The health consequences of backlash politics

March 5, 2019 by Liz Entman, Vanderbilt University

Public policies rooted in racial resentment can carry grave consequences for health and well-being, according to new research by Vanderbilt psychiatrist and sociologist Jonathan Metzl. His findings, based on seven years of fieldwork in Tennessee, Missouri and Kansas, can be found in his new book, Dying of Whiteness: How the Politics of Racial Resentment is Killing America's Heartland.

Metzl is the Frederick B. Rentschler II Professor of Sociology and Medicine, Health and Society, and director of Vanderbilt's Center for Medicine, Health and Society, which studies the social, political and community forces that impact health.

Metzl undertook the research for this book to understand how white Americans reconciled support for anti-tax, pro- in regions struggling with the impact of poor health care and education and high rates of gun death. He took a personal approach, focusing in three specific areas: Medicaid expansion in Tennessee, school funding in Kansas and gun laws in Missouri—three states where he's lived much of his life.

"What was interesting was that, even as the became more and more apparent, I found that it actually made people more adamant about supporting these positions, not less," Metzl said. "I realized you really can't understand this point of view until you understand the history of race in America."

What it means to be white

In his book, Metzl explains that today's skepticism toward gun control and government programs has a long history in the segregated South and Midwest, where gun ownership, and quality education were considered privileges that only whites deserved. Likewise, those attitudes reflected a view of whiteness that emphasized extreme self-reliance—the idea that individuals can and should be solely responsible for the health, safety and well-being of themselves and their loved ones.

According to Metzl, this view is linked to backlash following the U.S. Civil War and Federal interventions to end segregation. More recently, he said, these attitudes resurged following the election of President Barack Obama, paving the way for Metzl's research.

The "mortal trade-offs" of racial resentment

Credit: Vanderbilt University

Through and extensive in-depth interviews with working- and middle-class whites, Metzl found that anxieties about changing racial dynamics were significant predictors of support for pro-gun, anti-tax policies and rejection of government-sponsored health care programs. Support wasn't necessarily motivated by explicit racism, he said, though he did encounter that, too—all it took was an investment in this particular brand of "whiteness." Furthermore, through statistical analyses of population and life expectancy, he found these attitudes carried significant health consequences not only for minorities and immigrants, but whites as well. "In other words," Metzl said, "whiteness itself has become a negative health indicator."

He found that, in Missouri, when gun laws were relaxed, white men became 2.38 times more likely than men of other races to die by firearm suicide. In Tennessee, he calculated that opposition to the Affordable Care Act led to health care gaps that cost every white resident of the state 14.1 days of life. And slashing school funding in Kansas greatly increased the number of white teens dropping out of high school, which correlates with nine years of lost life expectancy.

Yet there remained a significant portion of the population who acknowledged the personal harms of these positions, but felt it was more important to prevent groups they felt were undeserving from taking unfair advantage of them. "So this sense of white identity and white identity politics was in some instances a more powerful driver than longevity or well-being for dictating how people behaved," said Metzl.

Seeking solutions for a healthier future

Why would voters support policies that make their lives sicker, harder and shorter? Metzl emphasized that his research does not suggest that these individuals are simply naive people who have been duped. In fact, many of the people he interviewed expressed far more nuanced views than were reflected in the region's political discourse. Rather, he found it's a symptom of how powerful and pervasive this hierarchical conception of whiteness is, and it shows how damaging backlash policies can be for everyone.

Metzl believes that neither major political party is going to have all the answers. "What I'd argue for instead is a progressive conservatism that emphasizes cooperation and common cause, and that actively promotes the well-being of all lower- and middle-income Americans," he said.

He hopes that his research will provide some ideas for a healthier way forward. "If you look at the toll that racial tension and is taking on this country—the toll on all of us," he said, "it's not a great mystery why addressing that would be better. Better for everybody."

Explore further: Race-based misdiagnosis still remains a health care problem

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