Diseases of despair

The diseases of despair are three classes of behavior-related medical conditions that increase in groups of people who experience despair due to a sense that their long-term social and economic outlook is bleak.  The three disease types are drug overdose (including alcohol overdose), suicide, and alcoholic liver disease.  

Diseases of despair, and the resulting deaths of despair, are high in the Appalachia region of the United States.  The prevalence increased markedly during the first decades of the 21st century, especially among middle-aged and older working class white Americans starting in 2010, followed by an increase in mortality for Hispanic Americans in 2011 and African Americans in 2014. It gained media attention because of its connection to the opioid epidemic.

Risk factors 
Although addiction and depression affect people of every age, every race, and every demographic group, the excess mortality and morbidity from diseases of despair affects a smaller group.  In the US, the group most affected by these diseases of despair are non-Hispanic white men and women who have not attended university.  Compared to previous generations, this group is less likely to be married, less likely to be working, less likely to be able to provide for their families, and more likely to report physical pain, overall poor health, and mental health problems, such as depression.

Causes 
The factors that seem to exacerbate diseases of despair are not fully known, but they are generally recognized as including a worsening of economic inequality and feeling of hopelessness about personal financial success.  This can take many forms and appear in different situations.  For example, people feel inadequate and disadvantaged when products are marketed to them as being important, but these products repeatedly prove to be unaffordable for them.  The overall loss of employment in affected geographic regions, and the worsening of pay and working conditions along with the decline of labor unions, is a widely hypothesized factor.  

The changes in the labor market also affect social connections that might otherwise provide protection, as people at risk for this problem are less likely to get married, more likely to get divorced, and more likely to experience social isolation.  Economists Anne Case and Angus Deaton argue that the ultimate cause is the sense that life is meaningless, unsatisfying, or unfulfilling, rather than strictly the basic economic security that makes these higher order feelings more likely.

Diseases of despair differ from diseases of poverty because poverty itself is not the central factor.  Groups of impoverished people with a sense that their lives or their children's lives will improve are not affected as much by diseases of despair.  Instead, this affects people who have little reason to believe that the future will be better.  As a result, this problem is distributed unevenly, for example by affecting working-class people in the United States more than working-class people in Europe, even when the European economy was weaker.  It also affects white people more than racially disadvantaged groups, possibly because working-class white people are more likely to believe that they are not doing better than their parents did, while non-white people in similar economic situations are more likely to believe that they are better off than their parents.

Effects 
Starting in 1998, a rise in deaths of despair has resulted in an unexpected increase in the number of middle-aged white Americans dying (the age-specific mortality rate).  By 2014, the increasing number of deaths of despair had resulted in a drop in overall life expectancy.  Anne Case and Angus Deaton propose that the increase in mid-life mortality is the result of cumulative disadvantages that have occurred over decades, and that solving it will require patience and perseverance for many years, rather than a quick fix that produces immediate results.

Terminology 
The name diseases of despair has been criticized for being unfair to the people who are adversely affected by social and economic forces beyond their control, and for underplaying the role of specific drugs, such as OxyContin, in increasing deaths.

References

Further reading 

 Michael Meit, Megan Heffernan, Erin Tanenbaum, and Topher Hoffmann (August 2017) Appalachian Diseases of Despair.  The Walsh Center for Rural Health Analysis at the University of Chicago. 
 Chris McGreal (12 November 2015) "Abandoned by coal, swallowed by drugs" The Guardian

Category:Death
Category:Poverty
Category:Public health
Category:Social problems in medicine
Category:Inequality