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September 10 - October 15, 2020
Trump didn’t bother denying any of it. During an interview on Fox News in March 2017, Tucker Carlson told the president that “counties that voted for you, middle-class and working-class counties, would do far less well” under the proposed repeal of the Affordable Care Act (ACA). “Yeah. Oh, I know that. It’s very preliminary,” Trump replied.
As promised, the new administration soon pushed a steady stream of cuts to health care delivery systems, financial regulations, environmental protections, job and child support programs, and drug treatment initiatives, all of which imperiled communities and locales where government functions were weak to begin with.3
Many Southern and midwestern states boast long histories of leaders who enact laws that disadvantage their own constituents and constituents who nonetheless repeatedly vote for these same politicians.
But just as frequently, when I met with middle- and lower-income white Americans across various locales, I found support for a set of political positions that directly harmed their own health and well-being or the health and well-being of their own families.
Dogma suggesting to Trevor that minority groups received lavish benefits from the state, even though he himself lived and died on a low-income budget with state assistance. Trevor voiced a literal willingness to die for his place in this hierarchy, rather than participate in a system that might put him on the same plane as immigrants or racial minorities.4
preexisting conditions like hepatitis C—oddly, in my opinion, because “preexisting” assumes that a person’s existence begins at the consummation of health insurance coverage.
where on-the-ground white Americans make tradeoffs that negatively affect their lives and livelihoods in support of larger prejudices or ideals. By design, vulnerable immigrant and minority populations suffered the consequences in the most dire and urgent ways. Yet the tradeoffs made by people like Trevor frequently and materially benefited persons and corporations far higher up the socioeconomic food chain—whose agendas and capital gains depended on the invisible sacrifices of lower income whites.
The white body that refuses treatment rather than supporting a system that might benefit everyone then becomes a metaphor for, and parable of, the threatened decline of the larger nation.
Second, these increasingly unified forms of conservatism advanced politically through overt or implicit appeals to what has been called white racial resentment.
White backlash politics gave certain white populations the sensation of winning, particularly by upending the gains of minorities and liberals; yet the victories came at a steep cost. When white backlash policies became laws, as in cutting away health care programs and infrastructure spending, blocking expansion of health care delivery systems, defunding opiate-addiction centers, spewing toxins into the air, or enabling guns in public spaces, the result was—and I say this with the support of statistics detailed in the chapters that follow—increasing rates of death.
Other effects were far less obvious—such as the long-term implications of blocking health care reform or defunding schools and infrastructure.
Succinctly put: a host of complex anxieties prompt increasing numbers of white Americans like Trevor to support right-wing politicians and policies, even when these policies actually harm white Americans at growing rates.
This is because white America’s investment in maintaining an imagined place atop a racial hierarchy—that is, an investment in a sense of whiteness—ironically harms the aggregate well-being of US whites as a demographic group, thereby making whiteness itself a negative health indicator.
In her thoughtful study Strangers in Their Own Land, Arlie Hochschild poses the paradoxical question: “Why, with so many problems [in poor white communities], was there so much disdain for federal money to alleviate them?”11
Moreover, health is just one of the many factors people take into account when making decisions that affect their lives—and writing this book has made me think repeatedly about choices I make in my own life that might negatively impact my own longevity.
It seems to me a lost opportunity to address Southern forms of whiteness as existing only in another “country,” rather than as exaggerations of systems of privilege that surround North and South, liberal, progressive, and conservative, interviewee and interviewer both.
Rather, as gun laws were liberalized, gun deaths spiked… among white people. This was because white Missourians dominated injuries and deaths via gun-related suicides, partner violence, and accidental shootings—and in ways that outpaced African American gun deaths from homicides.
As I show, lax gun laws ultimately cost the state roughly $273 million in lost work between 2008 and 2015 and ultimately led to the loss of over 10,506 years of productive white male life.
Looking closely at the data on health outcomes between Tennessee and neighboring Kentucky uncovers how, when averaged across the population, Tennessee’s refusal to expand Medicaid cost every single white resident of the state 14.1 days of life.
It should be taken as a matter of fact, but all too often is not, that systems in which race correlates with privilege have devastating consequences for minority and immigrant populations.
Increasingly, we now hear that people with racist attitudes fare poorly as well. Racist views make people “sick” and “unhealthy,” neuroscientists claim, because the psychological effort of discrimination can raise blood pressure or cortisol levels and heighten risk for heart attacks or strokes.
Addressing racism structurally allows me to raise what became the most troubling findings of my research: I found that, when tracked over time, racially driven policies in Missouri, Tennessee, and Kansas functioned as mortal risk factors for all people who live in these states.
Anti-blackness, in a biological sense, then produces its own anti-whiteness. An illness of the mind, weaponized onto the body of the nation.
History also teaches us that it’s best to avoid knee-jerk assumptions that more government, money, or health care are automatically good or that either end of the political spectrum corners the market on problematic racial assumptions.
Liberals and progressives have at times used disdain for conservatives, or a sense of superiority over them, as ways to mask their own ways of promoting inequity.
When politics demands that people resist available health care, amass arsenals, cut funding for schools that their own kids attend, or make other decisions that might feel emotionally correct but are biologically perilous, these politics are literally asking people to die for their whiteness.
With each visit over recent years, I could not help but notice that the tenor of the state became increasingly tense, polarized, and ever-more-heavily armed.8
situations such as the ones described by John illustrated a double standard through which society coded white gun owners as “protectors” and black gun owners as “threats.”
“Even though I want us to be protected, I can’t escape the fact that these are the same guns that are oppressing communities of color in our state.”
Were we in the woods on a fall day, these people would likely have been invisible. But because we were in a small regional one-room airport, they simply blended in with one another.
I asked him what guns meant to him, and he immediately responded, “Freedom. Liberty. Patriotism. That’s why we just voted Trump. No way we were going to let ‘Crooked Hillary’ take those things away from us.”
Grief is, by its very nature, immensely personal and isolating. Anne Lamott describes living with grief as akin to “having a broken leg that never heals perfectly—that still hurts when the weather gets cold, but you learn to dance with the limp.” For C. S. Lewis, grief felt “so like fear.” But grief can also produce community. Toni Morrison once said that in times of grief, instead of words or wishes, “I think you should just hug people and mop their floor.”
Protection even within a circle of people in pain, a circle defined by a radius in which fateful bullets forever changed, altered, and ended futures and lives. Guns, like life, are a way of life. Guns are connective tissue, or forms of interstitium. And as such, guns themselves, within the trajectory of the narratives in the room, remain, like whiteness, assumed, unexamined, invisible. They are a part of us that helps us identify each other when we are all dressed in camouflage, seeking to blend in.
We don’t blame the gun. It’s never the gun—it’s the person. Besides, if they say it’s the gun’s fault—well, they might come take away our guns, too.”
Identifying risk is of little solace in retrospect.
In pretty much all other forms of suicide except suicide by firearm, researching risk appears rather straightforward.
Christian dogma in seventeenth-century Europe promoted the notion that suicide was a sin. People actually dragged the bodies of suicide victims facedown through the streets before throwing them onto garbage heaps.
Yet there is a crack in this enlightenment narrative. What if suicide researchers are barred by their own government from obtaining federal funding to research or compile data about the leading method of lethal suicide in the United States? The method of suicide that kills more Americans than all other intentional means combined, including hanging, poisoning, overdosing, jumping, suffocating, or cutting? The method that kills more Americans than all of the murderers, robbers, terrorists, and attackers put together as well?8
Supporters of the ban—generally Republicans—assert that the restrictions are needed to block a “public health bias” or “tainted public health model” that inexorably pushes for gun control. Similar arguments often take aim at homicide and domestic violence studies as well—and arose in the aftermath of CDC-funded research suggesting that having guns in the home sharply increases the risk of fatal violence.10
Indeed, part of why we need oversight bodies like the CDC in the first place is to continually assess research objectivity and promote gold-standard research methods.13
After an extensive analysis of nearly a thousand cases, the authors found evidence supporting the notion that “the ready availability of guns increases the risk of suicide in the home” and advised that “people who own firearms should carefully weigh their reasons for keeping a gun in the home against the possibility that it may someday be used in a suicide.”14
In the fifteen years after the ban went into effect, federal funding for firearm injury prevention fell 96 percent, and peer-reviewed academic publishing on firearm violence fell by over 60 percent. Scholars who depended on federal funding and publication to advance professionally were often advised to stay away from researching gun violence prevention because of the potentially harmful effects on their careers.
They cannot determine the most effective points of intervention to prevent deaths among lawful gun owners or within particular social networks. They cannot compare various safe-storage methods in rural communities to find out whether gun lockers, trigger locks, or smart-gun technologies work best in households with guns and children. They cannot even receive a grant to study the potential psychological benefits of owning a gun.
From the perspective of death data, there is relatively little debate that more gun suicides occur in homes, cars, garages, schools, and yards where there are more guns than in homes, cars, garages, schools, and yards where there are fewer guns. The controversial 1992 NEJM study foretold an emerging consensus. Quietly, beneath the radar of public outcry, researchers used death data to uncover associations between guns in people’s homes and increased risk of gun suicide.
And a 2018 JAMA study performed an extensive cross-sectional analysis of death data from 3,108 counties in the 48 contiguous states of the United States and found that states with strong gun laws had lower firearm suicide rates.
But gun suicide often has its own temperament, its own pace, its own urgent, mercurial linearity. Turning a firearm on oneself (or a loved one in some cases of armed domestic murder-suicide) can fall into a category that experts call “impulsive”—a spontaneous response to immediate stressors, such as a romantic breakup, job loss, fight, or rejection.
Texas found that 24 percent of young people spent less than five minutes between the decision to commit suicide and the actual attempt, that 70 percent took less than an hour, and that “male sex” and a history of having been in a physical fight—but not depression—were found to be risk factors for these impulsive suicide victims.18
As suicidologists describe it, guns top the list because of their “inherent deadliness,” “ease of use,” and “accessibility”—in other words, because of many of the same qualities that draw people to guns in the first place.
gun suicide often represents “an irreversible solution to what is often a passing crisis.” How do you make a refrigerator magnet for that?
The best research respects the culture and the traditions it studies and should feel grateful to be let in. Yet, in the Cape at least, it seemed clear to me that better research and a more robust knowledge base could have lessened the blame and guilt that survivors felt for missing so-called warning signs, especially if the signs they were told to monitor were not wholly relevant in their particular cases. Research could have developed better models for recognizing risk. To put it very simply, better research could have helped the group to have better refrigerator magnets.
