‘Deaths of despair’ are really deaths of exploitation

The phrase “deaths of despair” has become cultural shorthand for deaths from overdose, suicide and alcoholism. Coined by economists Angus Deaton and Anne Case, it paints a provocative picture of what many people are experiencing. They may believe that no matter what they do, nothing is going to improve. They may no longer even care what happens to themselves. This is where despair becomes fatalism; death by overdose may seem inevitable to some people. If not this time, then perhaps the next.

Yet this description is also misleading; there are structural economic dynamics driving the despair. This is evident from the recent National Vital Statistics Report from the Centers for Disease Control and Prevention that examines the relationship between occupations and overdose deaths in the United States and presents staggering statistics that indict the economic prospects and working conditions of many employed adults.

The study examined deaths from overdoses by major occupations per 100,000 workers in that occupation. According to the data from the year 2020, overdoses killed 163 people out of every 100,000 who primarily worked in construction. For every 100,000 workers in food preparation and service, 118 died from overdose. Among every 100,000 personal care and service providers, such as childcare and home health workers, overdoses killed 74 of them. Simultaneously, the lowest rates of overdose death by occupations are found in the business and financial sector (11), computer and mathematics (9), and education, training and library positions (6). The combined death by overdose rate for the highest three groups is more than 13 times greater than for workers in the three lowest groups. This stark disparity requires explanation.

While it might be tempting to attribute the difference in overdose rates to intelligence, that’s a convenient fiction. Even in stable economic times, occupations with the highest rates of overdose deaths are among the most physically demanding. Construction and healthcare workers spend long hours on their feet, climbing, bending and carrying tools, materials or even people. These physical demands create dangerous conditions; workplace accidents and injuries are far more common with roofers, for example, than they are with librarians. If education does provide a protective factor, it is because education provides access to occupations that are inherently less dangerous.

There’s also a higher degree of employment uncertainty with construction, restaurant and personal care workers. Economic downturns hit the construction industry hard. Construction is weather dependent; many workers are pushed, or push themselves, to take advantage when the weather cooperates. When the economy is shaky, eating out becomes a luxury many eliminate. Restaurant closures soared during the pandemic and most likely will not return to pre-pandemic levels. Finally, personal healthcare workers during the pandemic often had to do more with less. Their turnover rate — those who left or whose employment was terminated — soared to 77%.

One of the biggest protections against overdosing is having affordable health insurance. Many employers don’t offer insurance, putting the onus on workers to buy their own healthcare plan or find a job — often an additional one — that does provide coverage. Even then, plans with high deductibles and copays preclude many from using their insurance for anything other than something catastrophic. Moreover, people need workday flexibility to go to appointments. If someone worries she’ll be fired or lose shifts, she’s less likely to seek medical care and may try to alleviate her pain by self-medicating with drugs she gets from family, friends or dealers. Fentanyl is commonly mixed with recreational drugs along with Xylazine, a veterinary non-opiate sedative, analgesic and muscle relaxant. In these instances, pain relief may come at the expense of one’s life.

The overdose epidemic is not the canary in the coal mine; it’s the mine collapsing. The misleading part of “deaths of despair” is that despair is a consequence of marginalization, powerlessness and exploitation. When people are marginalized in the economic, social and political realms, they are relegated to the sidelines, their voices ignored or silenced. Marginalization leads to powerlessness, a loss of control over major life decisions such as occupations, marital status and living arrangements. These people become more susceptible to the vicious cycle of economic exploitation: long hours, low pay, dangerous working conditions and fragile job security.

There are ways out of this downward spiral. The American labor movement has made significant recent advances in multiple sectors as workers achieve gains in wages and job stability and rediscover their power. Policies and initiatives to increase the enforcement of heat-safety violations and to launch the Global Health Worker Initiative to improve safety and equity can have significant impacts. Lawsuits that sue localities over discriminatory housing ordinances can be especially effective by becoming models for other challenges.

By addressing these dynamics of despair — marginalization, powerlessness and exploitation — we begin to create a real possibility of effectively reducing the number of people whose tragic, premature deaths are ultimately avoidable and preventable.

Peg O’Connor is a professor of philosophy at Gustavus Adolphus College, a recovering alcoholic and the author of “Life on the Rocks: Finding Meaning in Addiction and Recovery” and “Higher and Friendly Powers: Transforming Addiction and Suffering.”