angus Deaton (Author)

4.5 672 ratings

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A New York Times Bestseller
A Wall Street Journal Bestseller
A New York Times Notable Book of 2020
A New York Times Book Review Editors' Choice
Shortlisted for the Financial Times and McKinsey Business Book of the Year
A New Statesman Book to Read

From economist Anne Case and Nobel Prize winner Angus Deaton, a groundbreaking account of how the flaws in capitalism are fatal for America's working class

Life expectancy in the United States has recently fallen for three years in a row―a reversal not seen since 1918 or in any other wealthy nation in modern times. In the past two decades, deaths of despair from suicide, drug overdose, and alcoholism have risen dramatically, and now claim hundreds of thousands of American lives each year―and they're still rising. Anne Case and Angus Deaton, known for first sounding the alarm about deaths of despair, explain the overwhelming surge in these deaths and shed light on the social and economic forces that are making life harder for the working class. They demonstrate why, for those who used to prosper in America, capitalism is no longer delivering.

Deaths of Despair and the Future of Capitalism paints a troubling portrait of the American dream in decline. For the white working class, today's America has become a land of broken families and few prospects. As the college educated become healthier and wealthier, adults without a degree are literally dying from pain and despair. In this critically important book, Case and Deaton tie the crisis to the weakening position of labor, the growing power of corporations, and, above all, to a rapacious health-care sector that redistributes working-class wages into the pockets of the wealthy. Capitalism, which over two centuries lifted countless people out of poverty, is now destroying the lives of blue-collar America.

This book charts a way forward, providing solutions that can rein in capitalism’s excesses and make it work for everyone.

Print length

312 pages
Language

English
Publisher

Princeton University Press
Publication date

March 17, 2020
Dimensions

6.5 x 1.3 x 9.4 inches
ISBN-10

069119078X
ISBN-13

978-0691190785
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Editorial Reviews

Review

"A New York Times Bestseller"

"One of New Statesman's Books to Read in 2020"

"Excellent.", Joyce Carol Oates on Twitter

"One of the Financial Times Selected Titles for 2020 Visions: The Year Ahead in Books"

"Why economics really matters is illustrated in Deaths of Despair and the Future of Capitalism. . . . The authors argue that the capitalism that lifted countless people out of poverty is now destroying blue-collar America. They have solutions to make it work for all. They had better be right.", New Scientist "

[A] remarkable and poignant book."---Dani Rodrik, Project Syndicate

"We Americans are reluctant to acknowledge that our economy serves the educated classes and penalizes the rest. But that’s exactly the situation, and Deaths of Despair shows how the immiseration of the less educated has resulted in the loss of hundreds of thousands of lives, even as the economy has thrived and the stock market has soared."---Atul Gawande, New Yorker

"Timely and important."---Ed Balls, Financial Times

"Well-researched, compassionate."---Susan Babbitt, New York Journal of Books

"An excellent book."---Nicholas Kristof, New York Times

"A remarkable new book."---John Harris, The Guardian

"The system is broken and every bit of it needs fixing. This is a sobering – and essential – book."---Diane Coyle, Enlightened Economist

"Disturbing. . . . . Case and Deaton do a great job making the case that something has gone grievously wrong."---Jim Zarroli, NPR

"[Case and Deaton] dive into and weave the data through different demographic and clinical lenses ― race, gender, age, social connectedness, work history, and the most important through-line: education. Thus Case and Deaton connect the dots, literally, in the many charts that explain what factors are driving the Deaths of Despair."---Jane Sarasohn-Kahn, Health Populi Blog

"The rise in premature deaths among working-class whites has become a national crisis, and the authors tie the problem to the weakening position of labor, the growing power of corporations, and to a health-care sector that redistributes working-class wages to the wealthy.", Publishers Weekly

"I highly, highly recommend it."---Cardiff Garcia, NPR Planet Money’s The Indicator

"Gripping. . . . [Case and Deaton] do not merely rehearse decades of mortality and wage statistics. Rather, they seek to catalogue how an entire way of life first frayed and then fell apart over the past half-century, and the cruelty of an American meritocracy that heaps lavish rewards on the winners while increasingly leaving others to rot."---Joshua Chaffin, Financial Times

"A highly important book."---Arlie Russell Hochschild, New York Times Book Review

"Case and Deaton explain how every detail of this crisis unfolded, examining recent historical events and rightly placing much of the blame on the United States’ distinctive strain of capitalism, designed to protect and grow the assets of the wealthy few."---Keri Leigh Merrit, Common Dreams

Review

"This book will be an instant classic, applying high quality social science to an urgent national matter of life and death. In exploring the recent epidemic of 'deaths of despair,' the distinguished authors uncover an absorbing historical story that raises basic questions about the future of capitalism. It is hard to imagine a timelier―or in the end, more hopeful―book in this season of our national despair."―Robert D. Putnam, author of Bowling Alone and Our Kids

"In the face of a government that failed to protect ordinary working-class Americans from the greed-fueled opioid epidemic and a media that was slow to notice the problem, Anne Case and Angus Deaton are true sentinels. Deaths of Despair and the Future of Capitalism is an urgent and clarion call to rethink pain, inequality, justice, and the business of being human in America. This book explains America to itself. I underlined damn near every sentence."―Beth Macy, author of Dopesick: Dealers, Doctors, and the Drug Company That Addicted America

"In this superb book, Case and Deaton connect the dots to explain the dramatic rise of deaths of despair among working-class white Americans. Totally unexpectedly, they trace the root cause to an exorbitantly expensive health-care system that sucks―and wastes―billions of dollars and so much human talent away from improving lives."―Ezekiel J. Emanuel, University of Pennsylvania

"With stunning data analysis, close observation, and smoldering urgency, Case and Deaton show why mounting deaths of despair are not only a public health disaster but also an indictment of the metastasizing stratification that is undermining working-class America."―David Autor, Massachusetts Institute of Technology

"This book explains so many of today's headlines with clear writing, sharp storytelling, and an almost symphonic use of research in economics, public health, and history. What it summons is a powerful analysis of who we are as Americans and what we have become as a country."―Sam Quinones, author of Dreamland: The True Tale of America's Opiate Epidemic

"America is experiencing a catastrophe. Those without a college degree are not just being left behind; they are dying from deaths of despair. Case and Deaton brilliantly describe and dissect the causes and explain how we can return to a path of rising prosperity and health. All citizens―voters as well as politicians aspiring to office―should read and discuss this book."―Mervyn King, former governor of the Bank of England

"Deaths of despair among US whites with low education cannot be attributed to lack of access to health care or ignorance of healthy lifestyles. When two leading economists turn their attention to the social determinants of this modern epidemic, the result is brilliant."―Sir Michael G. Marmot, author of The Health Gap

Product details

Publisher ‏ : ‎ Princeton University Press; Illustrated edition (March 17, 2020)
Language ‏ : ‎ English
Hardcover ‏ : ‎ 312 pages
ISBN-10 ‏ : ‎ 069119078X
ISBN-13 ‏ : ‎ 978-0691190785
Item Weight ‏ : ‎ 1.55 pounds
Dimensions ‏ : ‎ 6.5 x 1.3 x 9.4 inches

Best Sellers Rank: #97,379 in Books (See Top 100 in Books)
- #49 in Economic Policy
- #54 in Social Services & Welfare (Books)
- #58 in Economic Policy & Development (Books)

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4.5 672 ratings

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Angus Deaton
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Sir Angus Deaton is now a Senior Scholar at the Woodrow Wilson School, where his main interests are in poverty, inequality, health, development, well-being, and the use of evidence in social science and medicine. He also has a part-time appointment as Presidential Professor of Economics at the University of Southern California. He has taught at Cambridge University and at the University of Bristol. He is a member of the National Academy of Sciences, a Corresponding Fellow of the British Academy, and an Honorary Fellow of the Royal Society of Edinburgh. He is a fellow of the Econometric Society, and was the first recipient of the Society's Frisch Medal for Applied Econometrics. His current pursuits include research on poverty and inequality around the world, on the appropriate use of randomized controlled trials, and on the determinants of health and well-being, particularly on relationships with income, both domestically and internationally. He was President of the American Economic Association in 2009. Ph.D. Cambridge University. He holds honorary doctorates from the University of Rome, Tor Vergata, University College, London, the University of St Andrews, the University of Edinburgh, the University of Cyprus, Brown University, and the University of Cambridge. He was the recipient of the Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel in 2015. In 2016, he was made a Knight Bachelor for his services to economics and international affairs.
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Anne Case
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Anne Case is the Alexander Stewart 1886 Professor of Economics and Public Affairs, Emeritus at Princeton University, where she is the Director of the Research Program in Development Studies. Dr. Case has written extensively on health over the life course. She has been awarded the Kenneth J. Arrow Prize in Health Economics from the International Health Economics Association, for her work on the links between economic status and health status in childhood, and the Cozzarelli Prize from the Proceedings of the National Academy of Sciences for her research on midlife morbidity and mortality. Dr. Case currently serves on the President's Committee on the National Medal of Science and the Committee on National Statistics. She is a Research Associate of the NBER, a Fellow of the Econometric Society, and is an affiliate of the Southern Africa Labour and Development Research Unit at the University of Cape Town. She also is a member of the National Academy of Medicine, the American Academy of Arts and Sciences, and the American Philosophical Society. PhD Princeton.
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M Prywes

Compassion for the Trump voters.

Reviewed in the United States on November 21, 2020

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In 2014, Anne Case and Angus Deaton, professors in Princeton’s economics department, discovered that white male American deaths from suicide were rising sharply. A deeper dive into the statistics revealed that deaths of all white males were rising for the first time since the flu epidemic of 1919. Middle-aged white men reported more pain as well.

The publication of these results in 2015 was, in retrospect, the first hint that someone like Trump could be elected President.

In Deaths of Despair, the authors report that the three main cause of white male deaths are suicide, alcoholic liver disease, and drug overdoses. Furthermore, deaths rose principally among white men without a Bachelor’s degree. The BA degree acted, speaking statistically, like an inoculation. Many of the drug deaths followed from repeated overdoses, as if these were suicide attempts.

This white male demographic group matches the profile of the Trump voter. They are likely to be less educated and more likely to live in a rural area.

There are reasons for the demoralization of this population. Foremost, they’ve suffered from decades of real wage stagnation. The authors report that “white men without a four-year college degree lost 13 percent of their purchasing power between 1979 and 2018. Over the same period, national income per head grew by 85 percent.”

Men without jobs and men with poorly paying jobs make poor marriage partners. Economic research suggests this is why their marriage rates declined, denying them the benefits of companionship. Many middle-aged white men do not know their own children, while the majority of less-educated white women have children outside of marriage. As family ties weakened, church-going declined, removing a source of comfort. Trade unions have declined as well. We have instead a stunning rise of alcoholism and narcotics addiction. Deaths from narcotics overdose now run at 70,000 per year.

This resembles the experience of less-educated African-American males several decades ago. Mortality rates among Afro-American men have always been higher than those for whites. The gap, however, has been narrowing for many years.

The combination of stagnant real wages and poor health help explain the rage that led to Trump’s election. His voters sent him to Washington to vandalize a system that hasn’t worked for them in up-close and personal ways.

Of course there were other causes: a sense of contemptuous treatment by elites (Hillary Clinton’s “deplorables”) and disrespect for their fundamentalist Protestant religion. Beware of disrespect for religion! It’s easy to dismiss the Trump voters as racists and extremists, though many were Obama voters. Of course some are openly racist and Trump appeals directly to anti-Mexican and anti-Chinese sentiment. But I am writing to deny that race was the primary issue in the 2016 election.

Case and Deaton devote half the book to a discussion of the economic sources of wage stagnation. These are statistically well established features of our economy and less interesting than their account of the public health facts. Globalization and technological change are probably the main causes of wage stagnation for the less-educated. What’s special about the US is that high doctor, hospital, and especially pharmaceutical costs have cut the purchasing power of our population. Moreover, greater concentration of industry has increased oligopoly power and raised prices, further cutting household purchasing power. The problem is most evident in the pharmaceutical and internet platform industry (Facebook, Amazon, Microsoft, or example).

The information in this book cries out for compassion for the Trump voters –from Democrats and Liberals. The division in America does not flow entirely from extremism on the right. It’s visible in dismissal of the Trump voters as racists and, broadly, bad people. Time to recognize the other side as full human being who face real problems.

51 people found this helpful

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Mark Forrester

Important book delivered in perfect condition

Reviewed in the United States on December 6, 2023

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I was very pleased to have ordered this book by the independent vendor on Amazon. It was delivered speedily, shrink wrapped in plastic and in perfect condition.

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Shirley T Fang

Timely and thought provoking

Reviewed in the United States on April 20, 2020

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Overall, I recommend this book as it tries to explain the plight of white, working class Americans. Having lost so many things, including the privilege of race, it's easy to see why the white working class would vote for Trump. The first part of the book can be a bit dry, but uses loads of data to power its hypotheses. The second part of the book falls short, as it blames only one culprit for a poor outcome. True, the American healthcare system perversely generates inequality instead of provides universal care. However, I would have liked to see more discussion about education. Is it possible that our inefficient educational system also perpetuates generational inequality and transfers wealth from lower income students to rich university bureaucrats who contribute little of actual value? More discussion needed. I imagine multiple entrenched interests bleed money from the working class, reinforcing health and life outcome disparities that amplify through generations. While one book cannot possibly call out all those "Sheriffs of Nottingham," it should at least offer one chapter of discussion.

67 people found this helpful

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J.

Excellent. very insightful

Reviewed in the United States on October 15, 2023

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i would recommend. I had never heard the term "Deaths of despair" . We need to wake up

One person found this helpful

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Richard S. Wells

A Needed Diagnosis

Reviewed in the United States on October 24, 2022

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We live in the Age of Trump, which is to say that we elected a President who is a sociopath. But, we pay far too much attention to Trump himself, and far too little to the notion that Trump is a symptom of an ailing and dysfunctional social and political system. We need to have a better understanding of ourselves, rather than the sociopath we chose.
This book is valuable precisely because it considers what has gone wrong with us, and what ailments we are enduring, so that we choose a Trump. It is the best diagnosis of the disease that besets our American society that I have read thus far.

10 people found this helpful

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Ginger Witch

Ebook version has "Bad robot voice"

Reviewed in the United States on March 8, 2024

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This is a good book, but I bought the ebook version and "Anne Case" who read this book outloud for the audible version doesn't sound like a human being to me. I'm glad robot americans are getting credited for their work reading ebooks, but it's not a very nice listening experience.

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Matt L. Pimentel, Ph.D.

An accurate state of affairs without overt partisan blame

Reviewed in the United States on April 19, 2020

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I recommend this read. Although it focuses near exclusively on white non-Hispanics between the ages of 45-54 in the USA (well, since I fit into this category, it's germane to me), these two professors (Case & Deaton) make repeatedly cogent and substantive arguments about the correlation between "deaths of despair," (deaths from alcohol, opioids, & suicide) with those who have a bachelor's degree or higher versus those who do not. It's striking. A number of variables are controlled for. Moreover, the discussion of how the country was stratified economically, around the year 1970 is logically and factually laid out quite well. Moreover, the reference list provide a great resource for other reads that I'm already ordering on eBay on the cheap

34 people found this helpful

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Laura J Trombley

Excellent treatise

Reviewed in the United States on April 3, 2021

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This book, along with “The Hardhat Riots” help explain what is happening in America today. I would go a step farther to blame the MAGA movement and the Capitol riot on this underlying sense of loss that the uneducated formerly middle class segment of our society has experienced. This book goes on to proffer some solutions.

4 people found this helpful

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GABRIELA EDITH REYES MEJIA

MUY INTERESANTE.

Reviewed in Mexico on May 28, 2021

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Es un libro muy interesante, recomiendo ampliamente su lectura.

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Daniel Araya

Amazing book by two of the greatest minds in health economics

Reviewed in the United Kingdom on December 1, 2023

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Kind of a second part of The Great Escape.
Brought it after attending a conference by Case and Deaton.
Incredible and enlightening book about where we are heading as a society.
Totally recommend for economista and non-economists