Opportunity for Health

Health Consequences of a Changing Economy

While the U.S. economy has grown overall, some people are increasingly being left behind. Wages for low-income and middle-class Americans have stagnated, while those for the top have increased. This increasing divergence may be tied to increasing automation, competition from foreign trade, and changes in social and economic policy.

Sociologists like William Julius Wilson and economists like Anne Case and Angus Deaton have posited that fading job opportunities—particularly in manufacturing—have given rise to increases in “deaths of despair” (e.g., suicide and drug overdose). The idea is that a loss of economic opportunities means a loss of hope for the future, unrealized dreams, and – as a result poor health and elevated risk of early death.

In one of our earlier studies, “Economic Mobility and the Mortality Crisis Among US Middle-aged Whites” (2017), we examined how mortality rates among middle-aged white Americans changed over time in counties with low vs. high levels of economic opportunity. We focused on middle-aged white Americans given the alarming growth in mortality rates seen in this group. We found that counties in the bottom 25% of all counties in terms of upward mobility experienced a 5% increase in mortality rates relative to high mobility counties.

Using a natural experiment methodology and data from 1999-2016, we found that deaths from opioid overdose rose dramatically in counties located in areas where automotive plants closed.

We followed this short study up with a more detailed analysis in our “Association Between Automotive Assembly Plant Closures and Opioid Overdose Mortality in the United States” (2020). We started with the hypothesis that job opportunities are critical to a well-functioning economy and public health. We investigated what happened to health outcomes—specifically drug overdose deaths—when long-standing beacons of economic opportunity, automotive assembly plants, closed in the U.S.

Using a natural experiment methodology and data from 1999-2016, we found that deaths from opioid overdose rose dramatically in counties located in areas where automotive plants closed, relative to the same changes in counties where plants did not close. Manufacturing counties with these closures had 8.6 deaths per 100,000 residents more than unaffected counties due to a relative increase in overdose mortality. This effect was particularly larger young, non-Hispanic white men.

Figure 1. Trends in opioid overdose deaths after auto plant closures

Opioid overdose deaths have been called “deaths of despair” because of their possible connection to individual and community distress. This study looks at how proximity to auto plant closures — which represent large, traumatic, and culturally significant shocks to economic opportunity — affected opioid deaths among working age adults between 1999 and 2016. The authors focused on counties with a high level of manufacturing employment, and asked: did individuals living within the same labor market (i.e., commuting zone) as a plant closure go on to have increased rates of opioid overdose mortality compared to those residing in labor markets that did not have a closure?

Diminishing economic opportunities are associated with opioid overdose deaths. Policymakers should consider targeting regions affected by manufacturing losses with increased screenings and community-based interventions for substance use disorder. Affected communities may also benefit from health system and community engagement in identifying and addressing critical social determinants of health. Given the likelihood of further declines in manufacturing, social policies should target regions with longstanding economic ties to this sector.

Figure 2. Changes in automation and drug overdose mortality across U.S. counties

This figure plots changes in county-level drug overdose mortality rates for 18-65 year old men and women by changes in the number of robots per 1,000 workers in each commuting zone for the period 1993-2007.

In a report for the U.S. Social Security Administration (SSA), we examined whether automation – a key driver of fading economic opportunities in manufacturing – led to worsening mortality and higher rates of disability claiming in the United States. Using new data on the adoption of industrial robots in U.S. commuting zones, we found that increases in automation can account for 12% of the rise in drug overdose mortality between 1993 and 2007, and 22% and 12% of the rise in Supplemental Security Income (SSI) and Social Security and Disability Insurance (SSDI) applications, respectively, between 2000 and 2007.

We extended this analysis in a 2022 study published in Demography, Death by Robots? Automation and Working-Age Mortality in the United States.” In this study, we found large effects of automation on overall mortality, drug overdoses, completed suicides, and cardiovascular disease mortality, which varied by age and gender. We also showed in this work how social policies could blunt some of the negative impacts of automation on health.

These findings are consistent with work from other researchers, who have examined the impacts of automation on a range of health and human capital outcomes. They are also consistent with work demonstrating how area-level exposure to foreign trade, which similarly displaces manufacturing jobs, leads to increases in drug overdose deaths.

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