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The term “deaths of despair” was coined in 2015 by economists Anne Case and Agnus Deaton to describe the increasing mortality rate for White Americans without college degrees due to drug overdoses, suicide, and alcoholic liver disease. These deaths were attributed to the despondency experienced by the White working class, who were left behind by changes in the American economy. However, the mortality picture has changed since then. Mortality rates are now rising among both Black and White Americans without a college degree. Nearly all major causes of death are increasing more, or decreasing less, for people without college degrees. The educational gap in mortality has become so severe that, in 2021, adult life expectancy was more than eight years higher among college graduates. In this double issue of RSF, Case, Deaton, sociologist Andrew J. Cherlin, and an interdisciplinary group of contributors move beyond the concept of “deaths of despair” to explore the widening educational gap in mortality.

Issue 1 provides new perspectives on the education gap in mortality as well as new viewpoints on the non-college population. Christopher L. Foote and colleagues show that much of the educational gap in mortality may be due to smoking. One of the most popular explanations for the growing mortality gap is that college unlocks better job opportunities. However, Sam Arenberg and Sam Stripling find that what may matter for longer life expectancy is not so much having a “good” job as having a job at all, as high school dropouts with jobs have lower mortality rates than college graduates without them. Victor Tan Chen and colleagues reveal that people with opioid use disorders experience “precarity chains:” overlapping, connected hazards that combine to put people at increased risk of substance abuse.  

Issue 2 also gives new viewpoints on the non-college population and examines geographic and international variation in mortality. Grace Landrum-Hall and colleagues discover that men with health issues repeatedly enter and exit the formal labor force—referred to as “churning”—due to inflexible employer policies and income support program policies. Jennifer Karas Montez and colleagues show that rural areas and small cities have seen increases in mortality, while large urban areas have seen decreases. Iliya Gutin and colleagues find that the educational gap in health and wellbeing is typically larger in the U.S. than in Britian. This may be because education in the U.S.—and the resulting higher salaries—allows for more access to health-promoting resources.

This double issue of RSF provides fascinating insights into the stark and alarming mortality gap between those with and without a college degree in the U.S.

The term “deaths of despair” was coined in 2015 by economists Anne Case and Agnus Deaton to describe the increasing mortality rate for White Americans without college degrees due to drug overdoses, suicide, and alcoholic liver disease. These deaths were attributed to the despondency experienced by the White working class, who were left behind by changes in the American economy. However, the mortality picture has changed since then. Mortality rates are now rising among both Black and White Americans without a college degree. Nearly all major causes of death are increasing more, or decreasing less, for people without college degrees. The educational gap in mortality has become so severe that, in 2021, adult life expectancy was more than eight years higher among college graduates. In this double issue of RSF, Case, Deaton, sociologist Andrew J. Cherlin, and an interdisciplinary group of contributors move beyond the concept of “deaths of despair” to explore the widening educational gap in mortality.

Issue 1 provides new perspectives on the education gap in mortality as well as new viewpoints on the non-college population. Christopher L. Foote and colleagues show that much of the educational gap in mortality may be due to smoking. One of the most popular explanations for the growing mortality gap is that college unlocks better job opportunities. However, Sam Arenberg and Sam Stripling find that what may matter for longer life expectancy is not so much having a “good” job as having a job at all, as high school dropouts with jobs have lower mortality rates than college graduates without them. Victor Tan Chen and colleagues reveal that people with opioid use disorders experience “precarity chains:” overlapping, connected hazards that combine to put people at increased risk of substance abuse.  

Issue 2 also gives new viewpoints on the non-college population and examines geographic and international variation in mortality. Grace Landrum-Hall and colleagues discover that men with health issues repeatedly enter and exit the formal labor force—referred to as “churning”—due to inflexible employer policies and income support program policies. Jennifer Karas Montez and colleagues show that rural areas and small cities have seen increases in mortality, while large urban areas have seen decreases. Iliya Gutin and colleagues find that the educational gap in health and wellbeing is typically larger in the U.S. than in Britian. This may be because education in the U.S.—and the resulting higher salaries—allows for more access to health-promoting resources.

This double issue of RSF provides fascinating insights into the stark and alarming mortality gap between those with and without a college degree in the U.S.

2026 Texas Christian University (TCU) Texas Book Award Winner
2025 Coral Horton Tullis Memorial Prize, Texas State Historical Association
2025 Outstanding Academic Title, CHOICE

The first study of the Fort Worth Narcotic Farm, an institution that played a critical role in fusing the War on Drugs, mass incarceration, and public health in the American West.

In 1929, the United States government approved two ground-breaking and controversial drug addiction treatment programs. At a time when fears about a supposed rise in drug use reached a fevered pitch, the emergence of the nation’s first “narcotic farms” in Fort Worth, Texas, and Lexington, Kentucky, marked a watershed moment in the treatment of addiction. Rehab on the Range is the first in-depth history of the Fort Worth Narcotic Farm and its impacts on the American West. Throughout its operation from the 1930s to the 1970s, the institution was the only federally funded drug treatment center west of the Mississippi River. Designed to blend psychiatric treatment, physical rehabilitation, and vocational training, the Narcotic Farm, its proponents argued, would transform American treatment policies for the better. The reality was decidedly more complicated.

Holly M. Karibo tells the story of how this institution—once framed as revolutionary for addiction care—ultimately contributed to the turn towards incarceration as the solution to the nation’s drug problem. Blending an intellectual history of addiction and imprisonment with a social history of addicts’ experiences, Rehab on the Range provides a nuanced picture of the Narcotic Farm and its cultural impacts. In doing so, it offers crucial historical context that can help us better understand our current debates over addiction, drug policy, and the rise of mass incarceration.

Contributors: Alba Alexander, Megan Houston, Dennis R. Judd, Cynthia Klein-Banai, William C. Kling, Howard A. Learner, David A. McDonald, David C. Perry, Emily Stiehl, Anthony Townsend, Natalia Villamizar-Duarte, and Moira Zellner.

This book is freely available in an open-access edition thanks to the generous support of Johns Hopkins University.

Throughout India, Accredited Social Health Activists (ASHAs) visit households in their communities to deliver essential health services and link community members with key health benefits. Like many other female Community Health Workers across the world, ASHAs are often portrayed as virtuous, passive volunteers, selflessly providing services to their neighbors.

The reality is more complicated and much more interesting. Drawing on ethnographic work in Rajasthan, Running on Hope follows ASHAs through striking personal transformations. From their positions as rural daughters‑in‑law—a particularly low‑power position in Rajasthan—ASHAs have, over years of work, gained unprecedented autonomy for young rural women. They have also gained a deep understanding of what many argue is the exploitation involved in their low‑ranking position in the health system. ASHAs often earn less than $100 per month for extensive work, well below the legal minimum wage.

To counter this, many ASHAs have joined unions—an endeavor that has ultimately proven disappointing: union leaders’ desires for political advancement are often at odds with ASHAs’ own needs. However, ASHAs do not have connections, money, or social power to organize effectively on their own, without a political patron. In Running on Hope, authors Svea Closser and Surendra Singh Shekhawat interview women who work as ASHAs to learn about their organizing goals, their roles in their community as conduits to health education and resources, and their hopes for a better future.