the book's origins

Around the turn of the century, after decades of improvement, all-cause mortality rates among white non-Hispanic men and women in middle age stopped falling in the U.S., and began to rise. These were the findings of a study published in 2015 by Anne Case and Angus Deaton in the Proceedings of the National Academy of Sciences.

The pair found that while midlife mortality continued to fall in other rich countries, and in other racial and ethnic groups in the U.S., white non-Hispanic mortality rates for prime-aged adults increased. Mortality declines from the two biggest killers in middle age — cancer and heart disease — were offset by marked increases in drug overdoses, suicides, and alcohol-related liver mortality in this period. 

By 2014, rising mortality in midlife, led by these "deaths of despair," was large enough to offset mortality gains for children and the elderly, leading to a decline in life expectancy at birth among white non-Hispanics between 2013 and 2014, and a decline in overall life expectancy at birth in the U.S. between 2014 and 2015. Mortality increases for whites in midlife were paralleled by morbidity increases, including deteriorations in self-reported physical and mental health, and rising reports of chronic pain. 

Anne Case and Angus Deaton’s research and new book seeks to understand this turn of events.

Read more about Anne Case and Angus Deaton.

Pre-Publication Reviews

"[A] remarkable and poignant book." — Dani Rodrik, Project Syndicate

"Why economics really matters is illustrated in Deaths of Despair and the Future of Capitalism. . . . The authors argue that the capitalism that lifted countless people out of poverty is now destroying blue-collar America. They have solutions to make it work for all. They had better be right." — New Scientist

"The rise in premature deaths among working-class whites has become a national crisis, and the authors tie the problem to the weakening position of labor, the growing power of corporations, and to a health-care sector that redistributes working-class wages to the wealthy." — Publishers Weekly

"This book will be an instant classic, applying high quality social science to an urgent national matter of life and death. In exploring the recent epidemic of 'deaths of despair,' the distinguished authors uncover an absorbing historical story that raises basic questions about the future of capitalism. It is hard to imagine a timelier — or in the end, more hopeful — book in this season of our national despair." — Robert D. Putnam, author of Bowling Alone and Our Kids

"In the face of a government that failed to protect ordinary working-class Americans from the greed-fueled opioid epidemic and a media that was slow to notice the problem, Anne Case and Angus Deaton are true sentinels. Deaths of Despair and the Future of Capitalism is an urgent and clarion call to rethink pain, inequality, justice, and the business of being human in America. This book explains America to itself. I underlined damn near every sentence." — Beth Macy, author of Dopesick: Dealers, Doctors, and the Drug Company That Addicted America

"In this superb book, Case and Deaton connect the dots to explain the dramatic rise of deaths of despair among working-class white Americans. Totally unexpectedly, they trace the root cause to an exorbitantly expensive health-care system that sucks — and wastes — billions of dollars and so much human talent away from improving lives." — Ezekiel J. Emanuel, University of Pennsylvania

"With stunning data analysis, close observation, and smoldering urgency, Case and Deaton show why mounting deaths of despair are not only a public health disaster but also an indictment of the metastasizing stratification that is undermining working-class America." — David Autor, Massachusetts Institute of Technology

"This book explains so many of today's headlines with clear writing, sharp storytelling, and an almost symphonic use of research in economics, public health, and history. What it summons is a powerful analysis of who we are as Americans and what we have become as a country." — Sam Quinones, author of Dreamland: The True Tale of America's Opiate Epidemic

"America is experiencing a catastrophe. Those without a college degree are not just being left behind; they are dying from deaths of despair. Case and Deaton brilliantly describe and dissect the causes and explain how we can return to a path of rising prosperity and health. All citizens — voters as well as politicians aspiring to office—should read and discuss this book." — Mervyn King, former governor of the Bank of England

"Deaths of despair among US whites with low education cannot be attributed to lack of access to health care or ignorance of healthy lifestyles. When two leading economists turn their attention to the social determinants of this modern epidemic, the result is brilliant." — Sir Michael G. Marmot, author of The Health Gap

Post-Publication Reviews

Recommended by Shepherd Book Reviews - A New York Times and Wall Street Journal Bestseller.

Ailing and Unequal-   "Simply put, this is a terrific book. I suspect it will be on many people’s top 10 book lists of 2020. Although written before COVID-19, the book’s critique of the US approach to health care and inequality is remarkably prescient. In many ways, the opioid crisis Case and Deaton analyze is a microcosm of the anguish the world is experiencing today, and we would be remiss not to pay attention to their insights." Kenneth Rogoff for the International Monetary Fund (June 2020)

A review by La Vanguadia, the daily newspaper of Barcelona (Ramon Aymerich, May 2020)

Death and Politics - It’s not just opioids that are ripping into the lives of working-class Americans. It’s a political system that disserves them. This book is a must-read for anyone attempting to objectively understand our collective American pain as well as those gaining from it. (Rahul Gupta, Democracy Journal, May 2020)

How fighting one pandemic can deepen another -  The Washington Post reviews "Deaths of Despair" (Carlos Lozada, Washington Post, May 2020)

"This highly important book examines the pain and despair among white blue-collar workers and suggests that the hopelessness they are experiencing may eventually extend to the entire American work force" - New York Times Editors' Choice (April 23, 2020)

Anatomists of Melancholy in the age of Coronavirus: Anne Case and Angus Deaton diagnose the deadly despair that arises from the lack of a college degree. The current crisis only exacerbates the problem. (Spencer Lee-Lenfield, The Chronicle of Higher Education, April 2020)

Plumbing the Depths -In their comprehensive new book, Deaths of Despair and the Future of Capitalism, economists Anne Case and Angus Deaton explain why mortality rates in the U.S. are rising. (Mike Jakeman, Strategy & Business, April 2020)

White working-class blues (Gabriel Rossman, Washington Examiner, April 2020)

Publishers Weekly review of the Anne Case and Angus Deaton's book "Deaths of Despair" (April 2020)

What's Killing the White Working Class? (Stephanie Mencimer, Washington Monthly Magazine, March 2020)

Deaths of Despair and the Psychological Wages of Whiteness - Racism and policies supported by a majority of poor and white working class voters can kill them. (Keri Leigh Merritt, Common Dreams, March 19, 2020)

Deaths of Despair: Why America's medical industry explains working-class suicides (Chris McGreal, The Guardian, March 19, 2020) 

Deaths of Despair Examines the Steady Erosion of U.S. Working-Class Life (Jim Zarroli, NPR, March 18, 2020)

Deaths of Despair and the Future of Capitalism (Susan Babbit, New York Journal of Books, March 17, 2020)

How the White Working Class is Being Destroyed (Arlie Russell Hochschild, New York Times Book Review, March 17, 2020)

Why Americans are Dying from Despair - The unfairness of our economy can be measured not only in dollars, but in deaths (Atul Gawande, The New Yorker, March 16, 2020)

Why Deaths of Despair are Rising - as jobs are downgraded and health care costs spiral, more and more Americans are dying early. (Robin Kaiser-Schatzlein, The New Republic, March 10, 2020)

America needs to talk about the new book that says lacking a college degree might kill you (Will Bunch, Philadelphia Inquirer, March 8, 2020)

Left Behind - Helen Epstein reviews Deaths of Despair and the Future of Capitalism (The New York Review of Books, March 26, 2020 issue)

Diane Coyle of The Enlightened Economist reviews Deaths of Despair (March 3, 2020)