The “White Death” in International Perspective

Since the release of the paper by Anne Case and Angus Deaton showing that mortality rates amongst middle-aged White American males increased from 1999-2013, there has been a lot of anguished hand-wringing about the sorts of further regression or even collapses that it might portend. Comparisons have been made to the Soviet Union, which also saw an (alcohol-fuelled) spike in mortality since the 1960s, which reached its apogee in the 1990s.

This self-criticism, seen both on alternative media outlets like the Unz Review as well as higher profile venues such as The New York Times (Paul Krugman I see also made a limited Soviet comparison), is a perfectly health reaction to a problem which although quite severe by developed world standards is nowhere near the scale of that which afflicted the Soviet Union (where until the late 1980s discussion of adverse demographic trends was silenced by the Communist regime). This is something I stressed in my own post on this:

Nonetheless, regardless of the fact that the US mortality crisis is far less severe in absolute terms, and didn’t undergo the catastrophic “spike” that post-Soviet Russia experienced, the similarities – a major demographic group experiencing a sustained deterioration in its mortality prospects over a period of decades in an industrialized country – are otherwise quite remarkable.

Here are a couple of graphs that should prevent Americans falling into unreasonable pessimism. The figures for mortality rates / 100,000 for 50 year olds are drawn from mortality.org, which hosts one of the most detailed databases on mortality rates for a variety of OECD and ex-USSR countries. (I used it extensively to compile my forecasts of Russia’s 21st century demographics). And the blunt fact of the matter is that relative to what happened in the late USSR not to even mention the 1990s, when the Russian state lost its monopoly on vodka production, there is simply no comparison in absolute terms to the limited meth/painkiller epidemic that is currently suppressing life expectancy in some of the poorer US White communities. (Although this graph shows mortality for all 50 year Americans, do note that that age group is still very much predominantly White, so the all-American figures will to a very large extent be merely parallel to White American trends. For Whites specifically, just imagine the very marginal decline from 1990 to today as a flat line instead).

As we can see above, the American trends in the past two decades – characterized by stagnation – are qualitatively different from what afflicted the USSR and its successor states from 1965 to 1985, let alone the turmoil of the post-Soviet transition – characterized as they were by very significant outright increases in mortality followed by a sharp mortality spike in the 1990s. Even Poland, a country with some of the lowest prediclections towards vodka bingeing in Eastern Europe – though that, admittedly, is not exactly the highest of bars – has only recently just about finished recovering the sort of middle-aged mortality rates that it had half a century ago. In contrast, American middle-aged men – primarily thanks to medical advances – now enjoy mortality rates less than half of those that prevailed before the advent of advanced modern medicine in the 1960s.

The US health profile isn’t anywhere near as good relative to other countries in the developed world, but it should be noted that this has pretty much always been the case (though of course the burden of that difference has shifted in relative terms from US Blacks to Whites). As seen from the graph above, as of the early 2010s, the US had a significantly higher than middle-aged male mortality rate than the European country with the shortest life expectancy, Denmark, as well as the longest-lived Latin American country, Chile. Moreover, the US were from being around the highest end of the developed country range in the early 1990s, to something close to an outlier by the early 2010s.

This merits concern. Furthermore, whereas in my Soviet Fishtown post I posited that the cause of this US mortality lag might have been due to a vicious symbiosis of loose pharma advertising rules and obesity, the example of New Zealand – which has seen very strong and consistent reductions in mortality – puts a big question mark over that thesis. That is because as pointed out by the commentator Chuck, New Zealand was the only country in the world – alongside the US – to legalize direct to consumer advertising of prescription drugs; and New Zealand, too, has a fairly rotund obesity problem of its own. Nonetheless, it has not experienced the mortality stagnation that the US has.

Note however that New Zealand doesn’t exactly support “Leftist” explanations of the US White exception to First World middle-aged mortality declines either. That is because New Zealand too had a distinct “neoliberal” revolution – and one that hasn’t generally been judged to have been successful. Nonetheless, contrary to Leftist conventional wisdom, New Zealand in fact saw very rapid reductions in mortality – including middle-aged male mortality, as seen in the graph above – during the late 1980s and early 1990s, to the extent that it basically halved in overall terms.

Two meager conclusions follow:

(1) Don’t rush to assign overly “ideological” explanations to adverse trends, such as the stagnation in middle-aged US White male mortality. Neither the “Leftist” one of neoliberal reform, nor the “Rightist” one of increasing immigration and White demoralization (which most of Europe saw as well), nor even quasi-HBD one I posited in my “Soviet Fishtown” post (combination of easily prescriptiond drugs, obesity, and White melancholy) work very well.

(2) Although there is ample cause of concern, overly direct comparisons with what happened in 1990s Russia – or even the 1970s-1980s USSR – are as yet overwrought. And in any case, with medical technology continuing to advance, there might be a good chance that the last 25 years of stagnation in US White middle-aged mortality might end up being a temporary affair before the resumption of progress.