LAUSR

cesses are particularly important not only because a large proportion of the population feel they lack confidence, but also because income and status are so often seen as marks of personal worth. The failure of the authors to recognise these consequences of inequality is surprising given that they recognise similar psychological issues round black-white status difference and see them as relevant to the fact that deaths of despair are so much greater among the whites than African Americans. When they say that “White workers perceive black progress as an unfair usurpation” which has led to a white loss of sense of racial privilege, the basic issue – of who is better or worse than whom – is exactly the same territory as makes inequality so powerful. And Case and Deaton quote opinion polls to the effect that “more than  per cent of white working-class Americans believe discrimination against whites has become as big a problem as discrimination against blacks and other minorities”. At bottom it is about whether people feel valued or devalued. Whether that sense of being valued comes from a network of friends or from social status and income, research shows that these are among the most highly protective influences on health we know of. But instead of pointing in this direction, the book ends by naming the soaring costs (from  to  per cent of GDP between -) of American medical care as the ‘leading villain’. For Case and Deaton the problem this creates has nothing to do with the quality of, or access to, health care; it is instead that because employers pay many people’s medical insurance, the burden of rising costs will have prevented employers increasing working class incomes faster. But if medical care costs have been the chief villain, then surely there should have been at least a mention of their accomplices: among the biggest US companies the -fold pay differential between production workers and CEOs expanded over the period - to something like a fold differential (Mishel and Sabadish, ).