On the nonmetro mortality penalty in deaths of despair

Thomas Edsall's guest column in the New York Times a few days ago was titled, "There Are Two Americas Now: One With a B.A. and One Without.’" It is a follow up on the widely discussed work of Mary Ann Case and Angus Deaton, Princeton economists who are well known for their scholarship on deaths of despair.  Some of the focus here is on the upward trajectory and optimism of Black folks and the downward trajectory and pessimism of white folks.  They also note the recently rising mortality rate among Black men, quoting Carol Graham of Brookings: 

Over the past three years, however, there has been a sharp increase in drug overdose deaths among Black men, Graham noted in an email:

The “new” Black despair is less understood and perhaps more complex. A big factor is simply Fentanyl for urban Black men. Plain and simple. But other candidates are Covid and the hit the African American communities took; Trump and the increase of “acceptance” for blatant and open racism; and, for some, George Floyd and continued police violence against blacks.

Near the end of the piece, Edsall also turns to the rural-urban axis, quoting the work of rural sociologist Shannon Monnat of Syracuse University's Lerner Center:  

Monnat described these differences as a “nonmetro mortality penalty.”

For rural and exurban men 25 to 44 over the same 28 years, she continued, “the mortality rate increased by 70.1 deaths per 100,000 population compared to an increase of only 9.6 among metro males ages 25 to 44, and 81 percent of the nonmetro increase was due to increases in drugs, alcohol, suicide, and mental/behavioral disorders (the deaths of despair).”

The divergence between urban and rural men pales, however, in comparison with women. “Mortality increases among nonmetro females have been startling. The mortality growth among nonmetro females was much larger than among nonmetro males,” especially for women 45 to 64, Monnat writes. Urban white men 45 to 64 saw death rate per 100,000 fall from 850 to 711.1 between 1990 and 2018, while death rates for rural white men of the same age barely changed, 894.8 to 896.6. In contrast, urban white women 45 to 64 saw their death rate decline from 490.4 to 437.6, while rural white women of that age saw their mortality rate grow from 492.6 to 571.9.

I wrote about these issues in my 2018 law review article, The Women Feminism Forgot:  Rural and Working-Class White Women in the Era of Trump.  

The Edsall column continues:

In an email, Monnat emphasized the fact that Trump has benefited from a bifurcated coalition:

The Trump electorate comprises groups that on the surface appear to have very different interests. On the one hand, a large share of Trump supporters are working-class, live in working-class communities, have borne the brunt of economic dislocation and decline due to economic restructuring. On the other hand, Trump has benefited from major corporate donors who have interests in maintaining large tax breaks for the wealthy, deregulation of environmental and labor laws, and from an economic environment that makes it easy to exploit workers. In 2016 at least, Trump’s victory relied not just on rural and small-city working-class voters, but also on more affluent voters. Exit polls suggested that a majority of people who earned more than $50,000 per year voted for Trump.

In a separate 2017 paper, “More Than a Rural Revolt: Landscapes of Despair and the 2016 Presidential Election,” Monnat and David L. Brown, a sociologist at Cornell, argue:

Work has historically been about more than a paycheck in the U.S. American identities are wrapped up in our jobs. But the U.S. working-class (people without a college degree, people who work in blue-collar jobs) regularly receive the message that their work is not important and that they are irrelevant and disposable. That message is delivered through stagnant wages, declining health and retirement benefits, government safety-net programs for which they do not qualify but for which they pay taxes, and the seemingly ubiquitous message (mostly from Democrats) that success means graduating from college.

Cross-posted to Working-Class Whites and the Law.