“Dying of Whiteness: How Racial Resentment is killing America’s Heartland

Dying of Whiteness: How the Politics of Racial Resentment Is Killing America’s Heartland, by Jonathan M. Metzl

Trevor was dying. Liver disease and hepatitis C were the causes. Tennessee had not accepted the expansion of Medicaid provided for in the Affordable Care Act, and thus Trevor, a 41-year-old white Tennessean, had gone without health coverage. He strongly supported the decision of his state’s Republican officials on this matter. Had he lived a few miles away, in Kentucky—whose then-governor, a Democrat, had expanded Medicaid with an executive order—he would have been eligible for coverage and thus care that might well have saved his life.

But Trevor wouldn’t have accepted it. He “would rather die” than “support Obamacare or sign up for it.” Why? “We don’t need any more government in our lives,” Trevor answered, before fleshing out his response and fully revealing his thinking: “And in any case, no way I want my tax dollars paying for Mexicans or welfare queens.” And there you have the argument of this book in a nutshell. As the author, a physician with a Ph.D. in American Studies who currently serves as the Frederick B. Rentschler II Professor of Sociology and Psychiatry at Vanderbilt University, puts it, “Trevor voiced a literal willingness to die for his place in [the racial] hierarchy, rather than participate in a system that might put him on the same plane as immigrants or racial minorities.”

More broadly, Metzl explains, his research reveals “a reality that liberal Americans were often slow to realize: Trump supporters were willing to put their own lives on the line in support of their political beliefs … make tradeoffs that negatively affect their lives and livelihoods in support of larger prejudices or ideals.” The author “track[s] the full extent to which these political acts of self-sabotage came at mortal cost to the health and longevity of lower- and, in many instances, middle-income white GOP supporters—and, ultimately, to the well-being of everyone else.”

Metzl digs deep into the material effects of various Republican policies in three GOP-run states: Kansas, Missouri, and Tennessee. These policies “gave certain white populations the sensation of winning, particularly by upending the gains of minorities and liberals.” It was about “owning” those groups, apparently. The author adds that “the victories came at a steep cost.” He cites the result of cuts to health care programs as well as the prevention of the expansion of systems that would deliver care, gutting the spending on infrastructure and education, allowing greater damage to the environment and the enactment of pro-gun-rights policies. The result, backed by the data Metzl carefully lays out, was quite clear: More people died, and more people’s overall health suffered significantly, among both lower- and middle-class whites as well as the people of color toward whom many of them aimed their resentments.

In other words, those economically vulnerable whites who support policies that end up directly harming them are “literally dying of whiteness.” They are voting not just against their economic self-interest, but also “against their own biological self-interests.” As Metzl also notes, “anti-blackness, in a biological sense, then produces its own anti-whiteness. An illness of the mind, weaponized onto the body of the nation.”

The author, although focused largely on the data, makes an important point about the ideas driving the policies and why so many whites support them. He writes, “It’s too easy to blame the rise of white nationalism on politicians like Trump, Jeff Sessions, or Steve Bannon and far harder to address how the ideologies these politicians support benefit white populations more broadly. In this sense, the larger conversations about the effects of whiteness is one we, white Americans, badly need to have.” Although the book’s focus is on the harm these GOP policies visit on white Americans living near or below the economic median, Metzl also acknowledges the devastating impact racism has on people of color, as well as the real privileges that whites derive from living in a society that advantages them in structural ways, no matter which state they live in.

As for the data, it was eye-opening. Weakened gun laws in Missouri led to gun deaths that “spiked among white people” even more than among black Missourians. The most disproportionately harmed by the increases were rural white men. Overall, in the years from 2008 to 2015, loose gun laws resulted in the loss of “over 10,506 years of productive white male life.” Tennessee’s decision not to expand Medicaid “cost every single white resident of the state 14.1 days of life.”


As an analysis published just last week (after the publication of this book) found, Missouri is also the state with the highest rate of black residents ending up a victim of homicide, and has been virtually every year of the past decade or so.

In the book, Metzl notes that Kansas carried out an economic “experiment” under right-wing Governor Sam Brownback in which huge income tax cuts aimed at higher-income households paired with deep budget cuts. The experiment turned a budget surplus into deep deficits, despite Republicans’ predictions that the results would be economic growth and fiscal health. As for Kansans, 688 more white students became high school dropouts thanks to the cuts to education. Given the statistical relationship between dropping out and reduced life expectancy, this translates into almost 6,200 lost years of life for the white dropouts.

Metzl presents quite a bit of data, but the book is about more than numbers. It’s also about the history, including the racial history, behind the policy changes enacted in these states. Finally, it’s about the people he interviewed, people such as Trevor, or such as the white people in a Missouri suicide support group—people who grieved for loved ones who had taken their own lives with a gun and yet refused to even consider restricting access to firearms. Doing so would represent, in their minds, blaming the gun rather than the person responsible.

On health care, the author finds that, for most of the white Tennesseans he interviewed, “no …explanation of the ACA’s benefits came close to challenging concerns” relating to its connection to a black president or the fact that it “placed white Americans into ‘networks’ with immigrant and minority populations.” One Kansan, who had just called Gov. Brownback an “absolute disaster on all levels,” then said he would “support Trump no matter what he does,” even though he acknowledged the similarity in their policies. Why? “It’s not all that much about his policies.” It’s because he and others like him “just feel like, as white men in American, their voice wasn’t being heard. Trump gave them their voice back.” Metzl lets us see the thinking of the white people harmed by the Republican policies that most of them supported.

All three of these states had been, relatively speaking, purple ones in which bipartisan coalitions had enacted relatively moderate or even progressive policies on exactly the issues mentioned above. However, the rise of the tea party movement beginning in 2010 saw each of them shift hard to the right, and it is the effects on economically vulnerable whites of the policy shifts that followed those elections that Metzl examines.

Going forward, Metzl believes that people can change how they think and, more importantly, how they vote. Policies enacted after one side achieves political victory can be undone if the politicians who enacted them are defeated. “Decisions are communally made and can thus be communally unmade and remade in better ways,” the author writes. “The way forward requires a white America that strives to collaborate rather than dominate, with a mind-set of openness and interconnectedness that we have all-too-frequently neglected.” Finally, he urges that we confront “ideologies of whiteness head-on” as a necessary part of encouraging that kind of change.

As for the book’s purpose and potential impact, Metzl is very clear in saying he rejects the idea that white conservatives don’t know what they are doing when they oppose, say, health care reform that could save their own lives. He hopes to change minds, but doesn’t think his book will simply flip a switch for massive numbers of people, as he explained in a recent interview with The Guardian:

I’m not imagining that MSNBC talking more about “how guns are proof that you’re racist” is going to change this debate. The point I’m making is more a diagnostic one than a prescriptive one. I’m saying that until we understand the racial tensions that underlie the gun debate, we’re going to keep asking ourselves why this issue is so intractable.

Metzl is not a down-the-line progressive, although he certainly is a strong critic of the politics of racial resentment that is the focus of his book. In the Guardian interview he stated directly, “My argument is a lot more centrist than I think people realize.” His goal is to inform, and that he has done.

In Dying of Whiteness, Metzl has done an invaluable service. His book is carefully researched and presents conclusions that are backed up by data. It is also very human. It brings you in as a reader by alternating between brief snippets of his conversations with real people and more scholarly discussions of policy, history, and statistics. Readers will come away with a full understanding of why white conservatives have “chosen a regime whose policies come cloaked in the promise of restored privilege, enacted through mechanisms of polarization and divisiveness.” In other words, we learn why they have been willing to support policies that actually hasten their own deaths.

Above all, Metzl has made it impossible for anyone who reads his book to deny that the public policies supported by white conservatives—which are thoroughly suffused with racial resentment and a desire to maintain white supremacy—cause direct harm to all but the most well-off whites. Whether that information helps change large numbers of minds about either the wisdom of their beliefs about white supremacy or their voting habits remains an open question.

One thing to take heart from is that Kansas—which had the most radical shift rightward in policy of any of the three states, and perhaps any state in the country, after 2010—actually elected Laura Kelly, a Democrat, governor in 2018 (just after the author completed writing the book). They did so specifically as a rejection of Brownback’s policies, and the promise by her Republican opponent, the truly awful Kris Kobach, to extend them even further. Apparently, there’s a point at which white voters will reject self-harm or, if one wants to be more idealistic, embrace policies that help their fellow citizens of all colors. Let us hope that is a harbinger of things to come.

Ian Reifowitz is the author of The Tribalization of Politics: How Rush Limbaugh’s Race-Baiting Rhetoric on the Obama Presidency Paved the Way for Trump (Foreword by Markos Moulitsas)