Social Distancing Saves Lives. So Do Recessions.
If you’re weighing a recession versus a pandemic in terms of lives lost, there’s no contest. Contrary to popular belief, deaths go down during economic downturns.
When Donald Trump tweeted in late March, “WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF,” a lot of people had questions about what “worse than the problem” meant, exactly. “You’re going to lose more people by putting a country into a massive recession or depression,” he clarified a few days later in a Fox News town hall. “You’re going to lose people. You’re going to have suicides by the thousands.”
The assumption that people die more in recessions feels right, and so it seems like a good reason to suggest risking a more severe coronavirus outbreak with lighter restrictions on businesses and people, instead of inviting the worst economic crisis since the 1930s. There are, after all, a lot of reasons to imagine such a surge in deaths could happen: lost healthcare due to lost jobs, which would make people more vulnerable to otherwise preventable deaths and, of course, suicides.
But the assumption that people die more during recessions is wrong, at least in wealthy countries. Past economic downturns show that, in fact, mortality rates go down in recessions, for a number of reasons. If you’re weighing the human cost of a recession or depression against the human cost of illness and death from the virus itself, as Trump and policymakers across the country are doing right now, it’s important to keep in mind that the toll of a recession in terms of lives lost is not a factor.
It’s true that poor people die younger. That was true in France and Britain in the 19th century, and it is true in the United States today. People in their mid-40s in the top 1 percent of tax returns have about 15 more years to live than people in the bottom 1 percent. Yet is it not true that when people get poorer, they are more likely to die; annual death rates are lower in recession years than in boom years.
In our recent book, Deaths of Despair and the Future of Capitalism, we argue that the long-term, 70-year, slow-motion collapse of work, wages and community for working-class Americans is the root cause of the epidemic of drug overdose, suicide and alcoholism that has ravaged less-educated men and women. That epidemic, and those deaths, came after a slow and prolonged decline in the wages and jobs that supported working-class life—very different from the normal upswings and downswings of the business cycle. Despair came over years and decades, not from a short-term downturn in the economy.
One of the first studies of health and recession was published almost a century ago by sociologists William Ogburn and Dorothy Thomas (the first woman to be tenured at the Wharton School). They made the important distinction between “lasting changes in the economic order”—such as the Industrial Revolution or, to extend to our own work, the erosion of working-class life that underlies deaths of despair—and “brief swings in economic prosperity and depression, around the line of general economic trends,” such as the Great Depression.
They examined booms and busts from 1870 to 1920 and found, to their own astonishment, that death rates rose in good times and fell in bad times. They were careful not to overstate their findings—“we do not draw a definite conclusion”—so strong was the seemingly obvious presumption that bad times bring death. That presumption is widely held to this day.
One might think the pattern of recessions and death from a century ago is different from today. A century ago, pneumonia, influenza and tuberculosis were the leading causes of death, not cancer and heart disease. Deaths were “younger,” with death rates among infants higher than death rates among the elderly, the inverse of today’s pattern. Sixteen out of every 100 children did not live to see their first birthdays.
But the same pattern of recessions and deaths held throughout the 20th century. Mortality rates fell from 1930-33, the four worst years of the Great Depression; in the 1920s and 1930s, mortality rates were highest in the years of fastest economic growth. The same was true for the longer period from 1900 to 1996. Business cycles differ to some extent in different U.S. states, and mortality was lower in bad times state by state in the 1970s and 1980s. The same was true in England and Wales for economic fluctuations from 1840 to 2000. The relationship was stronger at some times than at others, but the pattern was consistent: Mortality declined more rapidly in bad times, and declined more slowly or even rose in good times. Europe and Japan show the same pattern.
What about the Great Recession after the financial crash in 2008? The economic effects were most severe in a few European countries, like Spain and Greece. Remember Greece? Its economy was so devastated that it threatened to crash out of the Eurozone. In the United States, it was used as the bogeyman, the perennial warning of what might happen to us if we did not get our fiscal house in order. Unemployment in Greece and Spain more than tripled, to the point where more than a quarter of the population was unemployed. Yet Greece and Spain saw increases in life expectancy that were among the best in Europe.
For the Great Recession in the United States, the story is more complicated, because the years after 2008 saw a large and growing epidemic of deaths of despair. But deaths of despair began to rise in the early 1990s and grew inexorably into the 2010s. They rose before the Great Recession, and grew during and after the Great Recession; the line of rising deaths shows no perceptible effect of the collapse of the economy.
The big question is: Why? And why is our intuition so wrong?
Many of us have the haunting vision of ruined financiers hurling themselves out of skyscrapers and off of bridges during the great crash of 1929. These accounts were doubtless exaggerated, but suicides did indeed increase during the subsequent Great Depression. Suicides, however, are the exception, not the rule, and they are a small share of total deaths. In 2018, there were 2.8 million deaths in the United States, of which 48,000 were suicides—less than 2 percent of the total. Each is a tragedy, but it takes very large changes in suicides before the suicide tail wags the mortality dog.
Why might the non-suicide deaths decline in recessions? High activity rates bring dangers. There are more traffic accidents. There are more occupational accidents when construction is booming and factories are running at full tilt. There is more pollution, a life-threatening danger for some infants. It is also possible that busier lives bring stress, and that stress brings heart attacks. Or that people have less time for exercise, healthy meals and self-care. In today’s rich economies, most deaths are among the elderly, and many older people are cared for by low-wage workers. When the economy is booming, when there are better paid jobs elsewhere, it is much harder to hire and retain these workers for nursing and elder-care homes. Care matters.
Which brings us back to suicides. Because suicides usually do rise in recessions, we think that there is a plausible case that the forthcoming recession will bring more suicides. But not inevitably.
Mass layoffs from plant closures have often brought suicides in their wake. Today, people are losing their businesses; workers and owners whose livelihoods and lives are structured and given meaning by what they have created—restaurants and coffee shops, bookstores, small businesses and non-profits of all stripes—may reasonably fear that they will never reopen, even if government packages provide some relief. They may feel shame that they did not make provision for such a calamity, shame unlikely to be shared by the managers of corporations who used their profits not to build a rainy day fund, but to buy back shares that enriched themselves and their shareholders, knowing that they would be bailed out in a catastrophe.
This recession, unlike others, involves social distancing or, for many and increasingly more as infection rates rise, isolation. Social isolation is a classic correlate of suicide. The United States has a suicide “belt” that runs north-south along the Rocky Mountains where population density is low. New Jersey, where we live most of the year, has the lowest suicide rate in the country; Montana, where we spend August, has the highest. Zooming in, Madison County, Montana, has a suicide rate that is four times higher than that of Mercer County, New Jersey. Isolation and depression can be deadly. Think, too, of the millions of people in recovery programs, like Alcoholics Anonymous, whose sobriety depends on community support. Social distancing will also bring more suicides this time around if hospitals are slow to respond, so that more attempted suicides may succeed.
Yet there is an important counterargument. Suicides tend to be low in wartime, especially when leaders can build social solidarity, the opposite of social isolation. Winston Churchill inspired the British in World War II. Governor Andrew Cuomo is inspiring New Yorkers (and many other Americans) who listen to his broadcasts. If the rhetoric of fighting the common enemy wins out against the possibility that Americans are jobless, alone, terrified and without meaning in their lives, even suicides could be low in the months ahead.