When Public Health Crises Become Entwined: How Trends in COVID-19, Deaths of Despair, and Well-Being Track across the United States

• DOI: 10.1177/00027162211069719
• Author: Ethan Dodd,Carol Graham,Emily Dobson
• Published date: 01 November 2021
• Date: 01 November 2021

88 ANNALS, AAPSS, 698, November 2021

DOI: 10.1177/00027162211069719

When Public

Health Crises

Become

Entwined: How

Trends in

COVID-19,

Deaths of

Despair, and

Well-Being

Track across the

United States

By

EMILY DOBSON,

CAROL GRAHAM,

and

ETHAN DODD

1069719ANN THE ANNALS OF THE AMERICAN ACADEMYWHEN PUBLIC HEALTH CRISES BECOME ENTWINED

research-article2021

COVID-19 landed in a United States that is deeply

divided in opportunity, health, and hope; a reality that

is manifest in the million lives lost to deaths of despair

in the past decade. We explore the places and popula-

tions most vulnerable to COVID and where they coin-

cide with vulnerability to despair deaths. We use

well-being metrics to explore spillover effects from the

confluence of COVID and despair. Our earlier research

finds that metrics like lack of hope and worry track with

mortality patterns, with minorities more optimistic and

less likely to die of despair deaths than whites. Using

EMS first responder data, we compare trends in 2020

with those in 2018 to 2019, assessing excess deaths of

despair and new survey data to explore changes in well-

being. Remarkably, the cohorts with the highest

COVID death rates—low-income Blacks—still report

more optimism than other cohorts.

Keywords: COVID inequities; well-being; deaths of

despair; resilience

The high costs of COVID-19 are evident in

lost jobs, dramatic falls in gross domestic

product (GDP) growth, compromised school-

ing, shuttered restaurants, and much more.

Some of these losses will be recovered over

time; some will not. The human costs of the

pandemic—above and beyond the gruesome

death toll—are much more difficult to assess.

Emily Dobson is a PhD student at the University of

Maryland and a research assistant at the Heartland

Alliance Social IMPACT Research Center. Her work on

addiction and poverty has been published in the

Chicago Policy Review.

Carol Graham is a senior fellow at Brookings, College

Park Professor at UMD, and a Gallup senior scientist.

She is a world-recognized expert on well-being econom-

ics and has received awards for her pioneering research

and for her books and publications in Science, Social

Science and Medicine, and many other journals.

Ethan Dodd is a senior at Yale College (class of 2022) in

the ethics, politics & economics program. He interned

at Brookings, working with Graham, in fall 2020.

Correspondence: CGRAHAM@brookings.edu

WHEN PUBLIC HEALTH CRISES BECOME ENTWINED 89

Our analyses in this article suggest that the emotional costs of the pandemic

are much higher for the poor and vulnerable than they are for the rich, heighten-

ing deep preexisting inequities in well-being in the United States and many other

countries.1 Before COVID-19, we discovered remarkable paradoxes associated

with such inequities—steep declines in well-being in rapidly growing middle-

income countries such as China and India—and, most recently, deaths of despair

amid prosperity in the United States (Graham, Laffan, and Pinto 2018).

In the United States, pre-COVID-19, with booming stock markets and the

official unemployment at record lows, deaths of despair—due to suicide, drug

overdose, and alcohol disease—took more than one million lives in just over a

decade (Case and Deaton 2020; Graham and Pinto 2019). These deaths were

concentrated among less-than-college-educated middle-aged whites—a group

that was privileged when manufacturing jobs were plentiful, but then experi-

enced declines in income and social cohesion as those jobs disappeared. Pockets

of deep vulnerability—and ill-being—persisted and even deepened in the decade

of steady growth following the 2009 financial crisis.

Since COVID-19, these trends and other preexisting inequities have been

exacerbated. The virus hit low-income populations, and minorities in particular,

much more severely than wealthy ones, in part because of the kinds of jobs,

housing arrangements, and health care that low-income groups have. These

trends are reflected in deep declines in reported well-being (Reeves and

Rothwell 2020). Surveys in March 2020 highlighted the differences in the initial

costs to well-being across the rich and poor (McCarthy 2020). Low-income

respondents reported significantly more negative emotions—worry, sadness,

loneliness, and anger—than did high-income ones.

Significant increases also occurred in negative emotions relative to earlier

years for all income groups. Our comparisons are imperfect, given that they are

based on similar but not the same samples: the Gallup panel for March 2020

versus the 2017 Gallup daily poll. The differences across the years are stark. The

average in 2017 for reported stress and worry for the low-income respondents

was greater than for high-income ones. A clear increase occurs in March 2020 for

both groups (for example, 64 percent worry for low-income groups versus 41

percent in 2017).

A recent study based on Google word searches and a regression discontinuity

approach also finds decreases in well-being in both the United States and Europe

after those governments put lockdowns in place. The authors find a substantial

increase in the search intensity for boredom in both countries, as well as in

searches for loneliness, worry, and sadness (Brodeur etal. 2021).

The United States stands out, though, for the burgeoning mental health crisis

it had well before the onset of COVID, with deaths of despair being the starkest

manifestation. These deaths are concentrated primarily among uneducated

whites—particularly those who have dropped out of the labor force. Patterns in

the deaths link closely with those in desperation—no hope and high levels of

NOTE: The authors thank Isabelle Sawhill for very helpful comments on this article and Sergio Pinto for

his inputs to the design of the econometric models.