On Case and Deaton's deaths of despair: implications for health inequalities research in the post-COVID-19 era

Anne Case and Angus Deaton's Deaths of Despair volume 1 deals with a stark public health and social problem that affects working class whites -but not only-in the United States and other Western wealthy liberal democracies.Despite the severity of this problem, except for a handful of authors who investigate it, this significant concern managed to stay under the radar for a long time.Deaths of despair refer to the midlife deaths among white persons who hold a high school diploma or less, and which are associated with drug overdoses, alcohol-related diseases, and suicide. 1 When combined with sluggish progress in the fight against heart disease and cancer, such deaths lead to not only distress and suffering but a significant increase in mortality among this population.1 To worsen this forecast, the increase in midlife mortality rates further amplifies the existing gaps in mortality rates between social classes, and between extremes of wealth and poverty. 1 In this critique, we do not question the phenomenon of increased deaths among working class whites, but we question the emphasis on it compared to ongoing racialized health crises, and we question the psychosocial explanations for it.Although deaths of despair have received increased attention in recent years, they are not new.Case and Deaton hypothesize that the rise in deaths of despair corresponds to a gradual buildup -over four decades of economic decline-of pain, suffering, and shattered worldview among white working-class Americans.The process began in the 1970s, with the decline of the United States manufacturing sector, and continued over the course of at least three major financial and social crises. 1 The current global economic recession set in motion by the COVID-19 pandemic supplies more examples of the close links between economic crises, increased unemployment, and mental health disorders, including alcohol and drug abuse and suicide. 2 Despair all around: accounts for the recent United States mortality surgeChase and Deaton's deaths of despair are discussed in the context of a sustained increase, recorded since the early 2000s, in mortality rates among whites who lack a college degree, in