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Donald Trump rose to office on promises to make white America “great again.” But the actual policies involved in bringing about such greatness end up making working-class white lives harder, sicker, and shorter.
I’ve come to this conclusion after studying the rise of white “backlash” politics in Southern and Midwestern US states for my book, Dying of Whiteness: How the Politics of Racial Resentment is Killing America's Heartland. These are the anti-government, anti-immigrant, pro-gun politics that promise to defend or restore the interests of white Americans. 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—and then became central refrains of President Trump’s rise to power. They now affect the government’s approaches to issues ranging from debates about immigration to efforts to repeal the Affordable Care Act (ACA). Under the Trump administration, backlash politics also shape issues such as gun policies and tax cuts.
As a white Midwesterner myself, my research has helped me better understand the complex ways that Trump speaks to white working-class biases and fears. He gives his supporters the sensation of winning in the face of an increasingly diverse world that seems to be spinning away from their interests.
However, from the perspective of health and longevity, Trump’s politics end up making the lives of working-class Americans—including the lives of white working-class Americans—far worse. In many instances, my research shows that the policies at the core of the Trump agenda function similarly to man-made risk factors like second-hand smoke, pollution, or asbestos—shortening lifespans for the most vulnerable persons in his base.
For instance, the Trump administration has undermined the Affordable Care Act and its related Medicaid expansion at every turn, while presenting no viable alternative for healthcare in poor states and communities. It should come as no surprise that the well-being of people in red state communities with weak healthcare systems suffer as a result.
When my colleagues at Vanderbilt and I researched the rejection of the ACA in Tennessee—a state in which working-class white voters resoundingly supported Trump—we found that GOP efforts to undermine the ACA harmed health across the board for lower-income white Americans. Working-class white Tennesseans saw doctors less often and paid more for office visits and prescriptions than they would have had the state expanded Medicaid. Without adequate coverage, people got sicker before seeking medical attention, and then came in with far more serious symptoms. Aggregated across the population, we discovered that lifespans began to fall by weeks and months for working-class white Tennesseans.
Another example of how Trump's policies are affecting people's health: The Trump administration supports extreme pro-gun positions—such as easing gun carry laws—without proposing any serious strategies for reducing gun-related injury and death.
I studied what happened when Missouri followed this approach—and the results were downright mortifying. While certain people enjoyed new freedoms to carry guns pretty much anywhere they wanted, the overall effect was soaring rates of gun-related trauma in the state. From a statistical perspective, the largest numbers of victims in Missouri were not gang members who shot one another, as National Rifle Association rhetoric often suggests. Rather, the primary victims of gun death were, by far, working-class white Americans. This was because working-class white Missourians dominated injuries and deaths via gun-related suicides, partner violence, and accidental shootings. And white men living in rural areas were far and away the most likely people to die from gun suicide.
The list goes on. In Kansas, GOP tax cuts that became the model for Trump’s 2016 tax bill eviscerated budgets at public schools without presenting any strategies for boosting education for the children of working-class families. Class sizes rose, while many poor districts eliminated student support services such as after-school programing, teacher salaries, and certain districts even had to end the school year earlier. Metrics such as high school dropout and falling graduation rates rose dramatically for working-class white children.
Tariffs that hurt American farmers. Climate change policies that ignore catastrophic effects on their crops. The defunding of treatment centers for veterans and people with addiction. Pretty much every Trump initiative or policy position to this point has benefitted wealthy people or corporations at the expense of working-class bodies or communities—including, and at times primarily, the bodies and communities of his white supporters.
Politics are often confounding. People identify with particular politicians for reasons that don’t make sense to outsiders who don’t share their views. Sometimes one priority overshadows another. Yet several themes emerged from my research that helped me understand why white working-class voters continue to support Trump even after the negative effects of his policies on their lives become clear.
One was an ability of GOP voters, especially those who mistrusted the government, to hold seemingly conflicting thoughts about government services. “I’d be dead without my Medicaid,” one man told the Tennessee focus groups I led, and next said, without a hint of irony, “the ACA is socialism in its most evil form.”
In these groups, complaints about ineffective government were often voiced through stereotypes and anxieties about race. I’ll 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 frequently encountered concerns about ways that minorities or immigrants has usurped undeserved resources, such as when another man in Tennessee claimed that, “the Mexicans, their food stamps, everything they want, we’re paying for it.”
Of course, by design, cutting government services like healthcare, food stamps, and public education, had devastating effects for minority and immigrant communities (although undocumented immigrants do not qualify for Medicaid in the first place). But such framing seemed to blind the men to ways that cutting services that minorities could benefit from was sinking their own ships as well.
Thinking back on these moments, it still seems remarkable to me that, even in their darkest hours, the “win-at-all-costs” constructions of whiteness to which these men subscribed pushed them to look with disdain at minority and immigrant populations who posed no real threat to their well-beings. All the while, the men made no mention whatsoever of the politicians and policies that were literally taking dollars from their pockets and days from their lives.
When I convened focus groups to talk to working-class white Americans about topics such as healthcare or guns, I also encountered many people who simply believed in smaller and more effective government, and tried to live their lives as best they could under trying circumstances. When they voiced critiques of opinions that differ from GOP dogma—“I can see how a single-payer health system might benefit everyone,” or “I’m pro-gun, by I think we should have universal background checks”—their concerns were quickly dismissed by other members of the group.
These instances seemed to highlight how Trump and the GOP cast core issues like healthcare, guns, and tax cuts not just as policies, but as white racial 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.” It was compromise coded as treason, even if middle-ground approaches to healthcare, guns, schools, and a host of other issues may have saved white lives.
Over the course of my research, I came to realize the extent to which these forms of white self-sacrifice drove the “success” of Trump’s style of GOP politics. Had working-class, Southern white communities embraced the Affordable Care Act and come to depend on its many benefits, it would have been much harder for politicians like Trump to block healthcare reform. And had Southern whites demanded improvements to the roads and bridges on which they drove or the schools their children attended, there would have been no way to pay for GOP tax cuts that benefitted wealthy people and corporations.
Here and elsewhere, Trump’s agenda depends on policies that render working-class lives—including white working-class lives—as expendable.
Greatness, it turns out, comes at a cost.
Jonathan M. Metzl directs the Center for Medicine, Health, and Society at Vanderbilt University and is the author of Dying of Whiteness: How the Politics of Racial Resentment is Killing America’s Heartland.