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tv   Ethical Perspectives on the News  ABC  December 13, 2015 11:00am-11:30am CST

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retired. welcome to ethical perspectives on the news. recently two princeton economists discovered a surprising change in the death rates of one demographic group, white peopop between 45 and 54 with only high school educations. in america, and certainly in developed countries around the world, at worst the death ratesesor some groups did not improve between 1999 and 2014 but this one group suffered increased rates of suicide and drug and alcohol deaths. most of us would expect such results for underprivileged minorities but those two groups either stayed the same or improved. what is happening to working class, poor whites in america? what can be done to reverse this startling trend and what are the political and ethical implications of this sad change in the lives
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poorly educated whites? we've asked today to discuss this complex and interesting and very troubling topic, we have three people. first to my left is pramod dwivedi, who is t linn county director of public health. next to him is erin davis, associate professor of sociology from cornell. erin davis: morning bob sessions: and david jepsen, retired prorossor of education frfr university of iowa. david jepsen: thank you for having us. bob sessions: thank you all for joining us this morning. pramod dwivedi: thank you. good morning. bob sessions: we don't have a lot of time. it's only a half hour but i do want to be sure that we're fairly clear on exactly what's being claimed by these two professors and what some of the concerns are with their data and so on but i don't want to spend our whole time talking about those details. erin, why don't you give us your perspective on exactly what it is that they're telling us? you're the
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mostly looking at changes in mortality rate. morbidity and mortality but i think a lot of i is focused on mortality. if you look at this particular group, those who have high school or less than high school education, middle aged, white americans, they found that there's a sort of increase in mortality rate, which is unexpected and dodo not, is quite different from other countries and somewhat different from other racial groups, other age, racial class groups within the united states. there have been someme not quite as much of an increase as the economists claim. however, even ople who critique it on that level between what's happening here and in other countries. i think the question is partly, why. what is behind this? pramod dwivedi: yes, just to be sure that overall death rate or mortality rate is declining in the united states, in iowa, and obviously in our county, linn county. what's troubling is really the specific
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group among white in the united states and that, since 1999, that has been the death h rate and also morbidity has been increasing in that population, although, the increase is not a lot. it's .5% per year. if you look at all these years since 1999 through 2013 it's nearly half a million people, those who could have, their lives could have been saved. it's a really, really, huge, huge public health issue, social, political, policy related issues. one thing that they are also talking about in the report in this article is that why is this happening? what's causing this? i think that the main thing
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looking, probably going forward in the future, we need to look at some factors in this specific group. we have been also looking at our data in linn county and iowa too, and we have seen in our society going up that there is poisonin related deaths as well, opiates are increasing in our population too so there are a number of health issues, those types of things that need to be looked at carefully. bob sessions: david, what is your perspective? david jepsen: i agree with the panelists in getting the big picture and i really appreciate how well they did it. i think the interesting thing to me is how the mortality data were related to the morbidity data. they were very careful to say there
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between t t two and they avoided causal language so we don't know. in fact, most of the critics and the authors themselves really backed off of saying, "this causes this," because there's too much, well, the data points artoo far apart yet and so i think they have little story i heard about how they got, how this came about, how it was published is that the two authors are man and wife. the man had d st come from stockholm where he won the nobel prize in economics and the wife has suffered from lower back pain for, incurable it says, for many years so she was very interested in suffering and what were some of the causes and cures of that. he had large data sets, had this
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reputation as well, and they just sort of by accident sliced the data to get this segment that we're going to be talking about and found this rapid increase in mortality. itit sort of an interesting story about how- bob sessions: yeah. david jepsen: science is not- bob sessions: yeah. david jepsen: all pre- planned. bob sessions: right, well the comparison to other groups, i think, is really interesting because, clearly this demographic are people o are having a hard time making it, okay? they're depressed- erin davis: yes. bob sessions: because they have a hard time finding work, or meaningful work, or work that's adequate to meet their needs and so on. they get caught in the cycle of taking drugs or drinking nd probably getting caught up in violence. their education isn't adequate for finding things better and they're depending more and more on welfare programs of various kinds and so
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have safety nets to help people like this so why is that this group though, whites in this age group, have a different profile than peop who are in minorities, blacks and hispanics and so on, because that's one of the things the data did seem to point to, okay? what's going on? wh's the difference, dodoou think? it's a way of kind of beginning- erin davis: right. bob sessions: to tease out what's going on with these people? erin davis: well, i think we first have to say, and i think unfortunatel y this has not been acknowledged nearly enough in the reports that have been written about this study, is that the mortality rates for african americans are still much higher than whites in general. i think why there's such a focus on this is this sort of increase that's happening here. if we just l lk across the board, i think the reasons why the mortality rate is high for this sort of lower educated group is very similar to the reasons why it's high for other groups.
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make causal arguments but i think there's a social context we need to sort of explore and you started talking about some of it. the fact that, in many cases, individuals in this group are underemployed ootheir employment prospects have been declining or have been limited over the years. the fact that a lot of these individuals talk abouteing in chronic pain and so we do have the rise in prescription drugs and nonorescription drug uses, which leads to sort of the alcohol and drug related deaths. we also have issues; this is a group`that's starting to think about retirement and may not haha their retirement savings or their retirement plans. i think one of the things, you know you asked how are they similar and how are they different? i think in many ways those arar very similar situations for either loloincome or individuals who have not had college education. i think college educations are increasingly becoming important for
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that's sort of a shift. i think whites in particular, this group, this particular age and education level group, is looking at the future and is not seeing the same opportunities that they thought they would have. i think with race, if you look at sort of african americans, there's sort of been, there hasn't been the same sense that, of opportunity that there have been for white americans. i think this is a oup who expected more opportunity that is now facing a situation where they're, they think that they may be the first group that is not doing better than their parents, that they don't see hope in the future in the way that they had anticipated. pramod dwivedi: that's a very interesting point that compared to african american you are saying that they, this age group, 45 to 54 age group did not see themselves going, you know, becoming worse off than their parents. i think that's a very interesting observatn. i think the
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social support. that could be a ntributor because the way the society is also changing and that creates problem among this age group. then the other thing is that long lasting hardships, job loss, i mean a lot of anxiety and fear creates these types of problems where people have poor mental health, poor, ovovall geneneal health is also poor because they looked at data, which clearly indicated that in this age group, people did not setheir mental health and overallgener al health up to the mark. those are some of the issues that we have to be aware of. the
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you know this population is also going into medicare eventually and that's, healthcare, health insurance is another area which we need to look at as well for this group, especially when they are not employed, if there is a j j loss so they are not ready to be part of medicare yet and there is a lot of stressors, external forces that are crippling this population, which before was not pressured, which was not crippled the way they are at the moment. bob sessions: what, i think we sort of have two
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out. one is, what kinds of things might be done or might society begin to look at, given that this is a very large scale, increasing public health issue? secondly, how is this playing out in our current political climate because let's face it, there's an election and it's being played to a great deal. let's do the first. what sorts of things might society begin to look at because i think pramod is right that there are a lot of support networks and support features that are just not there for a lot of people? david jepsen: one of the characterizations of the population that we're talking about is that they have lost contact with some of the supports that other people normatively would have, such as religion, family, unions, and other kinds of fraternal organizations. bob sessions: neighborhood s.
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that adds to the stressors i would think or at least it would take away opportunities to reduce the stressors some how. you memeioned, none of them are governmental programs. david jepsen: right. bob sessions: those are all things that society needs to do to reform communities, help people form communities. pramod dwivedi: that's why it's very, very important, critical to look at in social determinants of health. that's what linn county public health department is really focusing on at the moment, not for this population group but for the overall welfare and well being of our society. i think we need to look at social cohesiveness, social supuprt system, poverty, , connectedness, because we are getting more and more isolated from the sources where we could get support from. the three areas the
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opiate use, poisoning, alcohol use, and then the sclerosis, right? david jepsese liver diseases. bob sessions: right. pramod dwivedi: right, liver diseases because they increased; everything is fine but those increased. they are accounting for the increase in overall death rate among this population. at least we can, as a society, i think we should be talking about how to at least arrest the over use of prescription medications like opiates. as i was saying before that it's really the biggest man- made epidemic in modern medical history, really. we have to devise a plan by which we can change some ofhe practices,
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prescribe these medicines to the folks. that needs to happen. then there are a lot of other thingsgshat we can bring in at policy level but that we cannot do. at least politicians, political elected officials; they are able to do some of the other support sysyems, welfare system. erin davis: you started by sort of saying, what is different about this group and i think that in issues of informal social support, i think if we look at some of the compasons, they also speak to potentially some things to look at. you mentioned prescription, nonprescription drug use, times it starts with prescription drug use and then moves to nonprescription. there have been studies. we talked about how is this group different t om african americans. there have been studies that show
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to prescribe pain that's partly based on discrimination but yet it has this different outcome so i think we need to look a asort of our prescription policies and patterns. the other thing is we can compare, you know, it's not so much that other groups haven't faced economic challenges but i ththk it's this intersection of drugs with these economic challenges that are particularly problematic here. i think monitoring healthcare is one issue. we can also compare it to other cocotries, right? these rates, these increased rates of mortality have not been seen in other countries and i think that largely, or maybe not largely but to some extent has to do with the gap you were talking about, the social services, the governmental rvices, that sort of- there are more provisions in many other countries, pensions, other things that sort of create a stronger safety net. i think we have a couple of issues in additional to
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important. bob sessions: there's another dimension to this and that's work, okay? we've talked several times about how people don't have meaningful or adequate jobs. there are a lot reasons why that's happening. it's very complex. one of the factors, i taught courses on work for 25 years when i taught and wrote a couple of books on it and so on, one of the things that i don't hear people talking about nearly enough is that maybe the old jobs are not coming back. not only in america are manufacturin g jobs disappearing but they are in china too cause more and more jobs are being done by machines. it's not just manufacturin g. . it's in service sector jobs of all sorts. secretarial jobs and even managerial jobs can be done more and more by machines. it's interesting, historically when the industrial revolution got going, there was a kind of promissory note told to people that well, if you just do this terrible bor in these factories for a while, it's
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and one of the ways it paid off is you didn't have to have women and children working after a while, okay? you could make enough money because more wealth was produced by less and l ls work. well, that's continuing but the wealth is not being spread around, okay? the only way to get it is thugh the work and thugh social programs,pwhich don't give you nearly asasuch. maybe we need to revisit that issue. why shouldn't people be making more? we're doing that some extent with this push for increasing the minimum wage. at least the wealth that's being generated for mcdonald's s wherever, should at least in part go back to the workers but that's a major part of all this. it isn't just the amount of money; it's the meaning of e work. when work gets reduced to simply a way of making money, then a lot of the social networking, the meaningful relationships and so on disappear because people are being dririn so hard. david jepsen: i was s inking
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questions that y/u addressed to us prior to the program about making it loloal in some sense. the parallel i can recall best is the farm crisis of the 80s, which had some of the same, predominantly males were the sufferers, suicide rates were high, some of these other things, these other medical problems weren't. i went back and i thought, "well, what did we do? how did we help people get throroh that?" it wasn't so much that itit was looking for economic solutions because thos eventually came and came at a high price i would add, high price to the farmers but at the time there werere support groups. there were crisis lines. there were various ways in whicthose alienated and isolated men could connect with
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i think it's such an incumbent upon, not only political organizations but churches, and retired groups, and so forth to reach out to create support groups. i have been in those and i have seen the effects of those. we know how it works with people with alcoholism and mental illness and so forth, that i think those are some very practical things. the problem is we don't have the professssnals. they're all titi up doing therapy probably but we don't have enough professionals . i think there are, i think lay people can do some of that. there are other- i think the press could be a little less difficult on this population at the same time. there's a sense in which they're portrayed as poor and down and out. they don't really want to think that way
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rest of us to think of them in that way. i think it would be nice to say they're trying hard, among other things or to at least buttress the kind of positive ways of dealing with the stressors. bob sessions: that's kind of a issues. quite a few people, in thking about this issue, have been lookingngt the political followers of donald trump, okay? it's not a joke, okay? he's doing very, very well in part because he's somehow tapping into thisisery strong stream that we've been talking about, disenchanted white voters. he's very high, if you look at the emographic that we'r'rtalking about and he's speaking to their frustrations with the lack of work, which is what we were just talking about, and focusing on immigrants who might be taking away their work, doing the jobs that
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were going to have and so on. he's building on that concern that this group of people have about the people right below them, if you will, on the economic and social ladder. erin davis: i think it's also interesting, and this may be connected to that, the way the news has reported on the study. one of the things i see, you talk about sort of appealing to white voters, is that the headlines almost all just talk about increasing mortality among whites. occasionally you'll get middle aged whites. in the headline i have not, i think therermay have only beeeeone headline out of many articles, so i think 75-90% of headlines are just focusing on whiteness. i think it's sort of this attempt to sort of draw in viewers in a way that's kind of disingenuous bebeause this is, this to me is really a class issue in a lot of ways. it's really focusing on some of those economic changes as well as public health challenges. i think there's a way in which
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the ways in which we can really start thinking about, how can we address this the other thing is the extent to which this is still, you know the mortality ates for african americans are still higher than whites and i think for many of the same reasons, althougugthere are nuances wewee been talking about. i feel like this almost this divide strategy in the way even the media buys into this, which i think is really problematic. david jepsen: well, i is like a- i keep thinking when i hear what you're talking about here and that we can hope that the people who work with these huge sets of data will go back and slice it some more because i think the black/white thing is, as you've suggested, not particularly convincing because we don't k kow enough about
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good chance the mortality rate at younger ages has eliminated a lot of people and we don't know whether or not they gototeople in prison. we know that those kind of, that they're disproportion ate numbers- erin davis: right. david jepsen: in prisons everywhere including iowa. i hope that they will do some mororslices on this and i hope that they will, i hope that they will look, begin to look more at family histories too because one of the big problems in the farm crisis, for example, and i would think in cedar rapids in general among this population is this notion, this narrative as the author said, this narrative that our family will continue to prosper and do better. each generation will do better than the one before, which is- bob sessions: not happening. david jepsen: not working out.ob sessions: yeah, that's right. david jepsen: not working out at all but when it doesest work out it hurts so much more. that was the
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that century farms were being sold off and it wasn't just the seller but it was the seller's father, and grandfather, and son, and nephew and so forth. i is bigger than the individual. bob sessions: we just have a couple of minutes left. let me pose one final question, perhaps have each of you sort of address. one of the concerns that lot of people have is that peoplele who are in this, let's call them the donald trump demographic followers, is that while he does capture their frustration and their concern about how washington doesn't get anything done and son. he's the outsideand he's not beholden to the rich and so on, even though he's veryryich but they're realal, in following him, going against their own interest, okay? to be against social
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have adequate lives because they can't find good work and so on, because they don't have educations, that goes against their own self ihterest. if you had d ch a person in frontnt of you, okay, what would you say to them to try to maybe we need to increase the social network of support that's there rather than decrease it? pramod dwivedi: i think the data needs to be to people like those who are seeking elected office and make sure that they understand it a a the implications of this on our society because it's going to be devastating if we don't. we have made enormous progress, right, in terms of reducing mortality and we don't want to lose that momentum. for the last 15 years it seems like we haven't even taken note of this so it's a really huge denigratory and rhetoric
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transformativ e leadership and national leadership has to be accountable. this is not just that we have to do this or that. there has to be really, practical, evidence based, scientific approach to deal with this problem. bob sessions: erin, what do you say, quickly? erin davis: i would agree. i think we need to, instead of focusing just on sort of individual issues, we need to think about the public health and the structural issues, i think, as much as posble sort of outlining that evidence and sort of talking about the ways we can all benefit from stronger public health initiatives. david jepsen: i had a friend for several years who had fallen in this demographic that we're talking about and my first problem was to get him to vote. i think that's going to be the problem donald trump and all the candidates have. this group of men, i don't think will show up at the polls very much untnt somebody takes a personal
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sessions: i think that's- erin davis: let me add just to say- bob sessions: go ahead. erin davis: it's also women. in fact, some- bob sessions: yeah. erin davis: some of the studies- bob sessions: absolutely. erin davis: indicate that women are facing a areater risk so- david jepsen: yeah. erin davis: that's another side of it. dadad jepsen: oh it is. bob sessions: sorry, we have to end this conversation. we obviously could go on a long time but i want to thank all three of you r coming this morning. p pmod dwivedi: thank you. bob sessions: it was very interesting and- david jepsen: thank you for the invitation. bob sessions: helpful conversation. erin davis: thank you. bob sessions: yeah, good work.
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>> hello again and welcome to another edition of "financial perspectives" from premier
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i'm bob bruce, we all have the

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