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Princeton Researchers Link Pain, Overdoses, Suicide, and Trump Votes

Team suggests lack of education leads to physical problems caused by lifetime of heavy lifting, which can prevent sufferers from enjoying life

case and deaton
Anne Case and Sir Angus Deaton

A team of Princeton University researchers who received widespread attention for their work on “deaths of despair” has uncovered a political twist: a correlation between education, physical pain levels, death from drugs and alcohol, suicide, and support for President-elect Donald Trump.

Professors Anne Case and Sir Angus Deaton with Princeton’s Woodrow Wilson School said more study is needed before conclusions can be drawn about the connections between chronic suffering and its symptoms and political preferences.

donald trump
Credit: Gage Skidmore via Wikimedia Commons

But their examination of various data sets dating back to 1990 shows that parts of the country with higher percentages of residents who are in pain, commit suicide, or die from substance abuse were also where Trump was most popular. And the professors suspect that, like substance abuse and depression, this political choice reflects a wider “malaise” group of people who are largely white, didn’t attend college, and have felt increasingly excluded economically and politically.

The researchers shared their latest findings earlier this month during a symposium at Princeton’s Center for Health and Wellbeing, entitled “Pain, Pain Management and the Opioid Epidemic.” The conference, co-sponsored by The Nicholson Foundation, brought together national experts to discuss the root cause and impact of addiction issues and explore how providers and policy experts are seeking to better treat chronic pain and substance use.

Tens of millions of Americans suffer from chronic pain and, while providers now write more than 250 million opiate prescriptions each year, suffering continues to escalate, research suggests. At the same time, heroin and opioid addiction rates are soaring, with at least 20 million people now chronically dependent. In 2014, some 29,000 people died from their addictions, including more than 1,250 in New Jersey, federal data suggest.

The work of Case and Deaton, who were named to Politico Magazine’s list of 50 top "thinkers" earlier this year, sparked widespread interest last year when they published a study that showed Americans with a high school diploma or less suffered much higher rates of physical pain. They are also plagued by higher rates of suicide, drug overdoses, and alcohol-related deaths, the researchers found.

“There’s a very close correlation between areas where pain levels are high and where people are dying from these ‘deaths of despair,’” she said. “The opioid epidemic fits into this broader framework.”

These problems, which are also tied to employment levels, seem to have ramped up in recent generations, Case said. “These things seem to be getting worse,” she said. “It’s moving right through the Baby Boomers into Gen X as well.”

Deaton said that, while economic factors require further study, there appears to be a close connection with physical labor. Those with less education are more likely to work in a warehouse, factory, or making deliveries -- tasks that take a toll on the body. And the research did show that pain levels for this group started to decrease after retirement age.

“A lot of pain is associated with work,” he said. “I think this is something that has not been sufficiently emphasized in the literature -- the fact that, if you’re doing manual labor, your body wears out with age.”

Case said data also suggests that this pain and its symptoms also restrict this group of sufferers from enjoying other potentially beneficial activities. They are less likely to walk daily or socialize, she said, both of which contribute to a healthier lifestyle.

But while pundits had tried to draw premature conclusions from their initial research, published last fall, Case said overlaying their original findings with voting outcomes from the 2016 election suggested there was a clear correlation between this suffering and support for the anti-establishment GOP contender.

“It’s clear the Trump vote didn’t cause the pain that started 20 years ago,” Deaton joked, during a question and answer session following Case’s presentation. “Our working hypothesis is it’s this sort of malaise, being excluded one way or another, economically and politically, which is leading to these things. The Trump vote is a symptom of that and the pain and doubt are a symptom of that.”

“I really do think economics is really quite important,” Deaton added, underscoring the need for more research.

“We need to go back and investigate more deeply the economic conditions,” Case agreed.

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