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In reversal, rising death rates among middle-age whites in Michigan

In a downtown Grand Rapids shelter, the man reflected on what for him has been a bleak decade.

A high school dropout, he’d worked in an auto body shop and in production at the office furniture maker, Steelcase, Inc., making as much as $50,000 a year. But in 2003, after 13 years, he was caught in a wave of job cuts that swept through the furniture industry.

From there, Dave, who asked that his last name not be used, saw his career ‒ and health ‒ spiral. Work as a $12-an-hour painter in a body shop was ruining his lungs, so he took a factory job for $11.50. When that ended, he unloaded trucks for $10 hourly.

By then, Dave was years into heavy drinking, leading to days, he said, where “sometimes, I wanted to die.”

A couple of months ago, Dave checked into the Guiding Light Mission, a Grand Rapids shelter and rehabilitation facility, where he hopes to continue his recovery and return to the workforce, which he acknowledges, at age 47, is “kind of scary.”

A recent academic analysis suggests the series of stresses Dave describes are taking a deadly toll on hundreds of thousands of men and women like him – middle-age whites across the nation with a high school education or less.

According to the study, by Princeton University economists Angus Deaton and Ann Case, death rates for white, less-educated adults age 45-54 climbed 22 percent between 1999 to 2013, even as mortality rates for other groups fell. The findings are a reversal for this group following decades in which they, like other Americans, were living longer and healthier lives.

Perhaps the study’s most striking finding: Most of the increase for this white group was due to overdose of drugs (legal and illegal), liver disease tied to alcohol abuse and suicide.

Over this same period, the overall death rate for African Americans fell 37 percent and for Hispanics 24 percent, the study found. (It’s critical to note that while African-American death rates declined steeply over this period, they still remain higher than death rates for whites.)

While the study provides no one explanation for the differences, it notes an increase in opioid overdoses stemming from prescriptions to manage physical pain, along with a significant rise in “serious psychological distress.”

“Addictions,” the study concluded, “are hard to treat,” leaving those in this midlife, less-educated group “a ‘lost generation' whose future is less bright than those who preceded them.”

Stark numbers in Michigan

While the Princeton study did not break out numbers for Michigan, data kept by the state suggests a similar phenomenon at work here; a trend that could have serious implications as the state’s aging population moves unsteadily toward retirement.

Overall death rates in Michigan fell by 13 percent from 2000 to 2013, according to the state. The declines have been even more promising for African Americans, who saw mortality rates drop nearly 18 percent over this period. Black men and women in the 45-to-54-year-old group showed even greater improvement, with rates dropping 27 percent.

So too, white Michiganders as a whole did just fine, with a decline of 12.3 percent, according to the Michigan Department of Community Health.

But for middle-age whites in Michigan, a grimmer trend.

White Michiganders in the 45-to-54 age range saw an 11 percent rise in mortality. (The state does not break out death rates by education status, making it difficult to determine if less-educated whites in this group fared even worse than those who went to college.)

Why the spike for this segment of whites while rates for African Americans and Hispanics continue to decline?

David Weir, director of the health and retirement study at the Institute for Social Research at the University of Michigan, told the Washington Post the results are striking given that whites as a group have higher incomes, better education and other societal advantages that work against blacks. “In this case, that’s not happening,” he said.

Michigan State University economist Charles Ballard called the Deaton study's findings “startling,” though he cautioned that “we need more research before we can reach more definitive conclusions about what is going on here.”

He said the loss of jobs ‒ particularly in the manufacturing sector ‒ in recent decades seems the most likely culprit for the rise in mortality rates.

“These are exactly the people who have been hammered economically more than any other group for the last 40 years,” Ballard said.

“The boom of the 1990s (especially in manufacturing) brought a brief moment of improved prosperity, even for those who are less well educated. Since 1999, however, we have had two recessions, one of which is the worst in our lifetime.”

Ballard speculated that less-educated whites may have taken the economic decline harder than minorities, in part because they had farther to fall. “That sense of psychological loss could easily translate into substance abuse and other ills.”

Grinding economy brings despair

It is another troubling signpost for what appears to be a diminishing middle class, a slide that has been especially notable in a manufacturing state like Michigan, where median household income fell from an inflation-adjusted $64,778 in 1969 to $49,418 in 2013. The drop parallels in many ways the decline of the state's Big Three automakers, a fall that steepened in the first decade of this century.

According to Michigan's Department of Technology, Management & Budget, Michigan shed more than 430,000 manufacturing jobs in the first decade, from nearly 900,000 jobs in 1999 to 463,100 in 2009. The state lost more than 700,000 jobs of all types during that time.

This hit workers of all ages hard, but losses were particularly tough on high-school-educated workers many of whom lacked the skills or knowledge to adjust to a changing economy. For those with no other marketable trade, the alternative in a depressed economy might be a job at the mall or flipping burgers at just above minimum wage.

Compounding the blow, wages in Michigan continued to fall even as jobs disappeared. Analysis by the Michigan League for Public Policy, a nonprofit Lansing-based advocacy organization, found that Michigan fell from fourth highest U.S. median wage in 1982 to 24th highest in 2012.

In 2014, whites in Michigan with a high school degree earned $26,372 a year – a fall of 17 percent from 2005, when adjusted for inflation. For whites with less than a high school education, annual income fell even more steeply, from $23,142 in 2005 to $18,457 in 2014.

There are about 500,000 whites in Michigan age 45 to 54 with a high school degree or less. While economic setbacks might explain a lot, the puzzle is why this group appears to have suffered rising mortality rates while death rates continue to fall among African Americans of similar age.

After all, African Americans in the United States have a poverty rate nearly three times higher than whites, a status that is normally associated with poorer health outcomes. In Michigan, African Americans are even more likely to live in poverty than whites – 34 percent of blacks are in poverty, compared with 11 percent of whites. And in 2012, the share of black adults in Michigan with no high school degree was twice as high as whites, at 14 percent of the black population to 7 percent of whites.

The national study points to a trio of causes for the middle-age white mortality rate: Disproportionate numbers of less-educated middle-age whites are turning to drugs, alcohol or suicide as a way out.

From 1999 to 2013, the study found sharp increases in death rates among middle-age, non-college-educated whites from accidental drug and alcohol poisoning, chronic liver disease and suicide, while death from diabetes remained relatively flat.

Mortality rates from all causes among less-educated, middle-age whites stood at 736 per 100,000 in 2013, compared with 582 per 100,000 for black non-Hispanics and 270 per 100,000 among Hispanics.

The aging drug abuser

Other research confirms that middle-age Michiganders in general are increasingly losing their lives to drugs.

Though not broken down by education level, a 2014 study by the Michigan Department of Community Health found that Michigan residents in the 45-to-54-year-old range had the state’s highest death rate from drug overdose.

The overall death rate from overdose quadrupled between 1999 to 2012.

According to the U.S. Centers for Disease Control, Michigan's 2014 death rate from drugs stood at 18 per 100,000, an increase of 13 percent from the previous year. That exceeded the national average of 14.7 per 100,000.

Douglass Judson, a Grand Rapids social worker and counselor, said he’s not shocked by middle-aged drug fatalities. He’s been seeing working-class clients, some of them clinically depressed, stressed over job loss for years. This has been the case even as Michigan's economy has come back from the worst of the Great Recession.

“There isn't a lack of misery out there,” Judson said. “We are becoming less of a middle class. There are lots of people whose jobs have become obsolete. It's traumatic.”

Judson said that it is typical for individuals to personalize events in their life beyond their control. So when a worker loses a job, or a series of jobs, and maybe their house, they often blame themselves.

“It shatters their sense of self-worth. They become hopeless.”

And in many cases, Judson said, such individuals “self medicate,” turning to drugs and alcohol to numb their sense of despair. That only compounds their ordeal.

“Substance abuse increases depression and anxiety. It would increase mortality,” he said.

Struggling to help

As workers struggled through the layoffs of the past decade, Michigan has poured billions of dollars in federal funds into job retraining through its network of regional job agencies called Michigan Works. Whether it has been effective is far from clear.

A 2011 report by the Michigan Auditor General found problems in the state’s management of the Michigan Works, concluding it did not have data to prove its effectiveness in training and placing the unemployed in jobs. It found that some agencies spent as little as 3 percent on direct training.

Gov. Rick Snyder has repeatedly decried the lack of qualified workers to fit job openings, particularly in skilled trades including tool and die work, welding and advanced manufacturing, fields where many employers today require more than a high school degree. Many report an ongoing lack of qualified candidates for open positions, as state officials estimate there are 8,300 job openings in a variety of skilled trades.

But Ballard, the MSU economist, said there were limits to what retraining can do when hundreds of thousands of jobs disappeared in a decade.

“During a downturn as large as the one Michigan suffered in the first decade of this century, there are limits to how much can be achieved by retraining programs. If someone has lost his or her job in manufacturing, but if jobs are drying up all across the economy, it’s an uphill battle,” he said.

Substance abuse treatment for those who need it is another matter.

Michael Reagan, chief external relations officer for Cherry Health, a nonprofit health care organization in Grand Rapids, said national studies indicate only 10 percent of those who need drug or alcohol treatment actually get it. He called that record “abysmal.”

Reagan said access to substance abuse treatment is improved for many working poor under Michigan's expansion of Medicaid. But he said in many cases those who would benefit from treatment don't access care because of the stigma attached to addiction, lack of coordination between the medical system and treatment network and a shortage of specialty treatment options. Doctors may fail to follow up on indications of a substance abuse problem, such as anxiety, depression or difficulty sleeping.

“There is a big effort underway to increase screenings (for indications of substance abuse) and early intervention,” Reagan said.

Battling hopelessness

At the Guiding Light Mission, a man named Bob, 52, slim, with a pulled-back ponytail, said he fared all right with his high school degree until drugs and alcohol caught up with him. A 1982 graduate of Wyoming Park High School, he served three years in Army and then found work as a carpenter on home construction.

“I started using five, six years ago,” he said, a regime that included alcohol and cocaine and, occasionally, heroin.

He divorced six years ago and lost his house to foreclosure two years later. In his lowest moments, he said he thought of suicide.

“I made plans, thinking I would make it look like an overdose, so it wouldn't be so hard on my family,” said Bob, who also asked that his last name not be used.

Instead, he checked himself into the mission, where he hopes to get back on his feet. But he said he knows of plenty of others his age who are struggling.

“I've got a lot of friends that are in that category. They went from a really nice life to scrounging,” he said. “I think a lot of people lost hope.”

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