Exclusive: The plight of working-class white Americans, as their jobs have disappeared and self-destructive behavior has shortened their lives, helps explain Donald Trump’s success, writes Jonathan Marshall.
By Jonathan Marshall
The shocking new report that U.S. life expectancy declined last year is not only a disturbing indicator of Americans’ troubled physical health — our expected lifespan now ranks only 31st in the world — but of our troubled political health as well.
Social scientists and a few number-crunching journalists have uncovered surprising geographic correlations between white voters’ propensity to support Donald Trump and rates of drug overdoses, suicide and morbid conditions like obesity, which are major contributors to the national decline in life expectancy. Some examples:
–A study published this December by sociologist Shannon Monnat at Penn State University, focusing on the industrial Midwest, Appalachia and New England, confirmed that Trump performed significantly better than Mitt Romney in counties with higher death rates from drugs, alcohol and suicide. In parts of the Midwest suffering from the worst death rates, Trump outperformed Romney by a remarkable 16.7 percent, more than double his edge in counties with lower mortality rates.
–Using county-level data from the University of Washington, The Economist found that rates of obesity, diabetes, heavy drinking, and lack of exercise were the single best predictor of the change in eligible voters who went Republican from 2012 to 2014, holding other factors like race, education, and income constant. According to its model, “if diabetes were just 7% less prevalent in Michigan, Mr. Trump would have gained 0.3 fewer percentage points there, enough to swing the state back to the Democrats. Similarly, if an additional 8% of people in Pennsylvania engaged in regular physical activity, and heavy drinking in Wisconsin were 5% lower, Mrs. Clinton would be set to enter the White House.”
–Similar factors also helped Trump against other Republican contenders. Analyzing the Super Tuesday primaries, the Washington Post’s Jeff Guo concluded that “Donald Trump performed the best in places where middle-aged whites are dying the fastest.” Guo called it “striking that Trump’s promise to ‘Make America Great Again’ has been most enthusiastically embraced by those who have seen their own life’s prospects diminish the most — not [only] in terms of material wealth, but in terms of literal chances of survival. . . . We still don’t know what exactly is causing middle-aged white death rates to rise, but it seems that Donald Trump has adeptly channeled this white suffering into political support.”
Penn State’s Monnat cites the example of Scioto County in Ohio, a blue-collar region described eloquently by Sam Quinones in his book Dreamland.
Following the loss of its factories in the 1980s and 1990s, the country became “the pill-mill capital of America, with more prescription pain relievers per capita than any other place in the country. Today in Scioto County, incomes are lower than in the 1980s, and poverty, disability, and unemployment rates are high. Scioto County’s drug, alcohol and suicide mortality rate more than doubled from 32.9 in 1999 to 74.8 in 2014, and Trump received 33 percent more of the county’s vote than Romney.”
Monnat concludes, “Ultimately, at the core of increasingly common ‘deaths of despair’ is a desire to escape – escape pain, stress, anxiety, shame, and hopelessness. These deaths represent only a tiny fraction of those suffering from substance abuse and mental health diseases and disorders, and the effects ripple beyond the individuals who die to include families, friends, first responders, service providers, and employers. Drug and alcohol disorders and suicides are occurring within a larger context of people and places desperate for change.”
Although the causal links to national politics are complex, the rising physical distress of many white Americans is closely linked to their rising economic distress. Together, those conditions have fostered widespread anxiety and deep populist anger that Trump successfully exploited to win a majority of electoral votes. Those conditions are certain to continue long past the 2016 election.
Drugging and Dying of White America
Life expectancy is perhaps the single most telling summary measure of a society’s well-being. Worldwide, the trend in most countries has long been upward, paralleled by improvements in education, income, nutrition, public health, and medicine. One prominent exception was the Russian Federation, where experts warned of a “peacetime demographic crisis” (as life expectancy plunged during the 1990s amid the “shock therapy” prescribed to transform the Soviet centralized economy to one dominated by neoliberal or “free market” capitalism).
Now it appears that serious ills afflict the United States as well. The National Center for Health Statistics reported last week that rising death rates for heart disease and stroke, diabetes, drug overdoses, and accidents lowered the life expectancy of Americans in 2015.
Princeton economist Anne Case said, “I think we should be very concerned. This is singular. This doesn’t happen.”
Case was co-author, with Nobel laureate economist Angus Deaton, of a widely cited study last year that noted for the first time a rise in mortality among middle-aged white Americans from 1999 to 2013. It was big enough to cause half a million more deaths than if trends from previous years had continued.
“This increase for whites was largely accounted for by increasing death rates from drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis,” they observed. “This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround.” It was also unique to non-Hispanic whites; death rates fell for middle-aged black and Hispanic Americans.
The numbers are stark: Over the past decade, some 400,000 Americans committed suicide, a similar number died of drug overdoses, and a quarter million died from alcohol-related diseases. The researchers also cited a significant rise in reports among the living of chronic pain, psychological distress, alcohol use, and general difficulty with “activities of daily living.” More than a third of middle aged whites reported suffering from chronic pain, a major risk factor for suicide, alcoholism, and drug abuse.
New figures released by the Centers for Disease Control and Prevention (CDC) show that deaths from opioids — including hydrocodone, heroin, and synthetic fentanyl — reached a record 33,000 last year, a fourfold increase over 1999.
“In a grim milestone,” the Washington Post reported, “more people died from heroin-related causes than from gun homicides in 2015. As recently as 2007, gun homicides outnumbered heroin deaths by more than 5 to 1.”
Debate Over Causes
Conservative social theorists, who used to blame joblessness and family breakups among African-Americans on a “culture of poverty,” now lament that similar moral and culture failings afflict many white families and their communities.
Charles Murray, whose critique of African-American intelligence in The Bell Curve earned him a racist reputation in some circles, turned his attention to working-class whites in his 2012 book Coming Apart: The State of White America, 1960-2010. Citing rising rates of chronic joblessness, crime, divorce, and alienation from churches, Murray said discouraged whites had lost touch with the “founding virtues” of America — industriousness, honesty, marriage, and religion. He blamed lax cultural standards rather than economic insecurity or deindustrialization for their woes, many of which he considers preventable and self-inflicted.
National Review contributor J. D. Vance similarly sees “a sense of learned helplessness” behind the travails of many white inhabitants of Greater Appalachia, whom he describes in Hillbilly Elegy: A Memoir of a Family and Culture in Crisis. “There is a lack of agency here,” he writes, “. . . and a willingness to blame everyone but yourself.”
In contrast, liberal analysts — like those at the Economic Policy Institute — have for at least two decades called attention to the loss of factory jobs and falling real wages for less educated white men in this country. Today, an astonishing one of every eight men in the prime ages from 25 to 54 has left the job market entirely, more than three times the fraction in the 1960s. The causes include rising employer demand for college-level skills, foreign competition, and the demise of unions, but the result has been to marginalize traditional blue-collar workers and frustrate their attempts to achieve the American dream.
Such economic trends don’t explain everything. Case and Deaton point out that death rates have not risen in other countries with similar wage trends. One reason may be that they have tighter safety nets, which soften the blow to individuals, families and communities.
Some reverse causality may also be at work, from health to bad economic and social outcomes. For example, pain, substance abuse and severe obesity contribute to increased rates of disability and workers dropping out of the labor force. Princeton economist Alan Krueger recently reported that 40 percent of prime-aged men who aren’t employed or looking for work say pain prevents them from working at a full-time job. Most of them take potent prescription pain medications on a daily basis. They also report less happiness, more sadness and more stress than unemployed men.
Another contributor to the pain-and-disability epidemic may be America’s never-ending wars in Afghanistan and the Middle East. “A study in the Journal of the American Medical Association showed that half of all troops who return from Iraq and Afghanistan suffer from chronic pain,” writes libertarian critic Cathy Reisenwitz.
Reisenwitz and other analysts blame a crackdown by the Drug Enforcement Administration (DEA) on painkiller prescriptions for increasing suffering among patients and leading many to turn to dangerous street drugs and alcohol for temporary relief. When vets and other pain sufferers do get addicted, she adds, the DEA makes it tough for them to get methadone to manage their withdrawal symptoms.
“The DEA’s efforts to keep chronic pain sufferers from accessing prescription painkillers and methadone is literally killing them,” she writes. “The best thing the Trump administration could do to end the overdose epidemic is to stop the war on painkillers.”
Connecting the Dots
The physical and psychological distress experienced by many white Americans has generated angry resentment toward government and particularly toward America’s first black president.
As J. D. Vance put it, “We know we’re not doing well. We see it every day: in the obituaries for teenage kids that conspicuously omit the cause of death (reading between the lines: overdose), in the deadbeats we watch our daughters waste their time with. Barack Obama strikes at the heart of our deepest insecurities. He is a good father while many of us aren’t. He wears suits to his job while we wear overalls, if we’re lucky enough to have a job at all. His wife tells us that we shouldn’t be feeding our children certain foods, and we hate her for it — not because we think she’s wrong but because we know she’s right.”
Significantly, political scientists Michael Tesler and Philip Klinker found that Trump’s assault on “political correctness” won him overwhelming support from Republican voters who score highest on surveys of resentment toward minority groups. Citing the recent works of academic popularizers such as political scientist Kathy Cramer (The Politics of Resentment) and sociologist Arlie Hochschild (Strangers in Their Own Land), Jeff Guo argues that many white voters resented minorities and immigrants for supposedly moving ahead of them in economic opportunity, social status, and access to government programs. Adopting white identity politics, they lashed out at the Democratic Party for enabling what they viewed as an unfair distribution of power, money, and respect.
As Guo put it, “what Trump has taken a sadistic advantage of is not so much raw anger, but rather its more basic predicate: the shame of being lesser-than.”
Trump didn’t offer any meaningful prescriptions for the suffering of angry white people, but he did go out of his way to acknowledge their pain. He portrayed America as a train wreck, not a land of opportunity. He didn’t just hammer away at the loss of well-paying factory jobs; he promised as well to stop “drugs pouring into our country and destroying our youth.” And he made it clear by words and gestures that white America would come first in his White House.
The policies his team favors — cutting taxes for the rich, gutting the Affordable Care Act, rolling back regulations against air and water pollution, freezing the minimum wage and favoring charter schools over public education — are unlikely to remedy the psychic and physical pain of many white Americans.
Soon their celebration of Trump’s victory will fade. Their sense of loss may be compounded by a sense of betrayal as Washington once again fails to mitigate their plight. Where they choose to project their anger next will have a major impact on American politics over the next four years.