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Living and Dying in America: An Essay on Deaths of Despair and the Future of Capitalism


  • Christopher J. Ruhm


This essay reviews Deaths of Despair and the Future of Capitalism (DEATHS), by Anne Case and Angus Deaton, a fascinating account of life and death in the United States during the late 20th and early 21st centuries. While primarily targeted towards a popular audience, the volume will be of interest to many economists and other social scientists. It postulates how public and private policies currently practiced in the United States, combined with and partly causing the declining economic and social circumstances of less educated, have led to increased mortality from drugs, suicide, and chronic liver disease. After describing the material in DEATHS in considerable detail, I suggest a variety of research questions that need to be answered to confirm or refute Case and Deaton’s arguments and describe challenges to their key hypotheses. Among the latter are the ability of the postulated relationships to explain the sharply differing mortality trajectories of non-Hispanic whites, compared with other groups, and the timing of the observed mortality changes. Along the way, I raise doubts about the usefulness of the “deaths of despair” conceptualization, with its strong implications about causality.

Suggested Citation

  • Christopher J. Ruhm, 2021. "Living and Dying in America: An Essay on Deaths of Despair and the Future of Capitalism," NBER Working Papers 28358, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:28358
    Note: EH LS PE

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    Cited by:

    1. Randall Akee & Donn L. Feir & Marina Mileo Gorzig & Samuel Myers Jr., 2022. "Native American “Deaths of Despair” and Economic Conditions," Opportunity and Inclusive Growth Institute Working Papers 062, Federal Reserve Bank of Minneapolis.
    2. Ann E. Davis, 2023. "Ukraine War: Policy Miscalculations or Contradictions of Capitalism?," Review of Radical Political Economics, Union for Radical Political Economics, vol. 55(4), pages 557-567, December.
    3. Johanna Catherine Maclean & Justine Mallatt & Christopher J. Ruhm & Kosali Simon, 2022. "The Opioid Crisis, Health, Healthcare, and Crime: A Review of Quasi-Experimental Economic Studies," The ANNALS of the American Academy of Political and Social Science, , vol. 703(1), pages 15-49, September.

    More about this item

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J11 - Labor and Demographic Economics - - Demographic Economics - - - Demographic Trends, Macroeconomic Effects, and Forecasts
    • J18 - Labor and Demographic Economics - - Demographic Economics - - - Public Policy

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