There is a question that has puzzled some sociologists for years: If America’s poverty is concentrated in the South, as data clearly show, why is it that those states are the most reliably Republican voters – essentially voting against the government assistance they would seem to need?

This week, there emerged a new and seemingly unrelated question, though similarly perplexing: Why has the mortality rate for middle age white Americans gone up dramatically since 1999 – even as it has gone down for other groups of Americans and whites in other countries?

On some level, it would seem that the answer to both of these questions might lie in the popularity of Donald Trump.

For months, the real estate tycoon has sat atop Republican presidential polls to the befuddlement of the political universe. But there is a growing body of evidence that many Americans – particularly white, working-class Americans in red states – are battling against what Princeton University sociologist Paul Starr calls “a dire collapse of hope.”

When Mr. Trump says he wants to “make America great again,” his message is resonating far beyond a political slogan into an existential angst for these Americans.

In short, a number of indicators suggest that they are simply struggling to survive and have lost faith in the American government’s ability to do anything about it.

“I think a lot of people relying on the government are fed up with relying on the government,” says John Jones, a 50-something poultry dealer without a college degree. For these people, he says, Trump is a breath of fresh air, even hope. “He doesn’t pull any punches. He tells it like it is.”

Axis of need

The issues facing these economic survivors are evident in a host of statistics.

The study released this week by the Proceedings of the National Academy of Sciences found that the surprising rise in middle-age, white mortality in America from 1999 to 2013 was driven by a rise in suicide, drug abuse, and alcoholism. The trends were strongest among those with the least education and in the predominantly red South and West, with the authors suggesting a vicious cycle of physical pain and addiction to painkillers, compounded by fiscal uncertainty.

“[M]any of the baby-boom generation are the first to find, in midlife, that they will not be better off than were their parents,” the authors write.

Meanwhile, data show that the primary red axis of the country, running from Appalachia to the Southern coastal plains, is the epicenter of some of the nation’s greatest stresses. It’s here that the lack of well-paying jobs and large-scale abandonment of the job market are most pronounced, where obesity and health problems are most dire, where Walmart is winning a race to the bottom of what the American consumer can afford amid stagnating wages, and where the rising dependence on disability and Medicare is most pronounced.

“We know that problems of poverty and health are more endemic … in the red parts of the country,” says Jacob Hacker, a political scientist at Yale University. “That suggests that there’s probably lots of Republicans who live in areas where more effective government action could help them.”

Yet the South is where Obamacare sign-ups lag far behind other parts of the country. Nationwide, only 38 percent of white voters without college degrees voted for President Obama in 2012.

The answer to these apparent contradictions points to the equally strong rejection of the Republican establishment so far this election cycle: Trump has owned the red state working class, with non-college-educated whites favoring him at twice the rate of college-educated Republicans.

Two of those supporters are Paul Jones and Polly Huff, siblings who are watching the light traffic in the small Georgia town of Rutledge through the dusty windows of their classic small-town hardware store. Mr. Jones (who is unrelated to the poultry dealer) says he’s on Obamacare, and resents it. “I hate taking something that other people are paying for,” he says. “People think this stuff is free. It’s not. Somebody always pays.”

Ms. Huff says the distress is palpable in their business, which hasn't recovered since the recession. The problem is that fewer people have extra money to spend, some because they're underemployed, others because “they’re scared of losing the jobs they do have,” she says.

A poll this week showed that 74 percent of Georgia Republicans would vote for Trump if he's the GOP nominee. “I’ll vote for him over anyone from the other party,” says Paul Jones.

Distrust Democrats, distrust Republicans

These Americans don’t trust the Democrats’ big government agenda or the Republicans’ ties to corporate America. And amid economic hardship, they’ve been unsettled by seismic changes to the country’s social fabric, such as the Supreme Court’s legalization of gay marriage.

Many “harbor enormous skepticism toward government,” Professor Hacker adds. “Their despair is driven by the fact that they don’t think the private economy can provide them the opportunities they need. They’re seeing communal institutions eroding. Yet they don’t have any faith that government can offer something positive in response.”

The politics of the presidential campaign so far “suggests a real fundamental disconnect between aggregate economic conditions of the country and the experience” of this stalled generation of white, largely blue-collar workers, Hacker says.

The broad picture, of course, is fretted with nuance.

The general South has welcomed millions of residents from bluer states, lured by promises of inexpensive housing and greater spending power. In that way, red America has become a relative land of opportunity for the economy’s refugees, providing a semblance of economic equality for many poorer Americans, whether white Republicans or black Democrats.

“Red states, like Texas, Georgia and Utah, have done a better job over all of offering a higher standard of living relative to housing costs,” wrote demographer Richard Florida in January in a New York Times opinion article. “That basic economic fact not only helps explain why the nation’s electoral map got so much redder in the [2014] midterm elections, but also why America’s prosperity is in jeopardy.”

But it is also in red states where safety nets are weakest – often at the behest of voters. On Tuesday, for example, Kentucky voters elected a new governor who promised to roll back Obamacare, despite the fact that the state’s uninsured rate has fallen by half since the program began.

Many conservative Americans have seen their safety net not in individuals or in states, but in the interconnectedness of the relatively stable and affluent communities that directly surround them, argues Yuval Levin, a fellow at the Ethics and Public Policy Center and co-author of “Room to Grow,” a call for Republicans to pay more attention to the needs of the working class.

“That kind of bottom-up common life, rather than massive, distant systems of material provisions, is [for them] what makes society tick,” Mr. Levin writes in the National Review.

It's not 'them' anymore

But that worldview is under strain.

The Republican push to cut government spending and help business has meant “more risk has been shifting from employers and government to the backs of individuals and families,” says Mark Rank, a sociologist at Washington University in St. Louis and author of “Living on the Edge: The Realities of Welfare in America.” “That means we need to shift our framework from thinking of it as ‘them’ [who are needing help] to thinking it’s ‘us.’ The fact is, it’s middle America that is really experiencing some hard times.”

For Mr. Jones, the poultry dealer, the struggle of young people without a college degree in his rural town to find full-time work is a symptom both of economic and cultural tides. Work habits dull for the underemployed. Young, idle men struggle to find life partners, or even get their own place. In the absence of meaning, drugs and alcohol are a potent lure.

Jones spent eight years as part of his children’s high school band program and frequently sees recent graduates in his small town of Mansfield. “I ask them, ‘What are you up to?’ and they say, ‘I’m working down at the fast-food place.’ ‘I thought you went to college?’ ‘I did, but it’s still the only job I could find.’ ”

There are signs that, under these stresses, Republican orthodoxy is fracturing. Last year, Gallup found that 45 percent of Republicans think rich people should pay more in taxes. The poll also found that more than half of all Republicans support increasing government spending on Medicare, education, Social Security, and road infrastructure over cutting government programs.

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The same trends are apparent among Democrats, too. Vermont’s Bernie Sanders is pitching “democratic socialism” designed to improve the lot of poorer Americans, and Hillary Clinton is appealing directly to working-class outcasts from the economy. But the red state working class is not rushing to Democrats, it’s turning its ire on the Republican establishment, and Trump has been their standard-bearer.

He is “an emblem of success, and … he taps people’s anger,” University of Akron political scientist John Green told the New Yorker. But, he added, “it’s not the same anger as a few years ago, when it was, ‘Where are the jobs?’ Now it’s ‘Where’s our share of the American dream?’ ”