JUN 19, 2019
We hear a lot about suicide
when celebrities like Anthony Bourdain and Kate Spade die by their own hand. Otherwise, it seldom
makes the headlines. That’s odd given the magnitude of the problem.
In 2017, 47,173 Americans
killed themselves. In that single year, in other words, the suicide count was
nearly seven times greater than the number of American
soldiers killed in the Afghanistan and Iraq wars between 2001 and 2018.
A suicide occurs in the United
States roughly once every 12 minutes. What’s more, after decades of decline, the rate
of self-inflicted deaths per 100,000 people annually — the suicide rate — has
been increasing sharply since the late 1990s. Suicides now claim two-and-a-half
times as many lives in this country as do homicides, even though the murder rate gets so much more
attention.
In other words, we’re talking
about a national epidemic of self-inflicted deaths.
Worrisome Numbers
Anyone who has lost a close
relative or friend to suicide or has worked on a suicide hotline (as I have)
knows that statistics transform the individual, the personal, and indeed the
mysterious aspects of that violent act — Why this person? Why now? Why in
this manner? — into depersonalized abstractions. Still, to grasp how serious
the suicide epidemic has become, numbers are a necessity.
According to a 2018 Centers
for Disease Control study, between 1999 and 2016, the suicide rate increased in
every state in the union except Nevada, which already had a remarkably high
rate. In 30 states, it jumped by 25% or more; in 17, by at least a third.
Nationally, it increased 33%.
In some states the upsurge was far higher: North Dakota (57.6%), New Hampshire
(48.3%), Kansas (45%), Idaho (43%).
Alas, the news only gets
grimmer.
Since 2008,
suicide has ranked 10th among the causes of death in this country. For
Americans between the ages of 10 and 34, however, it comes in second; for those
between 35 and 45, fourth. The United States also has the ninth-highest
rate in the 38-country Organization for Economic Cooperation and
Development. Globally, it ranks 27th.
More importantly, the trend in
the United States doesn’t align with what’s happening elsewhere in the
developed world. The World Health Organization, for instance, reports that
Great Britain, Canada, and China all have notably lower suicide rates than the
U.S., as do all but six countries in the European Union.
(Japan’s is only slightly lower.)
World Bank statistics show that,
worldwide, the suicide rate fell from 12.8 per 100,000 in 2000 to 10.6 in 2016.
It’s been falling in China, Japan (where it has declined steadily for nearly
a decade and is at its lowest point in 37 years), most
of Europe, and even countries like South Korea and Russia that have a significantly higher suicide rate
than the United States. In Russia, for instance, it has dropped by nearly 26%
from a high point of 42 per 100,000 in 1994 to 31 in 2019.
We know a fair amount about
the patterns of suicide in the United States. In
2017, the rate was highest for men between the ages of 45 and 64 (30 per
100,000) and those 75 and older (39.7 per 100,000).
The rates in rural counties
are almost double those in the most urbanized ones, which is why states like
Idaho, Kansas, New Hampshire, and North Dakota sit atop the suicide list.
Furthermore, a far higher percentage of people in rural states own guns than in cities and suburbs, leading to a higher
rate of suicide involving firearms, the means used in half of all
such acts in this country.
There are gender-based differences
as well. From 1999 to 2017, the rate for men was substantially higher than for
women — almost four-and-a-half times higher in the first of those years,
slightly more than three-and-a-half times in the last.
Education is
also a factor. The suicide rate is lowest among individuals with college
degrees. Those who, at best, completed high school are, by comparison, twice as
likely to kill themselves. Suicide rates also tend to be lower among
people in higher-income brackets.
The Economics of Stress
This surge in the suicide rate
has taken place in years during which the working class has experienced greater
economic hardship and psychological stress. Increased competition from
abroad and outsourcing, the results of globalization, have contributed to job
loss, particularly in economic sectors like manufacturing, steel, and mining
that had long been mainstays of employment for such workers. The jobs still
available often paid less and provided fewer benefits.
Technological change,
including computerization, robotics, and the coming of artificial intelligence,
has similarly begun to displace labor in significant ways, leaving Americans
without college degrees, especially those 50 and older, in far more difficult straits when it comes to finding new jobs that pay well. The lack of anything
resembling an industrial policy of a sort that exists in Europe has
made these dislocations even more painful for American workers, while a sharp
decline in private-sector union membership — down from nearly 17% in 1983 to 6.4% today — has reduced
their ability to press for higher wages through collective bargaining.
Furthermore, the
inflation-adjusted median wage has barely budged over
the last four decades (even as CEO salaries have soared). And a decline in
worker productivity doesn’t explain it: between 1973 and 2017
productivity increased by 77%, while a worker’s average hourly wage only
rose by 12.4%. Wage stagnation has made it harder for working-class Americans to get by, let
alone have a lifestyle comparable to that of their parents or grandparents.
The gap in earnings between
those at the top and bottom of American society has also increased — a lot.
Since 1979, the wages of Americans in the 10th percentile increased by
a pitiful 1.2%. Those in the 50th percentile did a bit better, making a gain of
6%. By contrast, those in the 90th percentile increased by 34.3% and
those near the peak of the wage pyramid — the top 1% and especially the
rarefied 0.1% — made far more substantial gains.
And mind you, we’re just
talking about wages, not other forms of income like large stock dividends,
expensive homes, or eyepopping inheritances. The share of net national
wealth held by the richest 0.1% increased from
10% in the 1980s to 20% in 2016. By contrast, the share of the bottom 90%
shrank in those same decades from about 35% to 20%. As for the top 1%, by 2016
its share had increased to almost 39%.
The precise relationship
between economic inequality and suicide rates remains unclear, and suicide
certainly can’t simply be reduced to wealth disparities or financial stress.
Still, strikingly, in contrast to the United States, suicide rates are
noticeably lower and have been declining in Western European countries where income inequalities
are far less pronounced, publicly funded healthcare is regarded as a right (not
demonized as a pathway to serfdom), social safety nets far more extensive,
and apprenticeships and worker retraining programs more widespread.
Evidence from the United States, Brazil, Japan, and Sweden does
indicate that, as income inequality increases, so does the suicide rate. If so,
the good news is that progressive economic policies — should Democrats ever
retake the White House and the Senate — could make a positive difference. A study based
on state-by-state variations in the U.S. found that simply boosting the minimum
wage and Earned Income Tax Credit by 10% appreciably reduces the suicide rate
among people without college degrees.
The Race Enigma
One aspect of the suicide
epidemic is puzzling. Though whites have fared far better economically
(and in many other ways) than African Americans, their suicide rate is
significantly higher. It increased from 11.3 per 100,000 in 2000 to 15.85
per 100,000 in 2017; for African Americans in those years the rates were 5.52
per 100,000 and 6.61 per 100,000. Black men are 10 times more likely to be homicide victims than white
men, but the latter are two-and-half times more likely to kill themselves.
The higher suicide rate among
whites as well as among people with only a high school diploma highlights
suicide’s disproportionate effect on working-class whites. This segment of the
population also accounts for a disproportionate share of what economists Anne
Case and Angus Deaton have labeled “deaths of despair” — those caused by suicides plus opioid overdoses and liver diseases linked to alcohol
abuse. Though it’s hard to offer a complete explanation for this, economic
hardship and its ripple effects do appear to matter.
According to a study by the St. Louis Federal Reserve, the white working class
accounted for 45% of all income earned in the United States in 1990, but only
27% in 2016. In those same years, its share of national wealth plummeted,
from 45% to 22%. And as inflation-adjusted wages have decreased for men without college degrees, many white
workers seem to have lost hope of success of any sort. Paradoxically,
the sense of failure and the accompanying stress may be greater for white
workers precisely because they traditionally were much better off economically than their African American
and Hispanic counterparts.
In addition, the fraying of
communities knit together by employment in once-robust factories and mines has
increased social isolation among them, and the evidence that it
— along with opioid
addiction and alcohol
abuse — increases the risk of suicide is strong. On top of that, a significantly higher proportion
of whites than blacks and Hispanics own firearms, and
suicide rates are markedly higher in states where gun ownership is more widespread.
Trump’s Faux Populism
The large increase in suicide
within the white working class began a couple of decades before Donald Trump’s
election. Still, it’s reasonable to ask what he’s tried to do about it,
particularly since votes from these Americans helped propel him to the White
House. In 2016, he received 64% of the votes of whites without college degrees;
Hillary Clinton, only 28%. Nationwide, he beat Clinton in counties where deaths of despair rose significantly
between 2000 and 2015.
White workers will remain
crucial to Trump’s chances of winning in 2020. Yet while he has spoken
about, and initiated steps aimed at reducing, the high suicide rate among veterans, his speeches and tweets have never highlighted
the national suicide epidemic or its inordinate impact on white workers. More
importantly, to the extent that economic despair contributes to their high
suicide rate, his policies will only make matters worse.
The real benefits from the
December 2017 Tax Cuts and Jobs Act championed by the president and
congressional Republicans flowed to those on the top steps of the economic
ladder. By 2027, when the Act’s provisions will run out, the wealthiest
Americans are expected to have captured 81.8% of the gains. And that’s not counting the
windfall they received from recent changes in taxes on inheritances. Trump and
the GOP doubled the annual amount exempt from estate taxes —
wealth bequeathed to heirs — through 2025 from $5.6 million per individual to
$11.2 million (or $22.4 million per couple). And who benefits most from this
act of generosity? Not workers, that’s for sure, but every household with
an estate worth $22 million or more will.
As for job retraining provided
by the Workforce Innovation and Opportunity Act, the president proposed cutting that program by 40% in his 2019
budget, later settling for keeping it at 2017 levels. Future cuts seem in the
cards as long as Trump is in the White House. The Congressional Budget
Office projects that
his tax cuts alone will produce even bigger budget deficits in the years to
come. (The shortfall last year was $779 billion and it is expected to reach $1 trillion
by 2020.) Inevitably, the president and congressional Republicans will then
demand additional reductions in spending for social programs.
This is all the more likely
because Trump and those Republicans also slashed corporate taxes from 35% to 21% — an
estimated $1.4 trillion in savings for corporations over the
next decade. And unlike the income tax cut, the corporate tax has no end date. The president assured his base that the big
bucks those companies had stashed abroad would start flowing home and produce a
wave of job creation — all without adding to the deficit. As it happens,
however, most of that repatriated cash has been used for corporate stock
buy-backs, which totaled more than $800 billion last year. That, in turn, boosted share
prices, but didn’t exactly rain money down on workers. No surprise, of course,
since the wealthiest 10% of Americans own at least 84% of all stocks and the bottom 60% have less
than 2% of them.
And the president’s corporate
tax cut hasn’t produced the tsunami of job-generating investments he predicted
either. Indeed, in its aftermath, more than 80% of American companies stated that their plans for
investment and hiring hadn’t changed. As a result, the monthly increase in jobs
has proven unremarkable compared
to President Obama’s second term, when the economic recovery that Trump largely
inherited began. Yes, the economy did grow 2.3% in 2017 and 2.9% in 2018 (though not 3.1% as the president claimed). There wasn’t, however,
any “unprecedented economic boom — a boom that has rarely been seen before” as
he insisted in this year’s State
of the Union Address.
Anyway, what matters for
workers struggling to get by is growth in real wages, and there’s nothing to
celebrate on that front: between 2017 and mid-2018 they actually declined by 1.63% for white workers and 2.5% for
African Americans, while they rose for Hispanics by a measly 0.37%. And
though Trump insists that his beloved tariff hikes are going to help workers,
they will actually raise the prices of goods, hurting the working class and
other low-income Americans the most.
Then there are the obstacles
those susceptible to suicide face in receiving insurance-provided mental-health
care. If you’re a white worker without medical coverage or have a policy with a
deductible and co-payments that are high and your income, while low, is too
high to qualify for Medicaid, Trump and the GOP haven’t done anything for you.
Never mind the president’s tweet proclaiming that “the Republican Party Will
Become ‘The Party of Healthcare!’”
Let me amend that: actually,
they have done something. It’s just not what you’d call helpful.
The percentage of uninsured adults, which fell from 18% in
2013 to 10.9% at the end of 2016, thanks in no small measure to Obamacare, had risen to 13.7% by the end of last year.
The bottom line? On a problem
that literally has life-and-death significance for a pivotal portion of his
base, Trump has been AWOL. In fact, to the extent that economic strain
contributes to the alarming suicide rate among white workers, his policies are
only likely to exacerbate what is already a national crisis of epidemic
proportions.
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