The Pain Behind Trump’s Victory
Since the conclusion of the election, a startling pattern has emerged showing that, compared to Mitt Romney’s presidential campaign in 2012, Donald Trump overperformed most in counties with the highest drug, alcohol, and suicide mortality rates. Penn State sociologist Shannon Monnat was one of the first researchers to put out data showing this correlation. Although Trump outperformed Romney in nearly 80% of counties country-wide, his biggest gains came in counties with above-median drug, alcohol, and suicide mortality rates.
Mannat further broke this data down by dividing mortality rate into quartiles. She found that the above relationship was more pronounced in the industrial Midwest and New England for counties with the highest mortality rates and less so in counties with lower mortality rates. For example, President Obama won Coos County, New Hampshire by 20 points in both 2008 and 2012. The same county, which has the highest death rate from drugs, alcohol, and suicide in all of New England now went to Donald Trump by nearly 10 points. The Economist also found — even after controlling for race, education, age, sex, income, marital status, immigration, employment, and share of non-college educated whites — the prevalence of obesity, diabetes, heavy drinking, and lack of regular physical activity most accounted for Trump’s overperformance compared to Mitt Romney.
This correlation was seen earlier by Jeff Guo, a reporter for The Washington Post. After the Iowa Republican Primary, Guo looked at the correlation between mortality rates for middle-aged whites and support for Ted Cruz, Donald Trump, and Marco Rubio. Guo’s data showed that in Iowa, Trump did better in counties where middle-aged whites had higher mortality rates, while Mario Rubio did the exact opposite and Ted Cruz showed no correlation.
The reason for focusing on middle-aged whites specifically when looking at mortality rates comes from data showing that, since 1998, there has been an increase in their all-cause mortality rates. All other major groups in the United States and groups in other developed countries have seen an average of a 2% decline in mortality since 1998. According to a paper by Anne Case and Angus Deaton, this uptick can be attributed to suicide, drug, alcohol poisoning, and chronic liver disease and cirrhosis. By 2011, poisonings had overtaken lung cancer as a cause of death in middle-age whites, with suicide not far behind. Increases in morbidity, as shown in Figure 3, corroborate these findings. There was a statistically significant decrease in the percentage of middle-age whites reporting excellent or very good health, with corresponding increases in fair or poor reports and reports of physical pain.
This data was corroborated by a recent NCHS Data Brief released by the Centers for Disease Control and Prevention which revealed that for the first time since 1993, the life expectancy for Americans overall declined in 2015, dropping from 78.9 years in 2014 to 78.8 years. Regardless of whether this is part of a longer-term trend, it is troubling to see when other developed countries have not seen a similar downturn. David Weir, director of the health and retirement study at the Institute for Social Research at the University of Michigan, stated, “There’s just this across-the-board phenomenon of not doing very well in the United States.” The CDC also found that death rates rose most for white men, white women, and black men, along with increases in unintentional injuries, which include drug and alcohol overdoses.
The increase in mortality rate does not apply equally to all middle-aged whites. International data has already shown that rural areas are at a disadvantage versus urban areas when it comes to health and mortality. Limited services, a lack of physicians, and difficulty in traveling to urban health centers all work together against individuals living in rural areas. Furthermore, people living in areas without easy access to primary health care providers are more likely to be hospitalized than those with more access. These same challenges have been found in the United States; Shannon Monnat and Camille Pickett found that individuals living in remote rural counties have the greatest chance of reporting poor/fair health. As seen in Figure 4, rural counties are significantly more likely to have persistent poverty, high unemployment, and population loss. In addition to these disadvantages, these communities often lack the economic or political power to demand investments in healthcare services from their local governments.
Monnat and Pickett also state that small rural populations contain “disproportionately ‘left-behind’ populations without the skills or means to migrate for social and economic opportunities.” These communities, usually composed of uneducated and low-skilled individuals, face having to deal with healthcare issues without access to health-promoting information and knowledge of health-promoting behaviors. This is in stark contrast to individuals in metropolitan areas who are more likely to have health insurance, are more likely to exercise, and are more likely to have access valuable health care information. The County Health Ranking and Roadmap program, which helps communities identify and implement solutions that make it easier for communities to be healthier, found that rural counties have the highest rates of premature death — lagging behind more urban counties. In fact, while other communities have continued to show varying levels of improvement, premature death rates have worsened in rural counties.
A discussion on increasing mortality rates cannot be completed without talking about the opioid and heroin epidemic that is driving most of the drug overdoses and drug-related diseases discussed above. Over the past decade, nearly 400,000 Americans have been killed for drug related reasons. Nearly 400,000 more have committed suicide, and 250,000 have died from liver disease and other alcohol-related illnesses. In 2015, more people died from heroin-related causes than from gun homicides. As recently as 2007, gun homicides had outnumbered heroin deaths by more than 5 to 1.
During this time, annual sales of OxyContin, which is the most widely prescribed narcotic, went from $45 million in 1996 to $3.1 billion by 2010. Sam Quinones, author of In Dreamland: The True Tale of America’s Opiate Epidemic, explained how Purdue Pharma, the company that makes OxyContin, aggressively marketed its drug to areas in with high populations of blue-collar workers who are greatest at risk for work-related back pain and other injuries. But in 2007, the company and three of its top executives plead guilty in federal court to charges that they misled regulators, physicians, and patients about OxyContin’s addictive nature and potential for abuse.
Unfortunately, by that time, 5.2 million Americans were already abusing the drug. And while efforts to reduce the number of prescriptions of OxyContin have been successful, the gap has been filled by heroin, which produces the same high and is just as addictive. Purdue Pharma had done a good job at targeting blue-collar workers for their drug. In the 1960s, it was predominantly young men in urban areas who would abuse heroin. However, a 2014 study found that more recent users were predominantly older, white, men and women living in more rural areas, who were first introduced to opioids through prescription drugs before they moved onto heroin.
All of this data goes to show that the fear and uncertainty that many feel after Trump’s victory is the same fear and uncertainty that was felt by some of those that voted for him. I started this article by stating that a “startling pattern has emerged.” For a pattern that has been nearly 40 years in the making, it should not have come to us as a surprise. But this is what occurs when we continue to live alone, in our own bubbles. We must realize that our well-being and our future is connected to the well-being and future of all Americans, regardless of who they voted for.
Markos Zúniga, founder of the Daily Kos blog, posted an article titled, “Be happy for coal miners losing their health insurance. They’re getting exactly what they voted for.” Even in our most difficult moments, we cannot afford stoop so low. The path of hatred will paralyze our progress. The path of bitterness will diminish our promise. But compassion and understanding has never hindered a movement. If we are to prevail, it will only be because we heard the voices of all our sisters and brothers. If Democrats had done more to acknowledge the pain felt by some middle-aged Americans and offered to help them, our election may have had a different outcome. Only 10,000 votes made the difference in Michigan. As progressives, we cannot make the same mistake again.
Edited by Kevin Warwick and Daniel Kauder (@pasadenazorro)
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