"Had Trevor lived a simple thirty-nine minute drive away in neighboring Kentucky, he might have topped the list of candidates for expensive medications called polymerase inhibitors, a life-saving liver transplant, or other forms of treatment and support," Metzl writes. But Tennessee officials repeatedly blocked efforts to expand Medicaid under the Affordable Care Act.
But Trevor is not mad at the state's elected officials. "Ain't no way I would ever support Obamacare or sign up for it," he tells Metzl. "I would rather die." When Metzl prods him about why he'd choose death over affordable health care, Trevor's answer is telling. "We don't need any more government in our lives. And in any case, no way I want my tax dollars paying for Mexicans or welfare queens."
Over the course of almost a decade, Metzl crunched mortality statistics and spoke with people in the South and Midwest. He sought to find out how—and why—many low-and-mid income white Americans embrace values and back politicians who institute policies that are literally killing them, from lack of health care to gun de-regulations to shoddy infrastructure. Metzl shows that from a public health perspective, the dogma propagated by Republicans is literally toxic to a majority of their constituents.
He also traces the history of how right-wing groups have promised to restore some ideal of white American "greatness"—usually at the expense of racial and ethnic minorities. That political trick reached its ultimate fulfillment in the election of Donald Trump and his slogan, "Make America Great Again."
Let's go back to Trevor. What killed him?
"At the most basic level, he died of the toxic effects of liver damage caused by hepatitis C," Metzl writes. "When the liver becomes inflamed, it fails to filter toxins from the blood and loses the ability to produce vital compounds such as bile and albumin. Without treatment, death comes by systemic deterioration. Jaundice gives way to ascites, which then gives way to hepatic encephalopathy and coma. It's an exceedingly slow, painful way to go out."
But Metzl reveals another culprit: the toxic effects of dogma absorbed by many white people that might lead them to accept a painful death over giving up their place in a hierarchy that puts them above blacks, Mexicans, immigrants, other nonwhite people and "the poor."
Raw Story spoke with Metzl, who is Director of the Center for Medicine, Health, and Society, at Vanderbilt University in Nashville, Tennessee, about the politics of racial resentment, conservative backlash, the rise of President Donald Trump and the idea of dying of whiteness.
Tana Ganeva: You open your book with a question that it seems every pundit has litigated since the dawn of time (or 2015). Why white working class Trump supporters would support Donald Trump. Broadly put, what is the conclusion you came to?
Prof. Jonathan Metzl: The book is really about the effects of a lot of the policies that Trump supports, right? The scope of the book looks at three core Trump administration issues, and the history of those issues, going back about 10 years before the Trump administration. So I open the book talking about health care reform and why certain states would go ahead with rejecting Medicaid expansion, when the health of populations in those states was failing so badly.
I also looked at guns in America, particularly in red states that support very open gun policies even when populations are suffering very bad health effects in terms of gun injury and death. In the third part of the book, I look at massive cuts to infrastructure, led by purple states. And really, I tried to understand why it is that people would support cuts to services that they use, like roads and bridges.
So those are three very different examples, but in the book I try to tie them all together for a couple of reasons.
First, because they all became central components of the Trump administration, but also there were ten to twenty year histories behind these polices before Trump, so I saw how Trump took those stories and manipulated them.
I show how even though many of these policies were couched around the promise of making particularly white populations great again, by addressing a sense of lost greatness or anxiety about the world spinning away from them -- I looked at a lot of data and talked to a lot of people and at the on-the-ground level, the health of many populations suffers, but most of the negative health effects are suffered by working -class populations who are the core of Trump's support.
And three, there's something similar about these three examples, in that they all tie to not just promises in a broad sense of "what America used to be" but they often have invisible undertones of racial anxiety or a racial hierarchy. And it's all hard to see but I feel like the politicians who are supporting these issues ... and the Trump administration in particular really tapped into the anxieties about falling whiteness. These deep racial tensions were embedded in issues like health care and guns.
Let's take health care. When they tried to "impose" health care reform in the South during the 1950s, and before that in the Truman era, there was profound anxiety because hospital wards were being desegregated. So there a kind of racial history of resistance to health care reform, that the anti-ACA people were tapping into.
Guns, there's another good example. Guns were in many Southern states were only allowed for white Americans for a couple of centuries. So, the point of the book is, we can't understand why white people act against their self-interest unless we understand the histories and how these particular issues have racial meanings.
And the book traces these stories and reveals the costs. They make people's lives shorter, harder and sicker.
Tana Ganeva: So your research combines data analysis, such as mortality rates, and then also just talking to people across these Southern and mid-Western states. Did any of your findings challenge your expectations?
Prof. Jonathan Metzl: Absolutely. Let me just say that the reason I tell the story in multiple ways is I wanted to be clear that it's not just an individual story. In other words, I'm not saying that individual people are racist, or that certain people are uninformed. I found a great diversity of opinions among the people I spoke with, about race, about education, about class, economics.
The main thing I try to do in the book is look at all these different viewpoints. It helped me learn how the health risk to white Americans and everyone else doesn't come from individual bias. It's a structural story. The health risks come from living in a county or state where Tea Party style politics dictated the policy instituted by the government.
So that's why I looked at so many different data sets ... it's not just an individual story.
That being said, when I did talk to individual people I found something quite remarkable across the political spectrum. I spoke to very liberal people, very conservative people, I spoke with many people of different racial and ethnic backgrounds, and I think if you just went by Twitter, there's a sense that we're all fighting with each other all the time. In three sentences or less it's very easy to simplify and hate each other.
But when I spoke to people on the ground, there really was a much deeper longing than I expected, to find a middle ground. Even in the most extreme places.
I would go to very pro-gun areas and very pro-gun meetings, and people even there said, "Why can't we have background checks?" I would say that people were much more willing to compromise in person, than if you just looked on Twitter.
Tana Ganeva: Yes, Twitter is hell. So, it's great that you emphasize the history of these narratives in your work, because sometimes it feels like "Nothing ever happened before Donald Trump!" But you started this work in 2013, and you observe that it's been a common strain in right-wing politics going back decades -- the idea of a return to some kind of white American "greatness" at the expense of other people. Can you talk about the historical basis for these stories that Donald Trump picked up and ran with?
Dr. Jonathan Metzl: Sure. History is important, because if you're just looking at Twitter or the news right now, it seems like we're living crisis to crisis. So it's really hard to sit back and look at this in terms of a historical current. But in terms of all these issues, there are very important histories we need to know to understand why we're talking about them the way we are right now.
Of course, there are the long histories of overt and implicit white backlash movements going back to everything from the Tea Party and the Freedom Caucus, all the way back to John Birch Society, the KKK... the idea that there are organizations that thrive on racial animosity is not a surprise to anybody.
What I look at in particular is the role of hot button issues in those agendas. So, guns are a perfect example. There were many organizations in the South... from the KKK on down ... where their main purpose was to make sure that black Americans weren't able to get guns or have 2nd Amendment protections. When black Americans arm themselves, suddenly everyone is singing the praises of gun control. A lot of these movements are fanned by fears of minorities taking away your resources. It's also the basis for the idea that people should resist Medicare and health care expansion.
And I do think it's important not to be ahistorical because I think in answering the question "Why is it so hard to change people's minds?" There are like 200 years of history leading up to people's opinions right now. It's not like, you're pro-gun one day and anti-gun another day.
Tana Ganeva: How was Trump able to seize these narratives?
Prof. Jonathan Metzl: Trump has masterfully spoken to tensions that were already present in these low-income white populations. The politics of white loss, nostalgia and resentment. Other figures had done that before -- the Tea Party, Freedom Caucus -- but it was at a local, state or regional level. Trump nationalized a lot of those conversations. He was saying it to the entire country. That's why he was so jarring to a lot of people. Trump was singing this song on a national level.
The other is, he's just an incredibly good salesman tapping into a lot of these things, making people feel like someone cares about their interests at the national level, whether or not you agree with the policies. That's powerful. Trump didn't treat the South like flyover country. I think that's why people were willing to stand by him, no matter how many times he said some crazy thing.
Tana Ganeva: Describe "Dying of Whiteness" and why you chose to frame your book this way?
Prof. Jonathan Metzl: First of all, the theme of the book is that white working class Americans in the South and Midwest are suffering as a result of policies that are put into place by politicians who they support. And so the main thrust of the book is to track the health effects of certain core GOP policies like blocking health care reform, very pro-gun policies, anti- infrastructure policies and just looking at the health of communities.
The main reason I argue that people are dying of whiteness is that the GOP has built a base on this politics of racial resentment. In order to do, it's made the lives of supporters expendable. The GOP doesn't work unless their base makes a trade off that has very bad health effects on them.
