Supporting Trump is killing white America
The President’s policies are reducing white-working-class life expectancy.
By Jonathan Metzl
It is said that uncertainty drives voters to support politics that ultimately go against their own interests. What this generally means is that atmospheres of insecurity push voters into backing politicians who play on their fears by offering solutions, not just to pressing real-world issues, but to a perceived loss of status or privilege.
These politicians often find ‘others’ to blame, while promising to help those who feel that the system is no longer working for them. Yet such support represents a double-edged sword: the policies these politicians implement can foment mistrust even further, thereby worsening the very problems they claim to want to fix.
Of late, we have heard a lot about the economically self-destructive nature of policies based on nationalism and xenophobia, and for good reason — isolationism shrinks markets, often to the detriment of workers.
Thus in the US, media is replete with stories about how, for instance, farmers in conservative states continue to support President Trump even after his disastrous trade wars threaten their livelihoods. Meanwhile, in the UK, support for Brexit continues unabated, and even grows, in the face of warnings that a no-deal exit could lead to rising interest rates, lower GDP and economic recession.
My research shows that policies based in nativism or isolationism also have profoundly negative biological consequences, even for the populations whose support is needed to gain and hold power in the first place.
I have come to this conclusion after spending the past eight years studying the rise of white ‘backlash’ politics in Southern and Midwestern US states such as Missouri, Kansas, Kentucky and Tennessee for my recent book, Dying of Whiteness. By backlash, I mean anti-government, anti-immigrant, pro-gun politics that promise to defend or restore the interests of white Americans in the face of changing demographics or cultural norms.
Such themes, which have been part of American political discourse for decades, were given new life with the rise of groups such as the Tea Party during the Obama years. Since then, they have become central refrains of President Trump’s rise to power and his increasingly overt claims that immigrants, minorities and liberals present threats to white wellbeing.
A white Midwesterner myself, my research has helped me better understand the complex ways in which Trump speaks to working-class biases and fears, and gives his supporters the sensation of winning in the face of an increasingly diverse world that, as he repeatedly frames it, spins away from their interests.
Trump’s promises of white defence and restoration remain central to his boasts to make America “great again” and suffuse the US government’s approaches to issues including immigration, foreign affairs, tax cuts and healthcare.
But there is a twist: from the perspective of health and longevity, the actual policies that his administration promotes and implements often end up making the lives of working-class Americans — including the lives of his white working-class supporters — far worse. In many instances, the policies at the core of the Trump agenda function in the same way as other man made risk factors such as asbestos or second-hand smoke; shortening the lifespans of the most vulnerable in the Grand Old Party (GOP) base of support.
Take healthcare. On assuming office, the Trump administration inherited the beginnings of a national healthcare programme, the Affordable Care Act (ACA). But instead of bolstering healthcare networks, the administration undercut the ACA (and its related Medicaid expansion) at every turn, while presenting no viable alternative for healthcare for poor states and communities.
I researched ACA rejection in Tennessee, a state in which white working-class voters resoundingly supported Trump. There, efforts to undermine the ACA have harmed health across the board for lower-income whites. White working-class Tennesseans saw doctors less often and paid more for visits and prescriptions than they would have done had the ACA gone into full effect.
Without adequate coverage, people got sicker before seeking medical attention, and then came in with far more serious symptoms. Aggregated across the population, such a dynamic shortened the lifespans of white working-class Tennesseans by between two and three weeks of life.
Education was another example. Tax cuts in Kansas that became the model for Trump’s 2017 tax bill eviscerated budgets at public schools without presenting any strategies for boosting education for children of working-class families. Class sizes rose, and many poor districts eliminated student support services.
High school dropout rates rose dramatically and graduation rates fell precipitously for working-class children, including for children in white working-class families. Using data that correlates high school dropout rates with shortened life expectancy, I found that the GOP budget cuts corresponded to the loss of over 7,000 white life years in the first four years of the cuts alone.
Tariffs. Climate change policies. Defunding addiction treatment centres that managed the opioid epidemic in rural counties. Pretty much every Trump initiative or policy position has benefited corporations or the wealthiest at the expense of working-class bodies or communities, including, and at times primarily, the bodies and communities of his white GOP supporters.
I found similar trends when I looked into guns. In Missouri, pro-gun GOP politicians swept into power on the promise of enacting what were once considered extreme pro-gun positions, such as easing regulations that governed how people could purchase, own and carry firearms. The result: while some enjoyed the new freedoms to carry guns pretty much anywhere they wanted, the overall effect was soaring rates of gun-related trauma.
From a statistical perspective, the largest numbers of victims in Missouri were not gang members or carjackers, as the popular stereotype suggested. Rather, by far the primary victims of gun death were white working-class Missourians. This cohort dominated injuries and deaths via gun-related suicides, partner violence and accidental shootings. White men living in rural areas were overwhelmingly the most likely to die from gun suicide. I found that lax gun laws correlate with the loss of over 10,500 years of productive white male life.
Politics are often confounding. People identify with particular politicians for reasons that do not make sense to outsiders who do not share their views. Sometimes one priority overshadows another. Yet several themes emerged from my research that helped me to understand why white American voters continued to support certain politics even after the negative effects of these policies on their lives become clear.
As the title of my book suggests, stereotypes and anxieties about losing racial status topped the list. I will never forget how a man pulling an oxygen tank because of severe lung disease told me that he would rather die (and soon did die) than receive benefits from the ACA because it used “my tax dollars” on “Mexicans and welfare queens”.
I also often encountered concern that minorities or immigrants were usurping resources, with the perception being that they did not deserve to receive such support. For instance, another man in Tennessee claimed that “the Mexicans, their food stamps, everything they want, we’re paying for it”.
Such racial resentment occasionally also went hand-in-hand with conflicting thoughts about government services. “I’d be dead without my Medicaid,” one man told me, before continuing, “the ACA is socialism in its most evil form”.
Framing political and policy issues under the cloak of nativism and racism also made it harder to voice dissent. Indeed, I encountered a number of people who genuinely believed in smaller and more effective government and tried to live their lives as best they could under trying circumstances. But in my focus groups, people who voiced moderate positions (“I can see how a single-payer health system might benefit everyone”) were often dismissed by other members.
These instances highlighted how extremist politics function by casting core issues not just as policies but as identities. Being pro-gun or anti-healthcare reform at any cost marked people as being one of ‘us’ and questioning these positions made you one of ‘them’. Compromise coded as treason, even if middle-ground approaches to some issues may have saved lives. I came to realise the extent to which these forms of self-sacrifice drove the success of Trump’s us versus them style of politics. Had conservative white working-class populations demanded better healthcare, roads, bridges or schools in exchange for their support, it would have been much harder for Trump and the GOP to pay for the tax cuts they afforded to the wealthy and corporations.
All the while, an agenda that claimed to be concerned with the encroachment of ‘others’ enacted policies that rendered working-class lives, including those of its own core supporters, as expendable. Put another way, I found that the material realities of white working-class lives were made worse not by immigrants and citizens of colour — but by GOP policies.
What, then, to do about politics that promise greatness on an emotional level, but deliver the opposite in economic and biological terms? Part of the strategy needs to start with recognising how, in our current polarised moment, political change is far more complicated than simply telling voters that the people they are electing and the policies they are implementing not only do not help them, but actually hurt them, their families and their communities. Such straightforward appeals might make sense logically. But the examples of healthcare, education and guns in US red states show how deeply hot-button political issues intertwine with far deeper tensions about matters such as race, place, history and identity. Even the most logical counter-arguments need to take account of — and in some instances, respond to — these more emotionally based biases and fears.
This is not in any way to suggest aligning with racism or xenophobia. Rather, counter-messages need to be able to appeal on the emotional level, as well as being based in fact. Doing so means asking hard questions in an attempt to discover the key underlying issues: what worries you the most about immigration? What does your gun mean to you, and why do you feel you need it? What concerns you the most about a country in which everyone has healthcare?
And it means talking far more directly and honestly about the strengths and limitations of whiteness. This means reflecting on white traditions of generosity and resilience, and not just the anxieties, biases and fears of white communities. It means talking about ways in which white Americans can enhance or thwart American prosperity. And about how, to make America truly great, we need a more communal version of racial justice to emerge.
These deeper issues might seem immutable and impossibly rooted. But then you realise that tapping into and manipulating them is the precise (and increasingly well-honed) method used to divide people.
Jonathan M. Metzl is Director of the Center for Medicine, Health and Society at Vanderbilt University. His latest book is Dying of Whiteness: How the Politics of Racial Resentment is Killing America’s Heartland.
This article first appeared in the RSA Journal — Issue 2 2019