Losing ground at midlife in America

Recent decades have not been kind to those in the middle and bottom of the income distribution. From 1999 to 2013, real (inflation adjusted) per capita gross domestic product in the United States grew by 16%. During the same period, median real income for households headed by a high school graduate dropped by 19%. Despite this widening economic inequality and the additional stress of the 2007–2009 Great Recession, the continued improvement in United States life expectancy throughout this period—an increase of 2.1 y—along with better health among the elderly (1), provided at least some modicum of comfort that health was improving, even if economic standards were not. Case and Deaton, in their PNAS article “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century” (2), have dashed even this cautiously optimistic view of the past several decades.