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By Anne Case and Angus Deaton

Reversing a century of progress, life expectancy has fallen for three years in a row but only in the US. Rising rates of suicide, drug overdoses and alcoholism are largely to blame. There were early media reports about the trend, but this detailed yet readable book goes much farther. Deaths of despair are concentrated among working class non-Hispanic white Americans without a bachelor’s degree, both men and women. In the book, two Princeton economists dig deep into the weeds for the causes and what we can do about it. Declining wages, disappearing economic opportunities, loss of cohesive social communities, increasing levels of physical pain, and growing income inequality are all involved. But many of the underlying causes impacted other first world countries, some worse than the US, that didn’t suffer rising mortality. The authors save their harshest recrimination for America’s dysfunctional healthcare system. “The US spends huge sums of money for some of the worst health outcomes in the Western world. We will argue that the industry is a cancer at the heart of the economy, one that has widely metastasized, bringing down wages, destroying good jobs, and making it harder and harder for federal and state governments to afford what their constituents need.” They also blame opioid manufacturers and their regulatory and political enablers, the decline of unions, globalization, automation that replaced jobs, loss of faith in American institutions, and other failures of capitalism. I was so very pleased to see that their list of solutions for healthcare doesn’t start with the now popular, but entirely inadequate, payment reform tweaks. They understand this problem is too big for baby steps. The solutions will be very difficult politically, but they have all been implemented in other countries. America can do this. If you care about raising health outcomes for all Americans, this is a must-read.