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.