It was two economists at Princeton who first noted this uniquely American phenomenon, the husband and wife team of Anne Case, PhD, and Angus Deaton, PhD. It was right around the recent turn of the century that death rates for middle-aged whites stopped falling in the United States, abruptly turned course, and started rising for the first time in nearly a hundred years. At first, Case and Deaton thought they had their numbers wrong. They spent weeks confirming their findings, believing surely someone else would’ve noticed the unfolding calamity. In the end, they realized they were right and no one else had picked it up.
The next question was, “Why?”
It is true that advances in the treatment of heart disease and cancer — the two biggest killers in middle age — continued to cut death rates through this time. Those advances were eroded, however, by the staggering increase in opioid drug overdoses, suicides, and alcoholic liver disease. Case calls those “deaths of despair.”
For 3 years in a row, the U.S. has dropped in life expectancy, something that had only previously happened 100 years ago during World War I and the 1918 global flu pandemic.
The underlying reasons for this current increase in mortality are more of a mystery. That’s the subject of our new HBO film, One Nation Under Stress.
To start, we established that what was happening in the U.S. was globally distinctive. While the poor nearly always fare worse regardless of where they live, we learned this is not a story solely rooted in the economy. Other wealthy, developed nations continued to experience falling death rates among the middle aged over this same time period despite having similar ups and downs, including periods of significant economic decline.
They were supposed to inherit the earth (or at least the United States). That didn’t happen, and we subsequently learned those dashed expectations can be a remarkably toxic stressor to individuals and the society in which they live. It is far worse to have expected and not received, than simply to have not received.
Another toxic stressor for a society is blatant income inequality. It is measured using the Gini coefficient. While countries in Africa and Latin America have the highest income inequality, the United States leads the way among wealthy countries.
In the HBO film, we showcase the work of Frans de Waal, PhD, to visualize the impact of this sort of conspicuous income inequality. We show two capuchin monkeys performing a repetitive task for reward, in this case a piece of cucumber. The monkeys, in separate cages side by side, perform the same task easily 20 times in a row. Then, one of the monkeys starts receiving a grape (a more desirable treat). As you might imagine, the cucumber-receiving monkey starts rattling the cage and experiences escalating stress levels. Perhaps that is not a surprise, but subsequent studies show the stress levels of the grape-receiving monkey shoot up as well. It seems no matter where on the spectrum you lie, glaring income inequality causes stress to individuals and can make an entire society start to crack.
Dr. Sanjay Gupta is a neurosurgeon and Emmy-winning CNN chief medical correspondent. His HBO documentary, One Nation Under Stress, airs March 25 at 9pm ET.