Of dollars to boost opportunities for black, latinx and native american businesses if he wins the election in november. The democratic partys contenderfor the presidency sharply criticised donald trump, accusing him of intentionally stoking the flames of division and racism. The us attorney general has been defending the deployment of federal agents to american cities, saying they are needed to counter violent rioters. In testimony to congress, william barr claimed anti racism protesters in portland, oregon, are committing an assault on the government of the United States. Britains Prime Minister has suggested there are signs of a second wave of coronavirus in europe, as he defended a 14 day quarantine on travellers from spain. Borisjohnson said the government had to take swift action, and hinted holiday makers may face more quarantines. Now on bbc news, hardtalk. Welcome to hardtalk. Im stephen sackur. How do we judge the health of our economic systems . Well, it is about far more than those headline numbers on joblessness and growth. My guest today is the Nobel Prize Winning economist sir angus deaton. He has focused on what he calls the desk of despair, attributed to suicide and drug and alcohol abuse. Deaths of despair. Indicators he says of a sickness in the American Economic model. And now, of course, we have the coronavirus pandemic as well. So, has a fundamental weakness been exposed in capitalism . Sir angus deaton in princeton, welcome to hardtalk. Thank you very much. Im delighted to be back. Let me ask you a question. Youre one of the worlds renowned economists and into your latest work, you have focus very much on death. And mortality rates. Why have you done that . I have always believed that life is about much more than just money. And ive interested in throughout my career, in well being, in what makes people tick and what matters, and having money is not worth a whole lot if you dont have a life to enjoy it with. So mortality is a key component
of trying to assess a much more complete picture of what it is thats happening to people. You talk of a complete picture. The big picture according to several political scientists economists, the one big picture, notjust across the developing world as well, is a mortality story which is profoundly optimistic, that the longevity of the human race is rising and that weve frankly never had it so good and yet your work, which is very specific, seems to suggest in america in particular that is not right. Well, you and i are obviously talking about pre covid. So maybe well come back to that. But yes, and that was why what ann and i found when we started this work in 2013 or so, we discovered that death rates were going up for midlife people and middle aged White Americans, that we were just astonished. We were doing something else, where pulling down this data, we looked at these numbers, and we just couldnt believe what we were seeing. It could possibly be true because what you just said, we had a century a mortality decline and what was happening. Our first thought was it cant possibly be true because if it was happening, people would be shouting this from the rooftops. But it was true. And it was a major reversal from what we had seen for 100 years prior. As you say, we need to address what is happening with covid 19 as well. But before we get to covid 19, explain to me, as you dug into the data about mortality rates, particularly as you say amongst midlife americans, particularly poor, white midlife americans. You began to uncover what you called the phenomenon of deaths of despair. And i want to know exactly what you mean by that phrase. Well, you know, it is really just a convenient tab, butjust to go back to when we were first looking at this data, if we discovered that this mortality which had been declining for 100 years has suddenly stopped declining, the first thing we said was what in goodness name is it and we had already come of the reason we found is because we were working on suicide and so we knew that suicide rates are rising quite rapidly in midlife. And so we wanted to see what are the other things that are rising very rapidly and the other things that we found we drug overdoses and alcoholic liver disease. And these all had a sort of element of suicide about them. I really dont want to say that drug addicts want to die. They often dont. But it is sort of drug addiction, abuse of alcohol, suicide, those are all things that you are doing by your own hands. It was ann who came up in a press interview with the notion of deaths of despair as just a label to put the three things together. It really has caught off into the Public Discourse and has become one of these terms that it has a life of its own. Let me stop you for a second. Does that necessarily interest you as an economist . What if that is simply a phenomenon that is the result of the over prescription of a new kind of drug, at least new to many americans, that is the whole range of opioid drugs . Wouldnt that make itjust a temporary blip rather than a structural phenomenon that you as an economist would be interested in . Well, you have to ask the question as to why did this over prescription of opioids only happen here. And why is it not happening in britain to the same extent and why isnt it happening
in germany or france at all . So there is a real question of what is it about American Society and the American Economy that really causes this to happen. The other thing that is very important is when you said poor White Americans. It is not really poor White Americans. It is White Americans without a bachelors degree. Without this four year degree. So we were immediately in this thing where the economy is just not treating these people who have not got a four Year College Degree very well. Not only that, but it has unleashed these pharmaceutical companies on them to make a huge amount of money and to propagate an enormous amount of misery and destruction amongst these people. What kind of scale of extra death, if i can put it that way, are you ascribing to this phenomena . The last years in which we have data are 2017 and 2018. And there were 158,000 deaths on despair in each of those two years for which we have data. That is more people than have died of covid 19 in the us so far. Covid 19 may well exceed that. These are very large numbers. They are not all excess, because after all, there is always some suicide, people will die from alcohol poisoning, and so on. And we reckon that normally runs at about 60,000 a year. So it is killing about 100,000 people a year. So one of the analogies we use is if you take a boeing 737 fully loaded and it falls out of the sky, killing everybody on board, three of those every day is what we are talking about. These are big numbers. Very big numbers. But as you just indicated were getting used to potentially even bigger numbers with the scale of the covid 19 crisis, not least in the United States. That is right. Except for that covid 19 will stop, we hope. Either the virus will go away as donald trump likes to say or we will get a vaccine,
and medicine to deal with it. So, lets say in this year we lose 200,000 americans, we can pray and reasonably hope that that will not go on into the future. But the 158,000 deaths of despair shows no sign of diminishing at all. Is there any relationship at all between the way in which covid 19 is impacting america and the particular groups within america it is hitting hardest and the groups you have identified as being most vulnerable, most impacted by the so called deaths of despair . Yes. That is a really interesting question. We spent a lot of time thinking about that. One of the things that clearly happened with covid 19 is the division between people like me or you who can sit at home and work behind the screen and you continue to get paid and you run very little risk of catching the disease. Very typically, they tend to be more educated people,
people with deskjobs, and so on. Where as the people on the other end of the essential workers, the key workers, in many cases, they have to risk their lives, and they are more likely to be less educated people. It is not a Perfect Match because obviously there are doctors and Health Care Workers who are highly skilled. But the people that are working retail stores, people working in meat packing plants, food retail, all that stuff. Those people are relatively poorly skilled. So the less than College Educated people who were hurt by deaths of despair are hurt again by covid 19, and the one group that is different are African Americans here. Until about 2013, african america ns were not subject to any of this, the deaths of despair. Though after 2013, there was a sort of epidemic of fentanyl in the inner cities in the eastern United States which turned that fatality up,
but african america ns have really been suffering disproportionately during covid 19 in america. As indeed has been the case in britain. I want to get to the African American experience in greater detail later but i just want to be clear here, what youre actually saying. As i said at the very beginning, youre one of the worlds renowned economist. That is what you do. You are not a health specialist. Yet you seem to be making a very direct correlation here between the national health, that is the health of the american people, and economic conditions. And in essence, a lot of it seems to be about people and low paid jobs, and poverty, lower education. No, it is not. That is not right. It is right until you said poverty. We have no evidence that these people are in poverty. So this is not about poverty . Those people were doing pretty well until recently. So this is not a poverty thing. That is not part of the story. It is a less educated thing. We are not tying it in any very simple way to economic conditions. Because if you look at what happened to the Great Recession in 2008, deaths of despair was rising rapidly before the Great Recession and rose at the same rate during the Great Recession, and they rose at the same rate after the Great Recession. Nothing to do with the Great Recession. So the story we are telling is a much slower disintegration of the life of working class america, a life that was built at the end of the 19th century and thrived in the mid 20th century and has been coming apart ever sense and we tell a durkheimian story and you might say what are economists messing with durkheim for, but durkheim really got this right which is that if youre living in a world where meaning is of evaporating, that self destruction is a real rest. My reading of the book deaths of despair and the future of capitalism is that if there
is any one target of your anger right now, it is the American Health care system. And when you talk about the disintegration of the lives and culture of working class White Americans, it would seem to me that you put a lot of the blame for that at the door of americas private health care system. Am i right . Yes. You are dead right. What is to be done about it . There are a lot of things we can do about it. It is very difficult to do them because it is so well protected and fortified against criticism and change. But the nuts of the story is it cost far too much. It costs twice as much as any other Health System in the world. It delivers lousy outcomes. And its financed by what is essentially a poll tax on workers and so as we said somewhere else, it is taking a wrecking ball to the Labour Market for less educated people. Is that another way as an economist blaming capitalism because of course, capitalism underpins the American Health care system. It is a private system. It is for profit. There are very big profits to be made are you saying capitalism simply does not work in that context . In that context which is in the case of delivering health care. Britain is a capitalist country. You dont have a private health care system. Or you do but only it isa marginalthing. No other country in the world, no other rich country in the world tries to run its health care as a private market system. And it is a very important thing to realise that one of the greatest economists of the 20th century was ken arrow. He was the guy that proved the theorems that capitalism works and how capitalism was good for you and
when it is not good for you. The important thing about proving that was the need to figure out the assumptions that are needed to make it work. The assumptions to make it work do not apply for health care. We do not have a Competitive Health care system. It is riddled with all sorts of rent seeking, with government interference. It is not there to protect patients. The government interference is there to protect profit. And if i may say so, when americans are consulted about whether they want a truly socialised health care system, where the government in essence organises and runs the system and the profit motive is taken out of it, americans by in large say no. That is right. There are two things there. One is the word socialise, which has become demonised in america. And, secondly, you dont have to have a socialised system. Britain has one. France doesnt. Germany doesnt. Switzerland doesnt. Holland doesnt. Canada doesnt. There are a lot of options
for it to choose from without the government delivering health care. That is a perfectly soluble problem. We do not have to have a system in which the government employs the doctors and nurses and runs the hospitals. Britain is pretty unique in doing that. Let me come at this from a different angle. You for a long time, youre writing about for an equality in Health Care Outcomes and all sorts of other things, you have made it plain that you are an opponent of the way america currently does things. But there is a whole raft of thinkers about the way america currently does things. But there is a whole raft of other thinkers in america, political scientist and economists who say you are barking up the wrong tree and ultimately, this isnt so much about economic systems, it is about moral values. And that the modern day 21st Century America is unfortunately as they would put it full of people who lack the moralfibre to make the right kinds of decisions and that is the fundamental failing of the days america. And that is the fundamental failing of todays america. I dont think that is true. There certainly are deep socialogical moral issues that are really important, like especially ones associated with family formation, especially the consequences of the availability of abortion and of the contraceptive pill, where there really have been changes in social views of child bearing and marriage and living together. If i may say so. And the idea that people are out of the labour force because they become lazy is totally violated by the data. Right. But im looking at a quote from philip coen here. Hes done a lot of research on this. He says that you referred to is the phenomenon of deaths of despair is directly linked to the fact that marriage and he is talking about amongst white people particularly, marriage is not the institution it used to be. And that women in particular have changed their behaviour and attitude in ways that many
women would welcome and say are very important, but they have fundamentally changed the way Society Works and the way the economy works. Well, i agree with a lot of that. And we say that in the book. But i dont like this idea that somehow, they have decided they got up one morning and decided we will not behave ourselves any more. There were external things that made that very important. So the availability of contraceptive pills and the availability of abortion changed the responsibility for child bearing, for conception, from man, who had it before towards women, and for some women, that worked really well. It drove a wedge so that for people and women who were really well educated or could be well educated, as it opened up an enormous avenue of opportunity
that they could really now go to college and choose when to have their child bearing and did not have to choose between education and having the married life but for less educated and less talented women, that has been a disaster. But isnt that the problem in a way . I dont want to put words into your mouth but i would guess you characterize yourself as a liberal and a progressive. But it seems in a way, the message that you are delivering that the White Communities of america are experiencing forms of despair because of the decline of Family Community and religion, that is a message that could be taken by some of your perhaps ideological opponents as a defence of their conservative values. Well, youre characterising me. Im not characterising me and i dont accept that characterisation. One of the things that i have tried to do very hard it is not to label myself and to take the best from all particular things
and all particular lines of thought. You know, i dont think it is all that change and taste, in the loss of industry and virtue. You have to keep in mind that this is very important. These bad things are only happening to people who do not have a four Year College Degree. And the third of whites who have a four Year College Degree are doing great, thank you very much. So if it is a general decline in virtue, why does the decline in virtue only happen to the people who are less educated . It is because the world is collapsed around them. They have lost meaning. I dont care where you attribute it to. A lot of what we blame and the capitalist system is the degree of rent seeking in america. That is very much a right wing buzzword and im all for it. I want to come back quickly to the issue of what i