United States of Despair

Historically, pandemics have arguably brought greater equality. Most famously, the Black Death killed so many people in fourteenth-century Europe that it created a labor scarcity, which improved workers’ bargaining position.

Later, in the nineteenth century, cholera epidemics inspired the germ theory of disease, setting the stage for the modern increase in longevity, first in the rich countries, and then, after World War II, in the rest of the world. A great divergence in lifespans across the world gave way to a great convergence.

But the US has been experiencing a great divergence at home for two generations, and COVID-19 promises to widen the country’s already vast inequalities in health and income.

The effects of the virus are stratified by educational attainment, because those with more education are likelier to be able to continue working and earning from home. Unless they are among the highly educated workers in health care and other front-line sectors, they can sit back and watch the stock market propel the value of their retirement funds ever higher.

By contrast, the two-thirds of workers who lack a four-year college degree are either nonessential, and thus risk losing their earnings, or essential, and thus at risk of infection.

Whereas college graduates have largely been able to safeguard both their health and their wealth, less-educated workers must risk one or the other.

For this reason, the income and longevity gaps that the trend in deaths of despair has revealed are now widening further. But while less-educated whites have borne the brunt of the first epidemic, African-Americans and Hispanics have been disproportionately killed by COVID-19. As a result, the previous convergence of white and black mortality rates has been derailed.

There are many reasons for these racial disparities, including residential segregation, crowded living conditions, and commuting patterns.

While these factors have been especially important in New York City, they have played less of a role in other places. In New Jersey, for example, neither African-Americans nor Hispanics have disproportionately higher COVID-19 mortality rates.

America’s costly health-care system will continue to compound the pandemic’s effects. Many among the tens of millions of Americans who lost their jobs this spring also lost their employer-provided health insurance, and many will not be able to secure alternative coverage.

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