Book Review: Dying of Whiteness

Are lethal politics killing the heartland?

Posted Oct 31, 2020

Jonathan Metzl is a physician and researcher who is interested in the health of Americans. In his book, Dying of Whiteness: How the Politics of Racial Resentment is Killing America’s Heartland, he examines the health consequences of instituting certain core Republican Party policies.

As part of a “backlash conservatism” (movement conservatism, described in a prior post), once-fringe ideas were brought into the mainstream Republican Party in the last decades: dismantling social programs, starving government of funding, allowing the free flow of firearms. When they are implemented at the local, state or federal level, he calls this “backlash governance” (p. 7), with Donald Trump’s rhetoric epitomizing White racial resentment and the desire to upend gains made by minorities, giving a sense of “winning” back respect for white status. The problem, Metzl says, with backlash governance is that it “leads to states of denial, displacement, or amnesia, even in moments that demand accountability and self-reflection” (p. 281).

Metzl conducted focus groups to examine attitudes and concluded that White Americans are making tradeoffs, sacrificing their wellbeing, to support larger ideals, despite the fact that the tradeoffs made by lower-income whites (and others) largely only support the wealth and wellbeing of those higher up on the socioeconomic ladder. He noted:

 “The stories these people told me became jumping-off points for a more sustained investigation of how particular American notions of whiteness—notions shaped by politics and policies as well as by institutions, history, media, economics, and personal identities—threaten white well-being.” (p. 5)

He delved into three issues in particular states: repealing the Affordable Care Act, loosening gun laws, and enacting massive tax cuts that largely benefitted upper-income folks and corporations, with minimal, short-term benefits for lower-income people. Along with focus group data, he also amassed quantitative data.

Missouri, Connecticut and Gun Laws

Comparing Missouri, which loosened gun laws, and Connecticut, which tightened them after the Sandy Hook massacre, he reviews the evidence that liberalized gun laws increased injuries and deaths among Whites through partner violence and accidental shootings, and suicides (primarily among rural White men). Interestingly, according to Metzl, the gun culture we associate with the wild west was promoted in the 1980s, corresponding to legislation loosening gun laws and rhetoric put out by the National Rifle Association that having guns was the way to “help men recover their status, power, and respect” (p. 73). Today, guns “function as weapons, totems, and transitional objects that promise autonomy, protection, and self-reliance” (p. 76). “Armed white maleness connotes rights, privileges, and a place that, if not atop the hierarchy, was not at the bottom either” (p. 108). 

Comparing Tennessee and Kentucky on Health Care Provision

Comparing Tennessee, which refused to participate in the Affordable Care Act's expansion of Medicaid, with Kentucky, which did participate, he estimates, based on piles of data, that it cost every White Tennessean 14 days of life on average. He argues, based on his extensive data, that Whites (on average) defined “us” by what “we” have and defined “them” by their wanting what “we” have. “Narratives of suspicion, disdain, and rejection prevailed over narratives of inclusion and common gain" (p. 165).

He found many white (males, typically) expressing beliefs that governmental assistance, such as expanding community safety nets, was not to be trusted. He found that these professed judgments “aligned with beliefs about a racial hierarchy that overtly and implicitly aimed to keep white American hovering above Mexicans, welfare queens, and other nonwhite others” (p. 4), with an accompanying belief (a myth) that these nonwhites received lavish government assistance. He found that many who did not support expansion of healthcare voiced “a literal willingness to die for [their] place in this hierarchy, rather than participate in a system that might put him on the same plane as immigrants or racial minorities” (p. 4).

“Were it truly a post-racial America, cost concerns might have raised certain existential questions about citizenship and responsibility: What is life worth? What is our responsibility to each other? How can we balance individual behaviors and public wealth? But in the real world, cost generated in a feedback loop that we recorded in some of our focus groups, where white Tennesseans used “cost” as a thinly veiled way to talk about race.” (p. 186)

Kansas and Tax Cuts

Kansas-born, he examines Kansas as a case study of before and after the application of movement conservatism’s principles of governance during the governorship of Sam Brownback. Based in part on a negative framing of minority communities wasting government money through splurging, Kansans supported tax and budget cuts—until the economic austerity created holes in the budget and necessitated cutting support of schools, for example, in White neighborhoods. The effect was to reallocate resources from the many to the few, trickle up.

The Health Costs of Whiteness

Metzl points out that many of his focus group participants did not display racist attitudes themselves but they lived in states whose officials supported structural—political and economic—racism, which boomeranged back on lower-income Whites. In fact, he argues that gun proliferation, tax cuts and refusing to expand health care results in patterns of ill health that mimic exposure to secondhand smoke, water pollution and not wearing seat belts.

The data he collected and analyzed indicates that “whiteness itself” has become a “negative health indicator,” (p. 7) as Whites have been voting against their biological (as well economic) interests. There is a sense of “noble self-denial,” self-sacrifice for a holy cause (Frank, 2004). As part of the ideology that frames many people's voting decisions, compromise (the fuel of democracy) seems to be considered treason.

Historian W.E.B. Du Bois (1975) wrote that poor Whites found status in being “not-black,” thereby providing compensation for their exploitation by ruling-class Whites.

“Living in a state or a county or a nation dominated by a politics of racial resentment then becomes a diagnosable, quantifiable, and increasingly mortal preexisting condition” (Metzl, 2020, p. 18)

Indeed, Metzl writes that he “repeatedly found examples of policies, politics, or products that claimed to restore white authority but silently delivered lethality” (p. 6).

The Burden on White Men

Throughout his documentation, he discovered that White men in particular are harmed. He writes that White men are in a state of crisis, which occurs because they, as a formerly dominant, privileged group, feel threatened that the power structures are being upended. “Instead of the automatic authority they accrued by simply showing up, these men found themselves in a world in which they faced more competition and enjoyed less prestige” (p. 52).

Such framing of crisis is "often based more on an imagined sense of nostalgia than in any lived reality, inasmuch as many men fought to maintain what they held to be their natural authority even though every man was not a king, a boss, a plantation owner, or a CEO. By definition, the majority of men needed to be underlings for the system to survive” (p. 53).

But he also presents a broader perspective:

“The ways we define crisis allow us to attach the language of calamity to whiteness, men, or other seemingly dominant groups, while at the same time making it harder to see the suffering of women, immigrants, people of color, and other persons who do merit a 'crisis of authority'—because they are supposedly built for it, or because they have lived with crisis all along. This logic suggests that men need to be on top because they embody no skills for acting otherwise; and everyone else, to paraphrase an important book about women-of-color feminism, are born with bridges called their backs” (p. 53).

Metzl wants the reader to understand how systemic structures are biased against the wellbeing of all people and in many cases hurt Whites to a significant degree. He reminds us that Thomas Jefferson noted that the legitimate purpose of governance is to care for human life and happiness, not their destruction.

Related Posts

The Psychology Corruption: Kleptocracy vs Democracy

Historical Roots of Polarization: Oligarchy or Democracy

The Psychology of Domestic Terrorists: Eliminationism


Du Bois, W.E.B. (1975). Black reconstruction in America: An essay toward a history of the part which Black folk played in the attempt to reconstruct democracy in America: 1860-1880. New York: Atheneum.