Sir Angus Deaton: 'A lot of people feel they’re not in control of their lives anymore'

For much of the late twentieth century the United States and western Europe experienced an inexorable rise in living standards marked by falling levels of poverty and increased life expectancy. It was a period perhaps unlike any other in human history, where economic growth and advances in both public health and medical science coalesced, leading to longer, healthier lives for most of the population.

But then something changed. From around the mid-1990s onwards, mortality rates of middle-aged white Americans began to rise, fuelled by alcohol, drugs and suicide. It’s a phenomenon which Scottish-born economist Angus Deaton calls “deaths of despair,” the premature ending of lives characterised by physical pain and feelings of hopelessness.

Deaton’s most recent book, Deaths of Despair and the Future of Capitalism, written with his wife Anne Case, a professor of economics at Princeton University, argues that while there have been rising numbers of deaths elsewhere, in places such as Australia and Canada, there is only really one international equivalent for what is happening in the United States.

“There’s only one other country that has comparable rates of drug death to the US and that’s Scotland,” Deaton says on a call from his home in New Jersey. “Globalisation, loss of jobs and so on is not just something that happened to America or happened to Scotland, so there’s a question as to why things are so much worse (in those two places). At some level we don’t know the answer to that.”

While the rate of drug deaths in the US has been driven by legally prescribed opioids, namely painkillers such as OxyContin, there are similarities with what’s happened on the other side of the Atlantic – the decline of traditional industries and the fragmenting of once-strong social structures which provided cohesion and support.

Last year, Scotland recorded more than 1,300 deaths from drug misuse – the seventh year in a row that a record figure had been registered. Scotland now not only has a drug-death rate three-and-a-half times that of England and Wales, but the highest of any country in Europe.

And while life expectancy across the population as a whole had been increasing since the early 1980s and had remained largely unchanged in the last decade, last year saw the biggest annual fall since current records began – 0.3 years for men and 0.1 years for women. 

In the US, Deaton says much of the damage was caused by the pharmaceutical industry focusing the sale of highly addictive opioids on working-class communities in areas ravaged by job losses and societal breakdown. 

“They targeted places where there had been long-term industrial decline and where the social fabric was weak. Old mining areas, old manufacturing areas, heavy industry and so on. In many of those places people have pre-existing pain, sometimes from physical work and that gave an ‘in’ to the drug companies to push this stuff. It was the slow disintegration of the pillars of life – a labour market that wasn’t supporting less-educated people anymore…the breakdown of marriages etc.”

Deaton refers to academic study done by others on the so-called ‘Glasgow effect’, the city’s inability to shake off its post-industrial malaise – its “funk,” Deaton calls it – in the way equally deprived cities such as Liverpool and Manchester have done. 

“One thing that I took away from that (academic) literature was that they list the three causes of death that are the biggest differences between Glasgow on the one hand and Manchester and Liverpool on the other hand. Those are deaths of despair – they are suicides, alcohol, and drugs. 

“When (French sociologist) Émile Durkheim wrote about suicide in the nineteenth century, he identified the destruction of social supports around people. Why that was so much worse in Glasgow than in other places like Dundee or Edinburgh, I don’t know.”

While it’s now only barely discernible from his Americanised accent, Deaton was born in Edinburgh in 1945, and grew up there and in the Borders before winning a place to study at Fettes College and then university in Cambridge, somewhere he describes as feeling like “another world” compared to what he had known before.

At Hawick High School, he studied in the same class as another future Nobel prize winner, the biologist Richard Henderson. Deaton’s father, a former coal miner, had moved his young family to the Borders after studying to become a civil engineer by going to night school at what is now Heriot-Watt University. 

“When we lived in Edinburgh, my father had always been taken by Fettes for some reason, so he encouraged my schoolteachers at Hawick to train me up to take the scholarship exam, so that’s where I went.”

Deaton receiving his Nobel prize in economics in 2015

Deaton’s illustrious career took him from Cambridge to Bristol University to Princeton, where his work in analysing consumption, poverty and welfare was recognised with a Nobel prize in economics in 2015.

But does he think the social mobility he benefitted from still exists?

“I don’t think so. I think it’s much tougher,” he says. “I’m an archetypal meritocrat – I come from a humble background, and I passed a lot of exams. Both in the UK and the US, successful meritocrats like myself have made it much harder for the next generation. We were replacing an aristocracy and thought we were doing a lot of good, but the people at the top are pretty good at keeping people down.”

Perhaps one of the most startling parts of Deaton and Case’s research is the conclusion that poverty is not the major determinant of deaths of despair. While mortality rates for the white working class began to rise from the 1990s, well before the 2008 economic crash, the same was not true of other ethnic groups in the US.

“It’s not about poverty,” Deaton says. “These deaths of despair that we first noticed in 2013 were not happening to black people at all. In the US, black people are proportionately much more likely to be in poverty than white. What we’re talking about here is not so much a lack of material resources, but your life coming apart.”

Deaton says that fracturing, the feeling of disempowerment and dislocation, has helped lead to some of the seismic political changes we’ve seen in the past decade, such as Brexit or the election of Donald Trump.   

“There are cosmopolitan elites who are citizens of the world and who have prospered in the world as a whole and there’s a lot of other people for whom that really didn’t happen and whose prospects became more and more circumscribed. 

“It’s not just money – it’s hope and community. They feel not at all represented by a governing class of elites whether on the left or right. Labour members of parliament are now more educated than Conservative members of parliament – that didn’t used to be true. There really has been a democratic failing throughout the world. All through Europe and the US, there are a lot of people who feel they are not in control of their lives anymore. I put those sort of inequalities front and centre, more so than just income inequalities.”

Perhaps aware he’s about to venture into somewhat controversial territory, Deaton caveats the next part of our discussion by stressing there are certain theories which require further study, one being the idea of a “democratic deficit”. 

“There’s a sort of democratic deficit in Scotland, which many people think is happening in some parts of the United States,” he says. “People in Scotland have less direct control over their own fates in some sense, being governed by a relatively hostile political party, the Conservatives.”

I ask him if he still believes that to be the case even now, more than 20 years after the advent of devolution.

A young Deaton with his father and sister at Elie, Fife

“I don’t know – it’s just one of the things people mention in this context. In some ways the US is a better place to look for that in an almost reverse way because there’s been so much delegation of power to individual states and those states have been taken over and become all blue (Democrat) or all red (Republican). 

“In red states, in particular, there has been a chiseling away of democracy and it’s true that life expectancy and so on is doing worse in those states than in blue states. I’m not pushing for Scottish independence – nor am I trying to draw a direct line between that.” 

Deaton is unwilling to be drawn on the question of independence, but concedes that the situation in Scotland could, at least in theory, be improved with more economic levers at the country’s disposal. He recalls a childhood spent in the Borders village of Bowden, looking across the Cheviots, and the friends who farmed on either side of the border. While he says he has a “strong personal and historical attachment to the Union,” he finds Scotland’s current economic bind “very distressing”. 

While the US remains an outlier when it comes to deaths of despair, Deaton and Case’s book suggests that “storm clouds appear to be gathering in the UK,” amid stalling life expectancy and negligible rises in household incomes since the 1990s. The book, which was published before the pandemic, warns that austerity and Brexit have left the country politically divided like the US. 

“There are deaths of despair in England too, they’re just not anything like in proportion to what they are in Scotland or the US. For many people their lives came apart due to de-industrialisation and they haven’t been put together again.”

Deaton worries that the current cost-of-living crisis could have long-term implications and may lead to another period of enforced austerity, something he says did nothing the last time around “but make people miserable”.

“It’s a really worrying time. We could come out of this fairly quickly or we could have decades of stagnation and that was before the war in Ukraine, which has made things even more uncertain.”

For someone who wrote a book entitled Deaths of Despair, Deaton is surprisingly upbeat in person. A video posted by Princeton following the awarding of his Nobel prize shows him warmly receiving the praise of both colleagues and students alike, all of whom clearly hold him in high regard. 

But he admits some of his optimism about the future, humankind’s ability to triumph over adversity, has been shaken in recent times. 

Opioid addiction has become a major public health issue in the United States | Pic: Alamy

“At the end of my previous book, The Great Escape, I said there are setbacks all the time, but the forces that were unleashed by the Enlightenment – the idea that you could think your way out of things – would always triumph in the end. 

“We’ve certainly gone into a dark period and some of these things are going to be difficult to think our way out of. Climate change, for example, is a very hard thing for the forces of the Enlightenment, the forces of reason, to deal with because it requires so much cooperation from disparate people.”

I ask him if he thinks we’ll manage to pull together and act in humanity’s interest before it’s too late. Recent events, namely the war in Ukraine, do not augur well.

“I can’t give you a prediction,” he laughs. “Anyone that gives you a prediction of what the world will be like in 10 years is bullshitting.”