It’s hard to imagine a more alarming sign of a society’s well-being than an inability to keep its citizens alive. While some of the reasons are mysterious, others are fairly clear. American society has become far more unequal than it used to be, and the recent increases in mortality are concentrated among working-class Americans, especially those without a four-year college degree.

For many, daily life lacks the structure, status and meaning that it once had, as the Princeton University economists Anne Case and Angus Deaton have explained. Many people feel less of a connection to an employer, a labor union, a church or community groups. They are less likely to be married. They are more likely to endure chronic pain and to report being unhappy.

These trends have led to a surge of “deaths of despair” (a phrase that Case and Deaton coined), from drugs, alcohol and suicide. Other health problems, including diabetes and strokes, have also surged among the working class. Notably, the class gaps in life expectancy seem to be starker in the U.S. than in most other rich countries.