Why Is America's Suicide Epidemic Hitting Trump's Base So Hard?

We hear a lot about suicide when celebrities like Anthony Bourdain and Kate Spade die by their own hand. Otherwise, it seldom makes the headlines. That's odd given the magnitude of the problem.

In 2017, 47,173 Americans killed themselves. In that single year, in other words, the suicide count was nearly seven times greater than the number of American soldiers killed in the Afghanistan and Iraq wars between 2001 and 2018.

A suicide occurs in the United States roughly once every 12 minutes. What's more, after decades of decline, the rate of self-inflicted deaths per 100,000 people annually--the suicide rate--has been increasing sharply since the late 1990s. Suicides now claim two-and-a-half times as many lives in this country as do homicides, even though the murder rate gets so much more attention.

In other words, we're talking about a national epidemic of self-inflicted deaths.

Worrisome Numbers

Anyone who has lost a close relative or friend to suicide or has worked on a suicide hotline (as I have) knows that statistics transform the individual, the personal, and indeed the mysterious aspects of that violent act--Why this person? Why now? Why in this manner?--into depersonalized abstractions. Still, to grasp how serious the suicide epidemic has become, numbers are a necessity.

According to a 2018 Centers for Disease Control study, between 1999 and 2016, the suicide rate increased in every state in the union except Nevada, which already had a remarkably high rate. In 30 states, it jumped by 25% or more; in 17, by at least a third. Nationally, it increased 33%. In some states the upsurge was far higher: North Dakota (57.6%), New Hampshire (48.3%), Kansas (45%), Idaho (43%).

Alas, the news only gets grimmer.

Since 2008, suicide has ranked 10th among the causes of death in this country. For Americans between the ages of 10 and 34, however, it comes in second; for those between 35 and 45, fourth. The United States also has the ninth-highest rate in the 38-country Organization for Economic Cooperation and Development. Globally, it ranks 27th.

More importantly, the trend in the United States doesn't align with what's happening elsewhere in the developed world. The World Health Organization, for instance, reports that Great Britain, Canada, and China all have notably lower suicide rates than the U.S., as do all but six countries in the European Union. (Japan's is only slightly lower.)

World Bank statistics show that, worldwide, the suicide rate fell from 12.8 per 100,000 in 2000 to 10.6 in 2016. It's been falling in China, Japan (where it has declined steadily for nearly a decade and is at its lowest point in 37 years), most of Europe, and even countries like South Korea and Russia that have a significantly higher suicide rate than the United States. In Russia, for instance, it has dropped by nearly 26% from a high point of 42 per 100,000 in 1994 to 31 in 2019.

We know a fair amount about the patterns of suicide in the United States. In 2017, the rate was highest for men between the ages of 45 and 64 (30 per 100,000) and those 75 and older (39.7 per 100,000).

The rates in rural counties are almost double those in the most urbanized ones, which is why states like Idaho, Kansas, New Hampshire, and North Dakota sit atop the suicide list. Furthermore, a far higher percentage of people in rural states own guns than in cities and suburbs, leading to a higher rate of suicide involving firearms, the means used in half of all such acts in this country.

There are gender-based differences as well. From 1999 to 2017, the rate for men was substantially higher than for women--almost four-and-a-half times higher in the first of those years, slightly more than three-and-a-half times in the last.

Education is also a factor. The suicide rate is lowest among individuals with college degrees. Those who, at best, completed high school are, by comparison, twice as likely to kill themselves. Suicide rates also tend to be lower among people in higher-income brackets.

The Economics of Stress

This surge in the suicide rate has taken place in years during which the working class has experienced greater economic hardship and psychological stress. Increased competition from abroad and outsourcing, the results of globalization, have contributed to job loss, particularly in economic sectors like manufacturing, steel, and mining that had long been mainstays of employment for such workers. The jobs still available often paid less and provided fewer benefits.

Technological change, including computerization, robotics, and the coming of artificial intelligence, has similarly begun to displace labor in significant ways, leaving Americans without college degrees, especially those 50 and older, in far more difficult straits when it comes to finding new jobs that pay well. The lack of anything resembling an industrial policy of a sort that exists in Europe has made these dislocations even more painful for American workers, while a sharp decline in private-sector union membership--down from nearly 17% in 1983 to 6.4% today--has reduced their ability to press for higher wages through collective bargaining.

Furthermore, the inflation-adjusted median wage has barely budged over the last four decades (even as CEO salaries have soared). And a decline in worker productivity doesn't explain it: between 1973 and 2017 productivity increased by 77%, while a worker's average hourly wage only rose by 12.4%. Wage stagnation has made it harder for working-class Americans to get by, let alone have a lifestyle comparable to that of their parents or grandparents.

The gap in earnings between those at the top and bottom of American society has also increased--a lot. Since 1979, the wages of Americans in the 10th percentile increased by a pitiful 1.2%. Those in the 50th percentile did a bit better, making a gain of 6%. By contrast, those in the 90th percentile increased by 34.3% and those near the peak of the wage pyramid--the top 1% and especially the rarefied 0.1%--made far more substantial gains.

And mind you, we're just talking about wages, not other forms of income like large stock dividends, expensive homes, or eyepopping inheritances. The share of net national wealth held by the richest 0.1% increased from 10% in the 1980s to 20% in 2016. By contrast, the share of the bottom 90% shrank in those same decades from about 35% to 20%. As for the top 1%, by 2016 its share had increased to almost 39%.

The precise relationship between economic inequality and suicide rates remains unclear, and suicide certainly can't simply be reduced to wealth disparities or financial stress. Still, strikingly, in contrast to the United States, suicide rates are noticeably lower and have been declining in Western European countries where income inequalities are far less pronounced, publicly funded healthcare is regarded as a right (not demonized as a pathway to serfdom), social safety nets far more extensive, and apprenticeships and worker retraining programs more widespread.

Evidence from the United States, Brazil, Japan, and Sweden does indicate that, as income inequality increases, so does the suicide rate. If so, the good news is that progressive economic policies--should Democrats ever retake the White House and the Senate--could make a positive difference. A study based on state-by-state variations in the U.S. found that simply boosting the minimum wage and Earned Income Tax Credit by 10% appreciably reduces the suicide rate among people without college degrees.

The Race Enigma

One aspect of the suicide epidemic is puzzling. Though whites have fared far better economically (and in many other ways) than African Americans, their suicide rate is significantly higher. It increased from 11.3 per 100,000 in 2000 to 15.85 per 100,000 in 2017; for African Americans in those years the rates were 5.52 per 100,000 and 6.61 per 100,000. Black men are 10 times more likely to be homicide victims than white men, but the latter are two-and-half times more likely to kill themselves.

The higher suicide rate among whites as well as among people with only a high school diploma highlights suicide's disproportionate effect on working-class whites. This segment of the population also accounts for a disproportionate share of what economists Anne Case and Angus Deaton have labeled "deaths of despair"--those caused by suicides plus opioid overdoses and liver diseases linked to alcohol abuse. Though it's hard to offer a complete explanation for this, economic hardship and its ripple effects do appear to matter.

According to a study by the St. Louis Federal Reserve, the white working class accounted for 45% of all income earned in the United States in 1990, but only 27% in 2016. In those same years, its share of national wealth plummeted, from 45% to 22%. And as inflation-adjusted wages have decreased for men without college degrees, many white workers seem to have lost hope of success of any sort. Paradoxically, the sense of failure and the accompanying stress may be greater for white workers precisely because they traditionally were much better off economically than their African American and Hispanic counterparts.

In addition, the fraying of communities knit together by employment in once-robust factories and mines has increased social isolation among them, and the evidence that it--along with opioid addiction and alcohol abuse--increases the risk of suicide is strong. On top of that, a significantly higher proportion of whites than blacks and Hispanics own firearms, and suicide rates are markedly higher in states where gun ownership is more widespread.

Trump's Faux Populism

The large increase in suicide within the white working class began a couple of decades before Donald Trump's election. Still, it's reasonable to ask what he's tried to do about it, particularly since votes from these Americans helped propel him to the White House. In 2016, he received 64% of the votes of whites without college degrees; Hillary Clinton, only 28%. Nationwide, he beat Clinton in counties where deaths of despair rose significantly between 2000 and 2015.

White workers will remain crucial to Trump's chances of winning in 2020. Yet while he has spoken about, and initiated steps aimed at reducing, the high suicide rate among veterans, his speeches and tweets have never highlighted the national suicide epidemic or its inordinate impact on white workers. More importantly, to the extent that economic despair contributes to their high suicide rate, his policies will only make matters worse.

The real benefits from the December 2017 Tax Cuts and Jobs Act championed by the president and congressional Republicans flowed to those on the top steps of the economic ladder. By 2027, when the Act's provisions will run out, the wealthiest Americans are expected to have captured 81.8% of the gains. And that's not counting the windfall they received from recent changes in taxes on inheritances. Trump and the GOP doubled the annual amount exempt from estate taxes--wealth bequeathed to heirs--through 2025 from $5.6 million per individual to $11.2 million (or $22.4 million per couple). And who benefits most from this act of generosity? Not workers, that's for sure, but every household with an estate worth $22 million or more will.

As for job retraining provided by the Workforce Innovation and Opportunity Act, the president proposed cutting that program by 40% in his 2019 budget, later settling for keeping it at 2017 levels. Future cuts seem in the cards as long as Trump is in the White House. The Congressional Budget Office projects that his tax cuts alone will produce even bigger budget deficits in the years to come. (The shortfall last year was $779 billion and it is expected to reach $1 trillion by 2020.) Inevitably, the president and congressional Republicans will then demand additional reductions in spending for social programs.

This is all the more likely because Trump and those Republicans also slashed corporate taxes from 35% to 21%--an estimated $1.4 trillion in savings for corporations over the next decade. And unlike the income tax cut, the corporate tax has no end date. The president assured his base that the big bucks those companies had stashed abroad would start flowing home and produce a wave of job creation--all without adding to the deficit. As it happens, however, most of that repatriated cash has been used for corporate stock buy-backs, which totaled more than $800 billion last year. That, in turn, boosted share prices, but didn't exactly rain money down on workers. No surprise, of course, since the wealthiest 10% of Americans own at least 84% of all stocks and the bottom 60% have less than 2% of them.

And the president's corporate tax cut hasn't produced the tsunami of job-generating investments he predicted either. Indeed, in its aftermath, more than 80% of American companies stated that their plans for investment and hiring hadn't changed. As a result, the monthly increase in jobs has proven unremarkable compared to President Obama's second term, when the economic recovery that Trump largely inherited began. Yes, the economy did grow 2.3% in 2017 and 2.9% in 2018 (though not 3.1% as the president claimed). There wasn't, however, any "unprecedented economic boom--a boom that has rarely been seen before" as he insisted in this year's State of the Union Address.

Anyway, what matters for workers struggling to get by is growth in real wages, and there's nothing to celebrate on that front: between 2017 and mid-2018 they actually declined by 1.63% for white workers and 2.5% for African Americans, while they rose for Hispanics by a measly 0.37%. And though Trump insists that his beloved tariff hikes are going to help workers, they will actually raise the prices of goods, hurting the working class and other low-income Americans the most.

Then there are the obstacles those susceptible to suicide face in receiving insurance-provided mental-health care. If you're a white worker without medical coverage or have a policy with a deductible and co-payments that are high and your income, while low, is too high to qualify for Medicaid, Trump and the GOP haven't done anything for you. Never mind the president's tweet proclaiming that "the Republican Party Will Become 'The Party of Healthcare!'"

Let me amend that: actually, they have done something. It's just not what you'd call helpful. The percentage of uninsured adults, which fell from 18% in 2013 to 10.9% at the end of 2016, thanks in no small measure to Obamacare, had risen to 13.7% by the end of last year.

The bottom line? On a problem that literally has life-and-death significance for a pivotal portion of his base, Trump has been AWOL. In fact, to the extent that economic strain contributes to the alarming suicide rate among white workers, his policies are only likely to exacerbate what is already a national crisis of epidemic proportions.