DEATHS OF DESPAIR IN CANADA; HOW TO TELL STORIES WITH DATA
Evelyn Forget and Musah Khalid
CRDCN National Conference: Hamilton, Ontario
October 19, 2018
ANNE CASE AND ANGUS DEATON, 2015 & 20171
• Wanted to explain the rise of populism in the US.
• Believed it was related to the “crushed aspirations” of the white working class – those left behind by economic change.
• Set out to document the decline of the white working class.
1. (2015). Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences, 112(49), 15078-15083.; (2017). Mortality and morbidity in the 21st century. Brookings papers on economic activity, 2017, 397.
ANNE CASE AND ANGUS DEATON, 2015 & 20171
• All-Cause Mortality rates increased from 1998 – 2015 for white non-Hispanics Americans aged 45 – 54, especially those with a high school education or less
• Ascribed the spike in mortality rates to “Deaths of Despair”:• Drug overdoses, suicides and alcohol-related liver mortality
• Attributed their findings to crushed aspirations or “cumulative disadvantage” of layered economic changes (globalisaton, mechanisation, layoffs, wage stagnation)
1. (2015). Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences, 112(49), 15078-15083.; (2017). Mortality and morbidity in the 21st century. Brookings papers on economic activity, 2017, 397.
White non-Hispanicshigh school or less
Black non-Hispanics
White non-Hispanics (all)
Hispanics
300
500
700
900
deat
hs p
er 1
00,0
00
2000 2005 2010 2015Survey year
All-cause mortality by race and ethnicity, ages 50-54
Case, A. & Deaton, A. (2017). Mortality and morbidity in the 21st century. Brookings papers on economic activity, 2017, 397.
THE CASE AND DEATON STORY
• A slow collapse of white working-class America• Long term, steady deterioration of job opportunities for lesser educated white
males
• Decline in real wages
• Shift from traditional communal churches to religion which emphasizes personal identity
• Breakdown of the family institution: Lower marriage rates, higher divorce rates, men lose contact with their children
• Increasing distress and failure of life to turn out as expected
ANNE CASE AND ANGUS DEATON, 2015 & 20171
• Were challenged by critics who reminded them that other OECD countries have experienced similar economic change
1. (2015). Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences, 112(49), 15078-15083.; (2017). Mortality and morbidity in the 21st century. Brookings papers on economic activity, 2017, 397.
FRA
GER
UK
CAN
AUS
SWE200
250
300
350
400
450
deat
hs p
er 1
00,0
00
1990 1995 2000 2005 2010 2015year
ages 45-54All-cause mortality rates
USWWNH
FRA
GER
UK
CAN
AUS
SWE
200
250
300
350
400
450
deat
hs p
er 1
00,0
00
1990 1995 2000 2005 2010 2015year
ages 45-54, base year=2010Age-adjusted mortality rates
Case, A. & Deaton, A. (2017). Mortality and morbidity in the 21st century. Brookings papers on economic activity, 2017, 397.
ANNE CASE AND ANGUS DEATON, 2015 & 20171
• But Case and Deaton found “evidence” of “increasing deaths of despair” in other OECD countries, including Canada
1. (2015). Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences, 112(49), 15078-15083.; (2017). Mortality and morbidity in the 21st century. Brookings papers on economic activity, 2017, 397.
USW
GER
FRA
SWE
CAN
AUS
UK
2550
75de
aths
per
100
,000
1990 2000 2010year
Drug, alcohol and suicide mortality, men and women ages 50-54
Case, A. & Deaton, A. (2017). Mortality and morbidity in the 21st century. Brookings papers on economic activity, 2017, 397.
OUR STUDY
• We used:1. Mortality database
2. Linked CCHS – Vital Stats
• to examine the Canadian story of Deaths of Despair
THE CANADIAN CASE OF DEATHS
OF DESPAIR
MEN VERSUS WOMEN
ALCOHOL AND SUICIDE MORTALITY RATES ARE STABLE
DRUG MORTALITY RATES: THE EARLY STAGES OF A CANADIAN OPIOID CRISIS?
age20_244% age25_29
4%age30_34
10%
age35_393%
age40_4428%
age45_4917%
age50_5410%
age55_5914%
age60_647%
age65+3%
CANADA-WIDE MORTALITY DUE TO DRUG POISONING 2000 -2011
7%
87%
7%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Canada-wide mortality due to drug poisoning 2000-2011
PrimarySecondaryPost-secondary
47%
13%
33% 33%
50%
11%
69%
18%
8%
0%
10%
20%
30%
40%
50%
60%
70%
80%Sources of Income by Cause
Wages
Pension
SocialAssistance
CONCLUSIONS• Middle-aged Canadians are not dying disproportionately due to deaths of despair
caused by economic change.
• “Deaths of despair” doesn’t make much sense since “alcohol” and “suicide” deaths follow a very different pattern than “drug deaths”
• Drug poisoning mortality rates across all age groups are increasing:
• faster for 45 - 64 year olds.
• Although absolute numbers remain higher for men, both men and women see increasing rates of mortality due to drug poisoning.
• The rate of increase is larger for women.
• These numbers may reflect the beginnings of the opioid crisis, and the age / income range suggests that prescribed pharmaceuticals must be examined more closely.