Jonathan Metzl

A Vote Against Life Expectancy

Air Date: August 19, 2019

Vanderbilt University Center for Medicine, Health, and Society director Jonathan Metzl discusses his new book “Dying of Whiteness: How the Politics of Racial Resentment is Killing America’s Heartland."


HEFFNER: I’m Alexander Heffner, your host on The Open Mind. In his new Basic Books, title “Dying of Whiteness: How the Politics of Racial Resentment is Killing America’s Heartland” my guest reveals how the backlash policies against a multicultural liberal America have mortal consequences even for the people they promise to help. Dr. Jonathan Metzl is professor of sociology and psychiatry at Vanderbilt University where he also directs the Center for Medicine, Health and Society. He is research director of the Safe Tennessee Project, a nonpartisan volunteer-based organization that’s concerned with gun-related injuries and fatalities in America and in Tennessee. “Dying of Whiteness” says one of my favorite open mind guests Thomas Frank “is a diagnosis for America. It’s not reassuring. Failing health, failing graduation rates, guns everywhere, our fantasies are driving us to an early grave and Metzl is lucid and careful and mercifully clinical in telling us exactly how this public health disaster came to be. Read it today. There is still time before the autopsy.” Wow. Jonathan, quite the praise and stark warning from our mutual friend Thomas Frank. Welcome. Thank you for being here.

METZL: Thanks so much. It’s really great to be here.

HEFFNER: We interviewed Kathy Cramer and I don’t know if you’re familiar with her work, the politics of resentment. She’s a political scientist.

METZL: Sure.

But we actually interviewed her in the 2016 election year and she had done fieldwork that described the resentments as they were bubbling and I wanted to start there. In your research, in the concentrated period of time in which you were seeing the response of people who had been victim to those policies, what did you discover about these resentments and over what period was this?

METZL: Sure, so that’s a great opening question. I mean my book really started the research for the actual book itself started in about 2010, 2011. I was doing research in the south in Tennessee and talking to people who themselves would have benefited from the Affordable Care Act.

But were kind of on the front lines of saying that they didn’t, they didn’t want the Affordable Care Act, but were on the frontlines of saying they didn’t want Medicaid expansion. And it was just a really eye-opening experience for me because these were people who were very often medically ill and really would have benefited from what was coming down the pike everybody thought with the Affordable Care Act, you know, better access to physicians, help with medical bankruptcies, help paying people’s prescriptions. And so we just started focus groups in the south are around that time – 2010, 2011 before Trump was a blip on the horizon in terms of the presidency. And I’ll never forget that you know, the probably the most powerful stories that we heard were people who were literally on death’s doorstep, chronic medical illness, liver failure, kidney failure, things like that who would tell me and my colleagues, we’re not going to sign up for this program because even though it might help us, and these were often white working class Americans who we were talking to, they said, we don’t want to sign up for a project that, a program that might help immigrants or minorities.

In fact, I lead the book with a quote from a man who says, I’m not signing up for this Obamacare because I don’t want my tax dollars going to Mexicans or welfare queens. And it was just this powerful, powerful moment because here’s someone who himself really was literally on death’s doorstep but he was at the front lines of saying I don’t want this program in my life because it might also benefit immigrants and minorities. And that became really a jumping off point for a much bigger exploration in my book about what are the other places in which working class white Americans, but many other white Americans put their own health on the line, their own wellbeing, their own longevity in order to, as the kind of fantasy went in these groups, block the encroachment of immigrants or minorities and that tour for the next five, six years took me through Missouri where I talked to people about gun politics.

It took me through Kansas where I talk to people who were supporting tax cuts even though those tax cuts were eviscerating budgets at their own children’s schools. And it became really a broader exploration of what’s happening in white America that we don’t want to create a system that’s better for everyone and instead base our certain kind of politics on fear. And lo and behold would happen was that story that we started in 2010, 2011 led right into what happened in 2016. So I didn’t know that was what the book was going to be about, but it turned out these very regional policies and politics became national ones.

HEFFNER: So you’re based in Tennessee. You explore the issues in Kansas and Missouri, any other states?

METZL: Tennessee and Kentucky were a kind of comparison because Tennessee adopted the, Tennessee rejected the expansion and the Affordable Care Act and Kentucky accepted it.

So it was a kind of Kentucky, Tennessee comparison and then Missouri, Kansas and then looking more nationally at the end. Yeah.

HEFFNER: If you look at how people are voting and want to make the correlation between how they responded to your questions and how they behave politically, are they lower income, are they wealthy, because the Republican Party is the party of the 2017 tax reform. It’s a party that benefits from a continued support from high-income people. Right, so how does the economic reality complicate things in these states?

METZL: Right.

HEFFNER: If, you know, if that’s a factor, lower income people in these states have distrust of the government or is this a phenomenon across economic lines?

METZL: Well that’s a wonderful way to think about it. I’m going to give you two answers to that question because there are really two ways you could think about that.

On the practical level, there’s a lot of data and information and history in my book about the mortal consequences for working class white people of GOP policies. And so on one hand my book I think shows and is in conversation with other books, some of which you’ve mentioned, that the policies that claim to make white America great again for working class white Americans, end up making working class white lives and in particular and many other kinds of lives, harder, sicker and literally shorter. And so that part of my argument shows how policies from blocking healthcare reform, letting anyone buy a gun and carry it around, even 18 year olds carry AR-15s, massive tax cuts that undercut schools that those policies are as dangerous for working class people of every, all working class people, including working class white Americans, they’re as dangerous as asbestos or secondhand smoke or not wearing seatbelts in your cars.

They literally become disease risk factors that shorten people’s lives. And so if you take a medical frame, which is partially what I do in the book, I think the answer is that there are tremendous class implications, right? That the story of what’s happening from a medical perspective is that working class white GOP voters are being asked to lay their bodies down on the train tracks to support an agenda that in many ways from a material sense is going to benefit people far higher up the economic chain from them. And in a way that becomes a story about the GOP platform itself. In other words if working class voters started to say, I want better healthcare or better roads, better schools, the whole GOP platform collapses because they can’t give tax cuts to wealthy people. And so half of the story I tell is a story about that, about how working class people are being asked to shorten their own life spans to support these politics.

The other part of it though is that the way we narrate that as a society very often is to say, well, Trump supporters voted against their own self interest, as if we suppose we know what their self interests are. But what I also found is that there was this bigger story about whiteness. That’s why the book’s called “Dying of Whiteness” because this bigger story about whiteness, really was a story about how there were bigger agendas about racial hierarchy, this sense of loss, privilege, fear of encroachment from minorities and immigrants, a vague idea about supremacy that may have been much more theoretical than it was real. And so in that sense, it’s not like the people I spoke with didn’t know what they were talking about. They said, yeah, we know we were making these trade offs. They knew what the Affordable Care Act did. They knew what guns did, factors like that. And so the other part of the story is a story about how, about how there’s a narrative of whiteness in this country that would rather go to very extreme lengths to maintain this idea of supremacy rather than creating a more egalitarian, equal society.

HEFFNER: Let me put it quite plainly, there are rich racist people in this country too.

METZL: Yeah.

HEFFNER: Okay. So my point, and I was hoping that you could thread this needle with me, is that, are the, are those lower income people who did not want to, I mean, I’m presuming based on the research that the people who you’re considering, you know, interviewing for the book, were people who are not in major you know multinational or state companies. You were talking to lower income people primarily.

METZL: I talked to many, many people. I talked to people in cities; I talked to people in rural areas. I talked to people all across the economic spectrum. And so part of the reason I talk about this as a conversation about whiteness is part of what I highlight in the book are some of the narrative strains that connected people across socioeconomic levels. Even though as I said a moment ago, the real health effects were definitely the worst for people at the lower end of this.

HEFFNER: So this is, this is what I want to ask you. Those people who are concerned about not in my backyard, you know, I don’t want policies that are going to advance the lives of people in the, in the city or Mexican Americans or immigrants are those people cognizant of the rich racists who actually benefited from the Affordable Care Act and the way that it was designed and the windfall for insurance companies and the reality of their existence in this system.

METZL: I the people, I mean, I want to make a couple of things clear. I mean, the answer is yes. I’m not trying to in any way skirt around this question. People were incredibly well informed. I mean, shockingly well informed and I invite people to read the book and the healthcare section. The people who were rejecting the Affordable Care Act knew much more about what the Act actually did than many of my friends in coastal cities who are actually getting healthcare from the Affordable Care Act. So there was no illusion about what was happening with the Affordable Care Act.

HEFFNER: Did they also, but did they also know that it was actually during the Obama Administration after its passage, the insurance companies did all right by it? Did they know that?

METZL: Oh yeah, for sure. No, and the, the irony is, I mean the one thing that I couldn’t talk people out of was, they kept saying, I don’t want more government in my life.

And really the Affordable Care Act was a partnership right, between government and private insurance. And so I kept saying it’s not totally a government program, but, but the thing is there was this bigger story about race, about Obama, about, in other words, the information; it wasn’t a conversation about information. The conversation we ended up having about whether or not they accepted it, was, it was not about the details. I mean people, I mean, especially if you’re a working class person, of any background in the south, you know, what government programs do and don’t do because that’s your daily life trying to get treatment. But I will say that there was a bigger story that people were telling themselves and being told and telling me, which was about, I don’t want to be part of a system that is, where undeserving immigrants and minorities are gaming the system and taking away resources that might be coming to me.

And so that was the bigger story that ended up making all this stuff about what the Affordable Care Act was doing really secondary. But I, but I want to be clear that this wasn’t any confusion about what was actually happening. And I think the other important point to note is that again, people were, people were on the front lines here. So it wasn’t like they were, it wasn’t like if I gave them more information about a particular bill, but the other important point is the risk factor wasn’t whether one person or another person was racist. Some people I spoke to said racist things. Some people didn’t. Some people who never would have thought about those kinds of things, the risk factor was that they lived in a state that supported politicians whose policies were linked to this racial resentment narrative. And so the risk factor was if you lived in Tennessee and your state representatives blocked the insurance marketplaces for the Affordable Care Act, didn’t allow for the Medicaid, you know, expansion. And so really it was a question of the policies, not the people.

HEFFNER: Right. And I think that that’s important to emphasize. There was a disproportionality; there was an inverse relationship. They were claiming to not support the policies for the betterment of these districts. And ultimately these are the people where you found sickness, illness pervaded.

METZL: Right.

HEFFNER: Right. But if you were to assign this book to the governors,

METZL: Please, I would love governors to read …

HEFFNER: …from Tennessee, Kentucky and Missouri. Kansas is another story, which you, Tom Frank and I can talk about in a bit. But in those states, if you were to encourage or ask the governors to read this, what would they say?

METZL: I would love for governors to read this. Honestly, I would love for this to be part of a conversation about politics. You know, I think part of the story here is about the despair that’s resulting from policies in many southern and midwestern states. So if a governor read this book, I would hope, first of all, that they would be alarmed at just the level of, I mean, it’s not like I wrote this book to call people, you know, ill informed or uneducated. I wrote this book because I live in Tennessee, I’m from Kansas City and I saw a lot of people suffering from politics that were problematic, but they were also being manipulated. And so if a governor read this book, first of all, I would want them to feel bad about what’s happening on the ground to people. That would be number one. Number two, there’s just a lot of data that shows that the policies that many governors are implementing are shortening life spans. And so I would think if I was an elected official, I would find that alarming to think about how can we make policies that might bolster people’s life spans and not shorten their life spans? And I think that’s part of it. But the other point is, as I was just saying about the Affordable Care Act, it’s not just enough to educate people. There’s a, there’s a conversation about race that we need to have. And so maybe not the governors or something like that. But I do think that part of, I mean, it makes sense why you might ask, can’t we just inform people what the Affordable Care Act does. But there’s a bigger frame around here about race in America. And so I would hope that we could also have better conversations just about what it means to be white in America right now.

HEFFNER: Jonathan, here’s a better question. How do you get the governors, let me add the senators of those states to read this book, because they are refusing to accept the premise.

METZL: Yeah.

HEFFNER: Or they’re refusing to come to the table and acknowledge that corporate interests in their state have dominated the status quo.

But my point is how you get people to the table to believe in scientific data and, the approach that you take. So how do you get to that point with people who are really skeptical of academia and who are skeptical of what they might consider liberal institutions?

METZL: This research was not easy in many points, right? I mean I was looking through databases that were incredibly hard. I mean I have a lot on gun suicide. There is no database you can just go to. So I pulled together a lot of data from multiple places, but I tried to be very, very transparent in the book about where I was getting my information, who I was speaking with, what resources I used so that people who might not agree with me, could go back through and tried to do some of the same analysis.

I mean, what I found in my research was that the policies that many governors are supporting in many of these states are shortening the life spans of their own constituents. I would welcome, really welcome that conversation and I would hope it would be a generative productive conversation again, because I’m not trying to…

HEFFNER: Are those people that you spoke with willing to accept that reality on the ground.

METZL: I’ve had some surprising conversations. I mean I’ve done a lot of conservative media for this.

HEFFNER: So, and maybe they’re blaming people who are in some cases blame worthy in some cases not,

METZL: You know, it’s, I’m not trying to avoid this question. My point is if you talk to many people on the ground in southern states, from their perspective, they’re winning elections, right? From their perspective they’ve got a president who is going to make, to block abortion and do all these things that they’ve only dreamed about and things like that.

And so I think, I think I don’t want to speak for people, but I would say many people I spoke with saw their, saw this as a trade-off, that they were in some instances were willing to make in a way now, I think that that’s…

HEFFNER: Life expectancy isn’t an issue at the polls.


HEFFNER: That’s a problem. That’s why your book is so important.

METZL: We’ve had a three, three-year consecutive drop in…

HEFFNER: I noticed that.

METZL: Life expectancy for, I mean it’s under …

HEFFNER: For citizens across the country, but maybe not in every state and may be more exacerbated in certain states.

METZL: And white men, right? I mean it’s, think, think how crazy that is. I mean, no time since the flu of the, you know, 1915 to 1918, and World War I, have we seen a drop expectancy in the demographic majority group white men.

So we’ve had three years in a row of that. And part of what I argue is of course there are deaths of despair, addiction, all these things. But it’s also because of policies that many states are implementing and people are voting for. And so I think that part of the question here is how can we make better policies? And the other part is why are people for voting why are people voting for policies that are shortening, shortening their life spans.

HEFFNER: Which leads us to Kansas.

METZ: Oh my God.

HEFFNER: So in Kansas, we hosted Thomas Frank and I asked him about the “cool, cool conservative men.” Like 1776, the musical. And he and I discussed the plight of the Kansan voter voting for divestment from the school district. Lo and behold, folks are listening to The Open Mind and to Thomas Frank, the native of Kansas himself, they vote in a Democrat.

Now there were other circumstances leading to the election of a Democratic governor, but one of them was austerity in schools. And this is the question to you, and maybe it’s the most essential one. How do you channel those resentments constructively to the betterment of your constituencies?

METZL: I mean, there’s a tension in Kansas, which makes this a very important story because it’s not like, it’s always going to be, these issues are always at play in Kansas, right? So one of the, Kansas had this amazing school system. It was, you know, I’m from Kansas City, also. Top 10 in the country in fourth and eighth grade reading, high school graduations, things like that. They elect a governor named Brownback who takes an austerity scalpel to everything, including the schools. The schools start to fall in terms of every marker of performance. And that in some ways, in some ways in Kansas is a bridge too far, right?

People are proud of their schools, their own kids go to their schools and there starts to be a push back. And somebody I interviewed who I talk, talk about in the book, I said, why is it that schools became the issue where there’s push back? And they gave me this great quote. It said, we were fine with the fires being set in the fields, but it got too much for us when the smoke got in the mansion. In a way that all of a sudden people started to see these effects. It wasn’t just some other people. All of a sudden it was us. And so I do think that part of the story in Kansas is what’s a bridge too far, where people are going to push back against some of these austerity politics. But the other part is Kansas then is still having these very debates, right?

Kansas is still deciding about what to do. And another group of people who I talk to in Kansas said, yeah, I support these budget cuts. There’s another person I talked to in the book who says I don’t want my tax dollars going to minority districts because what I heard is that they’re taking the money to buy party buses for football games and stuff like that. There were all these urban myths about waste at minority schools and that’s why they supported us. So there’s always this tension, but I will say that the push back in Kansas, which has a certain centrist tradition was a very important part of the story.

HEFFNER: How does the Kansas example inform potentially Kathy Cramer’s working Wisconsin, the other states that you visited, Missouri, you’re based in Tennessee? Do you see the potential for that kind of consciousness to emerge? And I don’t know if it would be the same phenomenon as the mansions are on fire, but would it make a difference?

METZL: Well, I do think that Kansas on one hand is a very particular state because it’s got a history of bipartisanship. But I would also say that when people really started to see the effects on their lives and their children that was a point where people started to rethink maybe these politics in a way. And so I do think that there is a lesson in Kansas, not just about what’s it going to take to wake up Republicans, that’s not the story I’m trying to tell. It’s more like what will take to have a centrist bipartisan conversation. Because what happened in Kansas is middle ground Republicans and middle ground Democrats started to work together to try to rebuild the school system. And I met some remarkable, remarkable Republicans who were working across the aisle and in the State House.

And so I do think that it, it didn’t just foster a wake up narrative, it fostered a bipartisan narrative that seem to set things on a different course.

HEFFNER: I mean, isn’t it the case that there is this chasm there, there is this tension between the, you know, the whiteness in the mansion and the whiteness in the prairie. But some of the prairie is actually the mansion, right?

METZL: Oh, for sure. For sure.

HEFFNER: Capitalism breeds in these states a culture that is non-interventionist, deregulatory and I’m wondering how that adds up an internal conversation among whites, Caucasians about the kinds of leaders they’re electing and policies they’re instituting.

METZL: I mean the reason I called the book “Dying of Whiteness” not dying of health care policy, which is probably true also is that again, I’m trying to look at this bigger conversation about whiteness, now, whiteness in America right now has been co-opted by an administration and a narrative that really plays to many of the themes I talked about in the book. This idea that basically whiteness is under attack and we need to protect ourselves from immigrants and walls and all these kinds of things. And, it leads to a very particular set of con, of decisions, right, decisions to be isolationists, interventionists, all these kinds of factors. And so to push back on that, you know, we really need a counter narrative that says that’s not what whiteness is. That whiteness can also be generous. It can be communal, it can be community oriented. And so part of the reason I called the book “Dying of Whiteness” is to say if we want a different narrative of whiteness, one that’s based in many of the stories I heard from remarkable people along the way that, takes care of people, that’s confident, that’s generous.

We need to rearticulate what it means to be white in America and doing so actually requires a lot of self-reflection. And, and I think that’s really what’s needed because we can’t just say we don’t agree with Trump’s idea of whiteness. We need to say here is our counter narrative. A more communal, a more communal social justice oriented narrative. And, and it’s hard to do when we don’t have that language.

HEFFNER: Thank you for your time today. Jonathan.

METZL: Thanks so much.

HEFFNER: And thanks to you in the audience. I hope you join us again next time for a thoughtful excursion into the world of ideas. Until then, keep an open mind. Please visit The Open Mind website at to view this program online or to access other interviews and do check us out on Twitter and Facebook @OpenMindTV for updates on future programming.