Deaths of Despair in Comparative Perspective

A socially patterned epidemic of deaths of despair is a signal feature of American society in the twenty-first century, involving rising mortality from substance use disorders and self-harm at the bottom of the class structure. In the present review, we compare this population health crisis to that which ravaged Eastern Europe at the tail end of the previous century. We chart their common upstream causes: violent social dislocations wrought by rapid economic change and attendant public policies. By reviewing the extant social scientific and epidemiological literature, we probe a collection of dominant yet competing explanatory frameworks and spotlight avenues for future sociological contributions to this growing but underdeveloped domain of research. Deaths of despair are deeply rooted in socioeconomic dislocations that shape health behavior and other proximate causes of health inequality; therefore, sociology has great untapped potential in analyzing the social causes of deaths of despair. Comparative sociological research could significantly extend the extant public health and economics scholarship on deaths of despair by exploring the variegated lived experience of socioeconomic change in different institutional contexts, relying on sociological concepts such as fundamental causes, social reproduction, social disintegration, alienation, or anomie.