Dying of Whiteness: How the Politics of Racial Resentment Is Killing America's Heartland

by Jonathan M. Metzl

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.

Yet I could not help but think that Trevor’s deteriorating condition resulted also from the toxic effects of dogma. Dogma that told him that governmental assistance in any form was evil and not to be trusted, even when the assistance came in the form of federal contracts with private health insurance or pharmaceutical companies, or from expanded communal safety nets.

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.

Such trends lifted the overall well-being of many Kentuckians and particularly helped people who suffered from what are oddly called 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.

The stories these people told me became jumping-off points for a more sustained investigation of how particular American notions of whiteness—notions shaped by politics and policies as well as by institutions, history, media, economics, and personal identities—threaten white well-being.

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.

A number of people with whom I spoke, when I explained the thesis of my book, told me that positions that appeared to reflect racism instead reflected a larger, color-blind “hatred of the poor.”

Thomas Frank, in his modern classic What’s the Matter with Kansas?, writes that backlash conservatism rests on the foundation that “ignoring one’s economic self-interest may seem like a suicidal move to you and me, but viewed differently it is an act of noble self-denial; a sacrifice for a holier cause.”

Yet because of the frames cast around these and other issues hued with historically charged assumptions about privilege, it became ever-more difficult for many people with whom I spoke to imagine alternate realities or to empathize with groups other than their own. Compromise, in many ways, coded as treason.

Gun regulation is such a politically sensitive question in the United States that there has long been a congressional ban on funding for research on the health impact of firearms.

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. “Harboring prejudice may be bad for your health,” neuropsychologist Elizabeth Page-Gould writes, because racially prejudiced people experience such “biological reactions… even during benign social interactions with people of different races.”15

the pathogens were policies and ideologies,

Anti-blackness, in a biological sense, then produces its own anti-whiteness. An illness of the mind, weaponized onto the body of the nation.

More recently, writer Toni Morrison states the inherent conflict of American whiteness bluntly: to “restore whiteness to its former status as a marker of national identity, a number of white Americans are sacrificing themselves.”

these politics are literally asking people to die for their whiteness.

In 1996, Congress passed a ban on federally funded gun research. Legislators—lobbied heavily by the National Rifle Association—added a rider to the federal budget. That rider is known as the Dickey Amendment, and it stripped the Centers for Disease Control (CDC) of funding for gun violence prevention research and stipulated that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.”

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.

According to the US census, the percentage of non-Hispanic white people in the United States hit an all-time low of 62 percent in 2013 and kept falling every year after that. And yet over this same time period, 2009–2015, white populations consistently committed 92 percent of all gun suicides.

From 2009 to 2015, non-Hispanic white men accounted for nearly 80 percent of all gun suicides in the United States, despite representing less than 35 percent of the total population.

Despite national attention to the issue of firearm violence, most Americans are unaware that gun crime is lower today than it was two decades ago. According to a new Pew Research Center survey, today 56% of Americans believe gun crime is higher than 20 years ago and only 12% think it is lower.

In the 1890s, Durkheim, the sociologist, introduced the concept of anomie to describe a crisis of disconnect that emerged between personal lives and social structures. Durkheim wrote in an era of mass industrialization, a time when workers and collective guild labor found themselves left behind by evolving economies. Anomic suicide, as he called it, results when people lose a sense of usefulness and of where they fit in within their societies, leading to feelings of “derangement” and “insatiable will.”36 Anomie seems an apt description for the experiences of working-class white communities in places like Missouri during the latter twentieth and early twenty-first centuries. The value of many goods and services these communities produced diminished in the global economy.

The working definition of a “crisis” often assumes an upheaval felt by a dominant group in the face of a threat or change that leaves previous power structures upended.

Instead of the automatic authority they accrued by simply showing up, these men found themselves in a world in which they faced more competition and enjoyed less prestige.

The ways we define crisis allow us to attach the language of calamity to whiteness, men, or other seemingly dominant groups, while at the same time making it harder to see the suffering of women, immigrants, people of color, and other persons who do merit a “crisis of authority”—because they are supposedly built for it, or because they have lived with crisis all along. This logic suggests that men need to be on top because they embody no skills for acting otherwise; and everyone else, to paraphrase an important book about women-of-color feminism, are born with bridges called their backs.

a traditional public health approach overlooks how, from the perspective of white men, guns became not only lethal but sublime.

The intersecting trajectories of guns, whiteness, and privilege help explain why firearms came to convey particular meanings to specific populations and address why people who feel their privilege was bestowed by guns might be so loath to give them up.

But in the New World, white men “were armed and had to be armed,” as historian Edmund Morgan describes it. Upper-class colonial white people allowed poor white people to carry firearms to quell rebellions by chattel slaves or to repel Native Americans and pirates.

As Adam Winkler aptly describes it in his terrific book Gun Fight, “few people realize it, but the Ku Klux Klan began as a gun control organization” that aimed to confiscate any guns that free blacks may have obtained during and after the Civil War and thereby “achieve complete black disarmament.”

As Vox’s German Lopez explained it, Americans made up “about 4.43 percent of the world’s population [in 2015] yet owned roughly 42 percent of the world’s privately held firearms.”

the trends also symbolized three hundred years of history in which owning firearms and carrying them in public marked a privilege afforded primarily to white men.

gun laws validated the moral rights of white people, and often white men, to own firearms and carry them in public spaces. And they highlighted ways that the racial divide in guns, gun ownership, and societal reactions to armed civilians retained and derived meaning from historical connection to the tensions between white supremacy and black disarmament.

But starting in the 1980s, the rhetoric shifted around the same time that the rereading of the Second Amendment found its way into legislation and the new NRA emerged; gun manufacturers began promoting the notion that their products help men recover their status, power, and respect.

“So how do these white men restore the strength and prestige of their idealized past?” Steinhorn asks. “Through guns, which instill fear particularly among the urban and educated elites who hold the levers of power and status in society today.”

There was this weird sort of mentality amongst the rural white folk that we gotta take up arms because the protesters could be coming for us.

Yet the very idea of even studying risk becomes a risk itself when the conversation turns to guns, laying the groundwork for decisions that seem at odds with individual and national well-being.

Connecticut experienced a drop in its firearm suicide rate coincident with the adoption of a PTP handgun law that was greater than nearly all of the 39 other states that did not have such a law at that time, and Missouri experienced an increase in its firearm suicide rate following the repeal of its PTP handgun law that was larger than all states that retained their PTP laws.6 The analysis ultimately estimated a 15.4 percent reduction in firearm suicide rates associated with the implementation of Connecticut’s PTP law and a 16.1 percent increase in firearm suicide rates associated with Missouri’s PTP repeal.

One way to think about the accrued loss of life is via a statistic that public health researchers call PYLL(75). PYLL stands for “potential years of life lost,” and 75 represents the average life span in the United States. PYLL calculates the average number of years that a person would have lived had he or she not died prematurely by unnatural causes.

How in the world might we go about changing white masculinity? Or can we open a space to talk about why white men feel they need guns in the first place? What threats do they imagine, and what safety or reassurance do guns represent? Put another way, the data hints at the possibility that white male gun suicide may be a side effect of both loose gun policies and conceptions of white masculinity, in addition to the effects of troubled individual minds. And that in this sense, white men writ large make a Faustian bargain in order to accept the larger benefits of gun ownership more broadly.

Rather, privilege itself becomes a liability. White men themselves become the biggest threats to… themselves. Danger emerges from who they are and from what they wish to be.

There is an undeniable power in this form of us-versus-them logic in places like Missouri. Here, guns function as totems, symbols of belonging and of self- and community protection, revered sources of power.

I had seen firsthand how many voters in Trump country felt the burden of centuries of history that charged the idea of government intervention in general, and into health care specifically, with race and class politics—often accompanied by overt xenophobia and racism.

we found jarringly different attitudes among racial groups. African American men largely supported the ACA because the legislation potentially helped “everybody” and because they felt that anything would be an improvement over Tennessee’s crumbling health care delivery system. But many white men, like Trevor mentioned in the introduction to this book, voiced a willingness to die, literally, rather than embrace a law that gave minority or immigrant persons more access to care, even if it helped them as well.

Where guns invoked anxieties regarding risk, health care produced highly charged fears about cost.

Our focus groups highlighted another important similarity in the conversations surrounding pro-gun and anti-ACA politics in Southern and midwestern US states: both asked working-class white Americans to put their own bodies on the line in order to “defend” conservative ideologies.

Most of the men then fell into what policy experts dispassionately call the doughnut hole of coverage—meaning these men were just well enough to maintain menial employment, working hourly on assembly lines or at odd jobs. The income from these jobs put them just above the level of poverty—at the time, $15,856 a year per person. Most of them thus no longer met state requirements for Medicaid. Insurmountable mountains of medical bills then followed.

And yet in a room in a housing project in the real world of the American South, cost also functioned as a proxy for the tensions of race, as questions of Who is paying for whom? and Whose labor supports whom? led to deliberations about ways to hoard health for some persons, while denying it to others.

the ACA sought to widen health care networks and control costs by regulating and expanding private insurance and promoting prevention, while at the same time broadening Medicaid eligibility and coverage. Even the most ardent supporters of the ACA agreed that the law was far from perfect and represented a series of first-step and often painful compromises between private interests and the public good.

Thanks in part to an amicus brief filed by a conservative Vanderbilt University law professor named James Blumstein, the court ruled that the ACA exceeded its constitutional authority by “coercing” states into participating in Medicaid expansion. The court held that Medicaid expansion was “optional” for states and that each state could make its own choices about coverage for the less fortunate.

In other words, rarely in the history of recorded time was there a state more in need of, or more ideally fitted for, the ACA and Medicaid expansion than Tennessee. Medicaid expansion would provide coverage for the increasing numbers of people who fell through the cracks due to the failures of TennCare. Expanding the state’s health care infrastructure would also extend its capacity to serve doughnut hole populations. The ACA promised to offset the very costs that TennCare owed, inasmuch as the pooled funds of the federal government would effectively address TennCare’s debt. Evidence also suggested that the framers of the ACA attempted to learn from the lessons of the failure of TennCare specifically by promoting cooperation rather than promoting competition. Indeed, the caveats of TennCare might have positioned Tennessee politicians as sage national leaders as a result of their experiences. As public health scholar Christina Bennett puts it, the nation had the potential to learn from TennCare in order to “prevent similar problems in the national health care plan or in other state’s plans.”

Men are notoriously bad at talking about their health, identifying their own health problems, or visiting physicians.