No Job, No Friends, No Faith

The coming wave of "deaths of despair."

The average lifespan of American men declined in 2017. It declined in 2016 and in 2015, too. This loss isn’t equally distributed across the male population. Life expectancy in the US has long reflected inequality—the wealthy outlive the poor, and black Americans die younger than whites—but it has generally risen across demographics for a century. This recent decline, by contrast, is strongly tied to a specific group: less-educated white people, particularly working-class white men. And many of the deaths they’re dying early are of a specific type: suicide, drug overdoses, and diseases linked to alcohol abuse. Estimated to number around 600,000 in the past two decades, they’re called “deaths of despair.”

Our response to the new coronavirus will almost certainly multiply such deaths. Stay-at-home orders and social distancing more broadly exacerbate the conditions that foster deaths of despair.

This isn’t an argument for letting COVID-19 run wild—that would be deeply harmful too, as a grimly mounting death toll even with mitigation shows. Yet it’s much easier for someone like me to accept a stay-at-home order as the needful, ethical choice to save lives than it is for someone vulnerable to a death of despair . It’s easy for me, with a job I already did from home and a tech-savvy church and circle of friends, to opine about the necessity of fighting this pandemic. But if you live in a dying coal town in western Pennsylvania where what little work was available has been prohibited for weeks, and your internet connection is too slow to stream Mass, and you haven’t talked to your elderly mother in days because she can’t pay her phone bill, and your kid’s ...