There are two main ideas in Dying of Whiteness: How the Politics of Racial Resentment is Killing America’s Heartland:

1. Right-wing policies implemented by Republican administrations attract supporters because they align with a fundamental desire of many white voters to preserve their position at the top of an imagined racial hierarchy. 

2. In practice, these policies deliver mortal harm to the very people they are supposed to benefit, namely lower- and middle-class whites. “Mortal harm” means literally that: increased death rates, and decreased years of life.

The author is Jonathan M. Metzl, Professor of Sociology and Psychiatry at Vanderbilt University. He sets out to prove these claims by presenting three case studies of policies implemented by Republican administrations in states in the south and mid-west:

• Loosened gun restrictions in Missouri.
• Health care in Tennessee, specifically the refusal of that state to extend Medicaid coverage under the Affordable Care Act
• Drastic tax cuts in Kansas and the subsequent reduction in funding for public education  

His key finding is that Americans are literally dying of whiteness.

“This is because white America’s investment in maintaining an imagined place atop a racial hierarchy – that is, an investment in a sense of whiteness – ironically harms the aggregate well-being of US whites as a demographic group, thereby making whiteness itself a negative health indicator.” [p. 9]

Dying of Whiteness
By Jonathan M. Metzl
Basic Books, New York, 2019

Case Studies

For each of his three studies, Metzl conducted research between 2013 and 2018 including focus group interviews with residents of each state, and statistical analysis of population-level data.

For instance, starting around 2010 the State of Missouri began to roll back restrictions on guns. By 2016, Metzl writes, Missouri had:

• Ended prohibitions on the open or concealed carry of guns in public places
• Lowered the age for carrying a concealed gun from 21 to 19
• Eliminated many of the requirements for background checks and purchase permits
• Eliminated training and education requirements for carrying a concealed gun
• Extended “Castle Doctrine” and “stand-your-ground” protections for using lethal force against perceived threats both inside and outside the home
• Nullified city and regional gun restrictions within the state

All this, apparently, in the name of giving law-abiding citizens the unfettered right to defend themselves and their families.

But while murders and mass shootings dominate the news around gun violence in America, the sad fact is gun suicides account for about two thirds of all gun deaths. That’s actually the focus of Metzl’s Missouri case study. Here he presents a range of data showing the increased number of lives and years of life lost from suicide due to Missouri’s gun policies. And it’s overwhelmingly white male lives that are shortened and lost.

Metzl shows that between 2009 and 2015 nearly 80% of gun suicides in the US were committed by non-Hispanic white men even though they made up less than 35% of the population.  The state-level figures for Missouri are comparable.

Yet it’s the transcripts of focus group interviews that are the saddest and most harrowing parts of the book. Many of the people interviewed were family members who discovered the bodies and had to clean up the gore-spattered homes of parents or siblings who had committed suicide.

Almost without exception they still refused to consider any kind of restrictions on guns. People said guns were part of Missouri’s culture, and “it’s not the gun’s fault.”  

Metzl argues that this gun culture and the laws and policies surrounding it are designed to reinforce an idea of privileged white masculinity. For example, he tells how guns were marketed as a “Man Card” that would “restore the balance of power”.

The result:

“White men themselves become the biggest threat to … themselves. Danger emerges from who they are and what they wish to be. Over time, the data suggests, ‘being a white man who lives in Missouri’ then emerges as its own, high-risk category.” [p. 109]   

In Tennessee, Metzl examines the impact of that state’s refusal to adopt Medicaid expansion under the Affordable Care Act. The rationale for this refusal is often stated in terms of cost – it’s too expensive, it will blow a hole in the State’s budget, etc. But in reality, it seems to be about whites not wanting to pay the health care costs of people they consider undeserving, like “Mexicans and welfare queens,” even if it means going without health care themselves.

Metzl also argues that in southern states there’s a deep-seated resentment of the federal government stemming from the occupation of the South during the Reconstruction period after the Civil War when states were forced to grant political rights for freed slaves. Seen through this lens, a national health care program that covers everyone gets twisted into a federally imposed flattening of the racial hierarchy. (I think this may also explain some reactions we’re seeing today to federal coronavirus vaccine mandates.)

It’s no surprise that most of the formerly Confederate states have, like Tennessee, rejected Medicaid expansion. You can see it on this map.

What it adds up to is poorer health care for everyone, including whites. It means, as Metzl says, that “failure to expand Medicaid” is “among the leading causes of man-made death in Tennessee.”

Voting Against Their Own Interests?

Liberals and/or progressives (I include myself here, if those labels still mean anything) often ask how people can vote for policies that are so obviously counter to their own interests.  Metzl himself notes that,

“I repeatedly found examples of policies, politics or products that claimed to restore white authority but silently delivered lethality.” [p. 6]

But he also cautions readers not to assume that “we” know what “their” interests really are.

Metzl suggests that what motivates people – voters – in the three states he’s studied is not safety or health care or education, but rather perceived status and privilege within a racial hierarchy. And like many authors in this area, he points to the systemic and structural factors that support these beliefs.

He says,

“… the mortal risks of whiteness extend beyond questions of whether or not any one person holds any one set of biases or beliefs. Risk evolves from politics or policies that surround identities and give shape to interactions among people and communities.” [p. 271]

Unsolicited Feedback

I found large parts of Dying of Whiteness sickening, particularly the statements of people who have endured so much self-imposed suffering in pursuit of a false cause, racial superiority.

I had read before about the deep historical origins of racism and of white resentment but somehow Metzl’s interviews caused this to click into place for me.

There were some aspects of the statistical analysis in Dying of Whiteness that I didn’t find convincing. A few too many linear extrapolations and tenuous causal assertions for my liking.  I’d have to look into some of the underlying academic papers cited in the Notes to assess this more fully.

Earlier this year I read Heather McGhee masterful book The Sum of Us which describes the “drained pool politics” in which whites try to preserve their own status and privilege yet end up harming themselves and everyone else. You can read my review here. 

Dying of Whiteness was published a couple of years before The Sum of Us, and McGhee refers to Metzl’s work in her book.

The Sum of Us has a bigger scope; it looks at a broader range of issues and at deeper historical causes. Dying of Whiteness drills down into the details of specific policies in specific locations. But they both deliver the same message; historically rooted present-day efforts by whites to preserve their status within a false racial hierarchy amount to “political self-sabotage” that harms everyone, including themselves.