The book Dying of Whiteness: How the Politics of Racial Resentment is Killing America’s Heartland, published in 2019, is not my usual book review, so forgive me if I post about a nonfiction book for once. To read my reviews of recent historical fiction novels, please see:

Opium and Absinthe, by Lydia Kang

The Pillars of the Earth, by Ken Follett

Freshwater Road, by Denise Nicholas

A Long Petal of the Sea, by Isabel Allende

The author of Dying of Whiteness is a professor at Vanderbilt University and Director of its Center for Medicine, Health, and Society. Many of the arguments put forth in his book are rather complex, so I’ll summarize them the best I can. The book is quite readable, however, so don’t let complexity deter you from giving it a look.

What led Metzl to write Dying of Whiteness is his concern for the health of Americans. He is, after all, director of an organization studying health. Having also grown up in the so-called American Heartland, he takes a personal interest in that region as well. So, Metzl examined three things he believed were worsening health in the American Heartland. These three things were liberalized gun ownership laws in Missouri, Tennessee’s refusal to expand Medicaid under the Affordable Care Act, and budget cuts for public schools in Kansas.

Dying of Whiteness in Missouri

As most of my readers know, the issue of laws about guns in the US is one of the surest ways to receive knee-jerk reactions and make enemies. I’m simply reporting what Metzl found in his research. Please don’t shoot the messenger, he’s doing the best he can.

The problem of researching gun violence in the US is that the US government doesn’t track it. The US government reports obsessively on the number of deaths associated with any action—traffic collisions, types of suicides, even poisonings—except for guns. The idea is to discover risk factors, thereby allowing for more effective prevention of death. Except when it comes to guns. So, the only source of data regarding deaths from guns is data on the number of suicides performed with guns.

So, Metzl used this data to analyze what had happened in Missouri under laws that increasingly allowed for the easy purchase and ubiquitous presence of guns. The results were not encouraging. Suicides using guns climbed for all groups in Missouri. But they climbed most quickly for white males. Metzl compared Missouri with another state, Connecticut, that started from a similar place but adopted less permissive gun laws while Missouri went in the other direction. The loss of life to suicide by guns in Connecticut was far less per capita.

Dying of Whiteness in Tennessee

Health care was the issue related to health examined in Tennessee. The results here are not surprising at all. Tennessee didn’t adopt the Medicaid expansion under the Affordable Care Act. As a result, a number of Tennesseans lack health insurance, making them vulnerable to the huge costs of certain expensive procedures and denying them the benefits of preventative checkups. Couple this with Tennessee not being among the wealthier states to begin with, and the costs for health were significant.

The author compared health results in Tennessee with those of Kentucky, a state of similar demographics that initially did adopt the Medicaid expansion. Again, not surprisingly, people of Tennessee saw worse health care outcomes.

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Dying of Whiteness in Kansas

The situation in Kansas was somewhat different. There, Republican governor Sam Brownback radically overhauled the state tax system. One consequence was a change in school funding, forcing schools to make do with less. The connection between education and health isn’t as obvious as the connection between health care and health, but it’s there. People with more education not only make more informed decisions about health. They’re also more likely to have professional jobs that supply them with health care. Not to mention all the other ways that education enriches life.

The result was that students in Brownbackistan began graduating less frequently. Kansas fell from a state with a highly-regarded education system to one with low spending per student and declining outcomes.

What Does Whiteness Have to do With This?

Here’s where the history comes in. Metzl conducted numerous interviews with groups in all three states of his study to find out why people supported politicians and policies that literally killed them sooner. He found that people often gave reasons (sometimes explicit ones, other times more subtle) involving race.

Missourians wanted more guns to protect themselves after the Ferguson riots (of black people) in 2014. This despite that deaths by gun suicide far exceeded deaths by homicide. White Tennesseans feared expanding health care that might include welfare recipients even when it meant they themselves would die sooner. The students most impacted by loss of educational funding in Kansas were those (often non-white students) struggling with poverty in urban locations. Their school districts could no longer provide them extra assistance due to funding cuts, lowering their educational prospects.

One takeaway from the book, therefore, is that Metzl found people cooperating for mutual benefit lived longer, healthier lives than those who sought to deny benefits to others for the sake of maintaining their own privilege. Imagine that. He also found that political leaders (again, sometimes explicitly but also more subtly) could stoke fears of people. Especially racial fears. Even to the point of getting them to support laws like the Kansas tax cuts that funneled wealth upward while making the lives of most people worse via declining schools.

Evaluation

My description here can’t really do justice to the research of the book. It’s an overview, only. I’d suggest reading Dying of Whiteness if you want to understand the research and conclusions more fully. The book is, as I wrote above, quite readable despite its heavy research. A basic knowledge of how statistics work is all you’ll need. The handful of interviews published in the book also give a personal touch to the numbers. Although the results are not encouraging, Metzl shows empathy with those to whom he spoke. He really would like to see people live longer and regrets circumstances that prevent them from doing so.

The only thing I’d critique is that some of his historical background work was a little shallow. Some of the people he mentions wrote their books quite a while ago. So, that element could have shown more nuance. Understandable from someone who isn’t a trained historian, I suppose. In other respects, though, this is a book worth reading. Just be prepared for some depressing stories. Score Dying of Whiteness 9 out of 10.

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