Why do many working-class white Americans support politicians whose policies are literally killing them?

This is the question sociologist and psychiatrist Jonathan Metzl tries to answer in his new book, Dying of Whiteness: How the Politics of Racial Resentment is Killing America’s Heartland. The book is a serious look at how cultural attitudes associated with “whiteness” encourage white people to adopt political views — like opposition to gun laws or the Affordable Care Act — that undercut their own health.

The book is not about racism at the individual level, though you can certainly read that into it. For Metzl, the key question is how did a politics of racial resentment become so powerful that it overwhelmed even the basic instinct for self-preservation? To get answers, he spent years talking to voters in Southern and Midwestern states, asking them to explain their political choices. The answers aren’t terribly satisfying, but they are instructive.

I spoke to Metzl about what he learned and what he thinks we can do to solve this problem. A lightly edited transcript of our conversation follows.

Sean Illing

Why are so many poor and working-class white Americans endorsing policies that are literally killing them?

Jonathan Metzl

That’s the core question I address in the book. I look at the rejection of the Affordable Care Act in the South. I look at policies that make it far easier for people to get guns and carry guns everywhere. I look at tax cuts that benefit wealthy Americans but cut roads, bridges, and schools in poor and working-class areas. Every one of those policies has been sold as a policy that will make America great again. But they have devastating consequences for working-class populations, particularly working-class white populations, in many instances.

You can’t really understand why people might support those agendas if you just start the conversation today. There are long trajectories of anti-government sentiment that course through the South that Trump has tapped into. There are also concerns about what it means to have the government intervene in ways that equally distribute resources that working-class white populations fear might undermine their own sense of privilege.

I think the GOP has also been remarkably successful at tapping into this narrative — a narrative that makes people anxious that immigrants and minorities are going to take away privileges that are theirs.

Sean Illing

When you say that certain policies or dogmas are “killing people,” what exactly do you mean? How are people dying?

Jonathan Metzl

Well, part of what I do in the book is talk to people in their daily lives and try to examine the everyday effects of particular GOP policies. And the other part of the book looks at the data trends of those policies, which is pretty remarkable.

I found that if you lived in a state that rejected the Medicaid expansion and blocked the full passage of the Affordable Care Act, you lived about a 21- to 28-day shorter life span on the aggregate. So it was costing people about three to four weeks of life in those states.

When I looked at states that made it incredibly easy for people to buy and carry guns pretty much anywhere they wanted, I found that this correlated with hundreds of deaths that wouldn’t have happened otherwise, particularly in white populations, because gun suicide rose dramatically. And I found that if you lived in a state that cut away infrastructure and schools and funding, that correlated with higher high school dropout rates.

All these variables are associated with shorter life expectancies, so this is what I mean when I say these policies are killing people.

Sean Illing

Did you find that racial resentment was the primary reason so many people supported policies that are so obviously bad for them? And if not, what the hell is going on here?

Jonathan Metzl

I want to be very clear. I found a vast diversity of opinions. And I don’t, in any way, claim to know what’s in people’s hearts or in their minds. I certainly found many people who told me they support these policies because, as one person said, “It might hurt us but at least our tax dollars aren’t going to Mexicans and welfare queens.” So that sentiment is out there, and I don’t want to discount it. But I also found many people who didn’t have any hint of racism or racial resentment whatsoever, and were simply trying to live their lives as best they could.

The key point I make in the book is that all these negative health risks don’t necessarily stem from racist individuals. The health risks rise when the politics of racial resentment shapes the health care policies, the health policies, in your state or community. So it really was the policies themselves that were racially motivated, not the individual people or their psychologies.

Sean Illing

I worry that distinction will confuse readers, in part because it’s hard to imagine a politics of resentment succeeding if the individuals buying into it aren’t themselves racist. Can you explain what you mean when you say this is a “structural story,” and not necessarily a story about individual bias?

Jonathan Metzl

I want to be even more clear and say that I don’t know if people were racists. I don’t know what was in their hearts. And it wasn’t like I was giving them a racism scale when I talked to them. So maybe they were racists, maybe they weren’t. And that’s probably true across the population.

But it wasn’t my job to find out if they were racists. What I was trying to do was first explore how racial tensions shaped policies in particular states. And I found very clear evidence of the ways that fears of immigrants, fears that minority people were usurping resources, were shaping policy agendas in these regions.

In Kansas [where voters have supported massive cuts to public services], for example, a number of very far-right people told me that they felt like minority school districts were taking all the state taxpayer money and buying party buses and having parties. And those tensions shaped policies that defunded schools or blocked immigration or cut health care services. So were the individual people racist? I don’t know. But the policy itself was shaped by racial tensions, and that, ultimately, dictated health outcomes across the board.

Sean Illing

In other words, people have bought into a zero-sum politics in which their group only wins if the other group loses, and the groups are defined along racial lines.

Jonathan Metzl

Right, and working-class white populations are caught in this peculiar place. They could look at the wealthy persons or corporations or donors who were actually causing policies that were worsening their lives, or they could look at the people they believed were taking away their resources. And they chose, electorally, to look at the latter — and that’s hurting nearly everybody.

Sean Illing

I’m curious how you think about the role of propaganda and misinformation in all of this. Obviously, racism is real and a motivating force, but is it possible to know how much of this is being artificially whipped up in people by forces interested in preserving the status quo?

Jonathan Metzl

It’s a fantastic point. I found so many instances where people, if you talk to them in their daily lives — and this is true for all of us — are much more accommodating, they’re much more willing to compromise if they can understand somebody else’s point of view. When they engage, when they make eye contact with somebody, they have empathy. And I found that again and again in my research.

But I also found that there are powerful forces in this country that benefit from polarizing us and keeping us apart. People actually benefit from that polarization. And as long as we’re having these polarizing, nuance-free conversations driven by the [National Rifle Association] or Fox News, we’re unlikely to find a common ground.

Sean Illing

It seems bizarre to me that someone would care more about, say, [same-sex] marriage or gun rights than they would health care for their own children. Or that a desire to preserve a lost racial hierarchy would overwhelm simple economic self-interest. But perhaps this isn’t bizarre at all. Maybe it’s always been this way.

Jonathan Metzl

Philosophers have been wrestling with this in the United States for centuries. I mean, this was the core question that W.E.B. Du Bois asked after Reconstruction: Why is it that low-income whites, working-class whites, don’t align their interests with newly freed slaves? If they did, it would be an insurmountable union that would really force some benefits from upper-class people to make the lives of working-class people better.

And Du Bois really asked, why is it that whites and blacks at the same economic level don’t align? And what he found was that there was this idea of a reward of whiteness that was given to white people. It was a psychological benefit that allowed them to feel a sense of psychological prestige and overlook their own material conditions.

Sean Illing

How do we move forward? How do we communicate what’s in the best interests of Americans in a way that doesn’t alienate or divide and at the same time doesn’t accept or placate racism?

Jonathan Metzl

I get asked this a lot, and there are no easy answers. Ultimately, working-class white communities are going to have to demand more or better from their politicians. They’re going to have to stop falling for the racist scapegoating and instead demand better health care and roads and schools.

It’s pretty remarkable that so much of the GOP agenda depends on working- and lower-class white Americans considering themselves, in many ways, expendable. In other words, can you imagine what would happen to the GOP agenda if working-class white communities in the South said, “Yeah, we support the GOP, but we also want Medicaid expansion and we want better schools and bridges and we want the government to stop giving tax breaks to rich people”?

The minute that happens, the GOP agenda collapses. I don’t know if this message is going to come from progressive liberals or not, but it has to be embraced by conservatives as well — it’s the only way forward.