A concept that seems to me to be missing from the Ruhm vs. Case/Deaton debate on “deaths of despair” is that of social crisis.
This seems to me to be the case for American Indians, who began experiencing what looks like a similar social crisis to non-college educated whites about a decade beforehand: rapidly escalating rates of suicide, drug overdoses, exit from the workforce, and even alcohol-related deaths (which were already very high for American Indians well before 2000, of course):
Total fertility rates for American Indian women have dropped from the highest to by far the lowest among racial groups since the early 80s, and overall mortality for younger Indians (under 45) has increased by around 40% just since 2000:
What drove this social crisis? I of course don’t know, but I’d appeal to a similar explanation to the one I made for West Virginia- existing communities were already weakened, such that later-emerging dangers like the opioid crisis encountered less resistance. I also wonder how this social crisis lines up with the disbursement of casino income by tribes, which appears to discourage labor force participation and may disrupt communities in the medium run:
Somewhat similarly, I would argue that African Americans experienced a social crisis in the late 70s through early 90s: the wild increase in out-of-wedlock births, drug dependency, homicide, and underemployment was sufficient to reduce black male and female life expectancy and largely preceded mass incarceration.
Since the 90s, the African American social crisis has in my view significantly abated, with rapid declines in mortality and progress along a number of educational and employment outcomes (particularly for black women) since the 90s, and at least a slowed increase in the proportion of unmarried births. But this was only after the end of AFDC and the shift to TANF forced black women en masse into the workforce, combined with a massive increase in incarceration of black men which, even if it contributed to the fall in crime, undoubtedly had large social and communal costs.
The common thread here would seem to be replacement of workforce participation with transfer payments, particularly cash transfers (since, my own reservations about Medicaid aside, increases in in-kind payments and SNAP since the 80s haven’t seemed to exert the same disruptive effect.) As I’ve said before, it seems very likely to me that technology will push an ever larger segment of society out of the economy, sooner or later, but how to prevent this from tearing apart our social fabric I don’t know.