LR

Deaths of Despair – Detailed Study Notes

Introduction

  • Lecturer apologizes for raspy voice; promises a short lecture that frames the week’s independent content
  • Central theme: “Deaths of Despair” (D.o.D.) and their outsized impact in Missouri and the U.S.
  • Goal: define the term, explore data patterns, critique common mistakes, and connect sociological theories (anomie, inequality) to real-world trends

Definition & Core Components of “Deaths of Despair”

  • Phrase coined by demographers/economists to explain unusual mid-2000s mortality spike among older, rural white men
  • 3 mutually reinforcing death categories:
    • Drug overdoses – prescription pain-killers (hydrocodone, oxycontin), heroin, (now) fentanyl, and methamphetamine
    • Alcohol-related disease – chiefly cirrhosis and other liver pathologies
    • Suicide – self-inflicted fatalities
  • Observed despite an overall \uparrow life expectancy trend in the U.S.

Historical Discovery & Alarm

  • Mid-2000s data broke the usual pattern: white mortality generally lowest, yet this cohort spiked
  • Demographers flagged an epidemiological “blip” → prompted Congressional, CDC, JAMA studies
  • “Deaths of Despair” rose sharply after \text{2000} – coincident with wide opioid marketing/availability

Key Data Sources Mentioned

  • U.S. Joint Economic Committee (Republican staff report) → concise research brief (14 sources; model for student projects)
  • Missouri Foundation for Health infographic (contains math errors)
  • CDC surveillance, JAMA 2019 geographic heat maps
  • National surveys of happiness: General Social Survey (GSS), Pew, Gallup

Missouri: A Case Study

  • State exhibits dramatic D.o.D. rates; useful microcosm for studying rural impact
  • Infographic highlights steep rises in:
    • Drug overdoses: claimed “585%” increase (statistically incorrect)
    • Alcohol poisoning: “763%” increase (suspect)
    • Suicide: minor rise
  • Lecturer’s critique: you cannot show “585%” (percentages cap at 100\%); proper statement is “5.85-fold increase”
  • Rural counties show highest concentrations; pattern not limited to whites—recent data show minorities increasingly affected (likely earlier under-surveillance)
  • Prescription drug monitoring enables precise user counts, revealing demographic spread

Trend Lines (1930s → 2010s)

  • Composite D.o.D. curve rises gradually until \sim 2000, then steep \uparrow
  • Individual components:
    • Drug deaths accelerate fastest (opioid phase ➜ fentanyl/meth phase)
    • Alcohol line remains elevated; suicide line steadily high
  • Post-COVID numbers feared worse (pending data) — authors adding methamphetamine as 4th pillar

Racial & Gender Disparities

  • Alcohol-related death rates, ages 45-54:
    • Non-Hispanic white men top, followed by non-Hispanic white women
    • Hispanic men/women lower but rising
  • Drug-related death rates show identical racial hierarchy
  • Medical bias: whites more likely to be believed re: pain, thus more likely to receive opioids; non-whites often labeled “drug-seeking”
  • Gendered coping networks: women cultivate stronger social support, mitigating late-life despair; men fare worse

Geographic Hotspots (JAMA 2019 Heat Map)

  • Pacific Northwest
  • Upper Midwest / Upper Peninsula
  • “Rust Belt” (de-industrialized factory corridor)
  • Common denominator: employment loss, shrinking community infrastructure, limited healthcare access

Under-Counting & Survey Design Issues

  • CDC pilot found many opioid users deny “opioid” use because they don’t recognize the term
  • Questionnaire now lists each pain-killer by brand/generic

Sociological Explanations — Multi-Level Factors

  • Economic
    • Closure of manufacturing plants (GM, RCA, DuPont, etc.) → “Rust Belt effect”
    • Stagnant real wages since the 1970s \Rightarrow declining material wellbeing
    • Housing collapse (2006-08) & Great Recession (2008) worsen insecurities
  • Educational
    • Shrinking Pell Grants & rising tuition limit upward mobility
  • Political/Cultural
    • Polarization, policy gridlock, erosion of communal institutions (churches, unions)
    • Thomas Frank’s books (“What’s the Matter with Kansas?” & “Listen, Liberal”) argue Americans feel the American Dream is unreachable
  • Psychological
    • Increased reported unhappiness; GSS “very happy” responses lowest since 1970s
    • Anomie (Durkheim): normlessness, feeling one’s world is “crumbling”
    • Marx’s “false consciousness”/“opiate of the masses” metaphor → literal opioid epidemic
  • Technological/Social Media
    • Double-edged: connectivity vs. isolation, misinformation, comparison effects

Quantifying Unhappiness

  • Surveys chart % “not too happy” tracking economic shocks
  • Key correlation: \text{Unhappiness} \uparrow when inequality or perceived unfairness \uparrow

International Comparison

  • U.S. uniquely severe; peer nations avoid similar spikes due to:
    • Universal healthcare
    • Paid parental/sick leave
    • Subsidized higher education & job-retraining pipelines
  • UK, other Western nations face issues, but smaller public-health crisis magnitude

Evolving Crisis

  • Shift from Rx opioids → fentanyl & polysubstance mixes (fentanyl + meth)
  • COVID-19 lockdowns likely exacerbated overdoses and suicides (data forthcoming)

Policy/Practice Considerations

  • Universal healthcare, paid leave, affordable education, retraining identified as structural fixes in Missouri infographic
  • Sociological community reluctant to prescribe one-size solutions; calls for systemic rethink
  • Importance of accurate data collection, culturally sensitive outreach, and destigmatizing mental-health / SUD treatment

Ethical & Practical Implications

  • Medical gatekeeping & racial bias -> unequal harm
  • Economic restructuring vs. individual blame
  • Urgency: Lecturer ranks D.o.D. crisis near—or on some days above—COVID-19 as a public-health priority

Connections to Course & Upcoming Material

  • Builds on earlier lectures on anomie, inequality, drug policy
  • Sets stage for forthcoming unit on pharmaceutical industry’s role

Key Terms & Concepts (Quick Reference)

  • Deaths of Despair (D.o.D.)
  • Anomie (Durkheim): normlessness, social disintegration
  • False Consciousness (Marx)
  • Rust Belt
  • Prescription Opioids: hydrocodone, oxycontin, fentanyl
  • Crude Death Rate (CDR)
  • Relative Increase Formula: \text{Relative\ Increase} = \frac{\text{New\ Rate} - \text{Old\ Rate}}{\text{Old\ Rate}} (multiply by 100\% for percentage)
  • Fold-Change (times increase): \text{Fold} = \frac{\text{New}}{\text{Old}}

Study Prompts / Questions

  • How does anomie theory help explain geographic clustering of D.o.D.?
  • In what ways does racial bias in prescribing intersect with broader health inequities?
  • Compare U.S. structural factors to one peer nation; why different outcomes?
  • Brainstorm multi-level interventions (individual, community, policy)