May 2020
The white nationalists protesting stay-at-home orders across the country last month may very well have gotten people killed. If they did, it wouldn’t be the first time that white grievance has led to sickness and death in America. In fact, the link between white identity and rising mortality is perhaps the nation’s most significant and troubling demographic trend, one that has profound implications for the country’s health, both physically and politically.
Most big news outlets insisted that the protesters were a small minority of Americans. But the April 8 Quinnipiac University Poll found that a not-insignificant 25 percent of white men opposed the idea of a national stay-at-home order.1 And they were also significantly more likely than blacks or Latinos to say that they were ignoring state and local governments’ requests to stay at home. Likewise, an April 14 survey by the Pew Research Center found that “Both black and Hispanic adults are substantially more likely than white adults to express high levels of concern over the possibility they will get the coronavirus or transmit it to others.” While 70 percent of Hispanics and nearly six in ten (59 percent) of African Americans said they were “at least somewhat concerned that they will be hospitalized due to the coronavirus,” only about half (51 percent) of whites expressed some concern, with only 18 percent reporting being “very concerned.”2 Given its potential negative effect on one’s health, this could be considered a risky behavior, not unlike smoking, drinking, or taking drugs.
In 2015, Princeton economists Anne Case and Angus Deaton found that, starting in 1999, middle-aged white men and women at all levels of education were dying prematurely in large numbers. This trend, they wrote in Proceedings of the National Academy of Sciences, “reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround.”3 What’s more, it was unique to whites. Black and Latino mortality rates continued to go down.
The authors ascribed the increase in death rates for middle-aged whites—particularly among the working class—to increases in drug and alcohol poisoning, suicides, and chronic liver diseases and cirrhosis. And that isn’t all: a growing number of middle-aged whites reported significant deterioration in both their overall physical and mental health, an increase in chronic pain, an inabili- ty to work, and, quite simply, having a harder time navigating daily life. Clearly a large number of middle-aged whites were and continue to be in distress. But why?
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It is a well-established fact that a person who has suffered a loss of social status and has no hope to reclaim it has a heightened chance of suffering from psychosocial stress and/or engaging in habits to relieve that stress that are hazardous to one’s health, including excessive drinking, smoking, taking drugs, or suicide. This phenomenon also holds true for groups of people. If members of a given group feel they have collectively lost social standing and also lack the confidence that they can regain it, individual members of that group can suffer negative physical consequences that can result in premature death.
This phenomenon is not merely brought on by the loss of material well-being. It involves the collapse of functional social networks, ennobling narratives, and belief systems that help propel people forward even in the most difficult times. This explains why conquered peoples and scorned minorities can suffer not only sudden but also ongoing threats to their physical health.
The most extreme example of this is the Spanish conquest of Mexico in the sixteenth century. In addition to suffering military defeat and waves of epidemics of Old World diseases, the Aztecs also endured a blow to their will to live. Having literally witnessed their gods being toppled and their way of life destroyed, the survivors were plunged into depression and despondency, which led to lower birth rates, “systematic abortion,” and mass suicide. The end result of all this was one of the worst demographic disasters in history.4
More recently, the collapse of the Soviet Union produced the most extreme rise in mortality in modern history. In Russia, between 1990 and 1994, male life expectancy “dropped more than six years to fifty-eight years,” while “female life expectancy dropped more than three years to seventy-one years.”5 When the Soviet state collapsed at the end of 1991, millions of Russians not only lost their work and savings, but also the world they knew how to negotiate and a national vision of a motherland that—even in the hardest times—had always promised them a future. Middle-aged working-class Russians from the wealthiest areas of the country—cities like Moscow—were the most at risk of early death, particularly from cardiovascular disease, injuries, and alcohol-related illnesses.
Poverty wasn’t a primary factor in the increase in mortality in Russia. Heavy drinking clearly played a role in the rise of men dying from both injuries and cardiovascular disease. But classic risk behaviors are not thought to be responsible for the majority of cardiovascular deaths. Rather, high levels of psychosocial stress created by the collapse of the state is the likely cause of a significant percentage of premature deaths.
While both male and female mortality rates increased, the differences in how men and women coped with stress explain why Russia had the largest sexual difference in life expectancy of any country in the world. As Michelle A. Parsons argues in her magnificent ethnography Dying Unneeded: The Cultural Context of the Russian Mortality Crisis, many women maintained their sense of purpose by playing central roles within their families. Men, on the other hand, were more likely to suffer a complete loss of social connections as well as a sense of control over their lives, both of which are strongly correlated with cardiovascular health.
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Generally, it takes a war or a major political, economic, or epidemiological disaster to trigger a rise in a modern society’s mortality rates. Throughout the twentieth century, death rates steadily declined in the United States, as in all other developed Western countries. A combination of better nutrition, advances in medicine, improved public health measures, and changes in behavior led to fewer and fewer premature deaths. In the twentieth century, a 74 percent decline in the mortality rate in the Uni- ted States led to a 56 percent increase in life expectancy.6
The news that mortality rates for white Americans are on the rise is both shocking and dangerous. Although they make up a majority (61 percent) of the U.S. population, whites are increasingly behaving like a disgruntled and oppressed minority group. Significant numbers have found solace (or is it revenge?) in white grievance politics, and more and more are filing “reverse discrimination” lawsuits against nonwhites. The rising mortality numbers are additional signs that many whites are suffering from the kind of psychosocial stress that comes with the loss of status and hope.
In 2017, economists Case and Deaton published a follow-up paper that theorizes that “the collapse of the white working class” was brought on by a long-term decline in meaningful job opportunities for people with low education combined with the disappearance of traditional structures of familial, social, economic, and spiritual support.7 In other words, growing economic disadvantage collided with individual behaviors that led to further instability, such as the increase in children born outside of marriage coupled with the coming and going of multiple live-in partners. When life wound up being much more difficult than expected, they had no means with which to cope and make sense of it, hence the abuse of drugs and alcohol.
The key word here is “expected.” Between 1999 and 2015, working-class blacks also experienced similar economic declines to those whites were experiencing. But while whites with a high school education or less saw their death rates rise, similarly situated blacks experienced the opposite, to the point that mortality rates for the least educated blacks and whites converged to become roughly the same. Why? Pointing to national surveys, Brookings Institution researchers Carol Graham and Sergio Pinto found that poor blacks—and Latinos, for that matter—reported “higher life satisfaction” and lower levels of stress than did poor whites.8
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The most discussed aspect of the white mortality crisis has been the use and abuse of opioids, which is clearly both an expression and cause of distress. Glance at a chart of opioid deaths by race, and you’re likely to gasp. Between 1999 and 2018, 360,000 (or 80 percent) of the nation’s nearly 450,000 opioid deaths were to whites.9 That’s roughly 100,000 more than the number of Confederate soldiers who died in the Civil War.
I make the comparison because the last time whites suffered a massive opioid epidemic—and blacks did not—was in the post–Civil War South. A combination of wounded soldiers, the elite’s pervasive depression over their defeat, and overprescribing by doctors led to an epidemic of addiction. In 1877, a New York opium dealer remarked that “since the close of the war, men once wealthy, but impoverished by the rebellion, have taken to eating and drinking opium to drown their sorrows.”10 In the meantime, African Americans had low levels of addiction, possibly because they didn’t have widespread access to physicians and weren’t particularly depressed by the downfall of the Confederacy.
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Economists Case and Deaton dubbed the drug overdoses, suicides, and alcohol-related deaths that have dri- ven up the middle-aged white mortality rate “deaths of despair.” But despair—the complete absence of hope— doesn’t fully capture the range of emotions surrounding so much death.
It does, however, track with the popular interpretation of why Donald Trump won the presidency in 2016. Despite the fact that Trump deployed explicitly racist and scapegoating language against Mexicans, Muslims, and others, journalists felt more comfortable characterizing his surprise victory as a class rebellion rather than a racial one.
But in 2018, University of Pennsylvania political scientist Diana C. Mutz challenged the conventional wisdom. Writing in Proceedings of the American Academy of Sciences, she argues that Trump’s victory was a result not of working-class whites’ financial frustrations but of their anxiety over their future racial status in America. In a nutshell, she finds that financial well-being had little impact on candidate preference. Instead, she writes, their votes were related to positions “on issues related to American global dominance and the rise of a majority-minority America.”11
While racial status threat and global status threat are different issues, they can clearly be intertwined in the minds of whites who feel they are the prototypical Americans and therefore have the most to lose if their country is no longer dominant. Mutz makes clear that whites’ protecting their dominant status isn’t an act of old-fashioned racism that assumed minorities were morally and intellectually inferior. Indeed, in this case, whites are seeing threats coming from nonwhite domestic groups and foreign nations sufficiently capable of displacing them. When members of a historically dominant group experience a threat to their group’s position, any shift in people’s sense of their group’s relative position produces insecurity.
While Case and Deaton pointed to the disparity be- tween expectation and reality as the cause of white despair, Mutz points to competition between whites and nonwhites. Much of Trump’s strategy and appeal was his willingness to put nonwhites—both in the U.S. and abroad—in their place. That Trump’s language delighted so many whites doesn’t suggest that they felt he would lift them up as much as tear down their competitors— both real and imaginary. The feeling Trump tapped into wasn’t merely despair. It was also anger and the consequent desire for revenge against those they held responsible for their falling status.
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Anyone who studies self-inflicted death—whether by opiates, by alcohol, or by handgun—has to read French sociologist Émile Durkheim’s 1897 masterpiece, Suicide: A Study in Sociology. In it, the pioneering social scientist explains that while suicide appears to be an entirely individual phenomenon, it is actually very much determined by the social dynamics in which people live. Durkheim called the type of suicide prevalent in times of great social and economic upheaval anomic suicide from the French word anomie, which describes the breakdown of the bonds between an individual and their community. Durkheim’s explanation of the process that induces anomic suicide is both powerful and visceral. It also undermines the notion that the whites who are experiencing a decline in their social status are suffering solely from despair. Durkheim writes:
A man abruptly cast down below his accustomed status cannot avoid exasperation at feeling a situation escape him of which he thought himself master, and his exasperation naturally revolts against the cause, whether real or imaginary, to which he attributes his ruin. If he recognizes himself as to blame for the catastrophe, he takes it out on himself; otherwise, on someone else. In the former case there will be only suicide; in the latter, suicide may be preceded by homicide or by some other violent outburst. In both cases, the feeling is the same; only its application varies.12
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While Case and Deaton chose to focus on the least educated and middle-aged, where the increase in mortality was most pronounced, they acknowledged that the rise in mortality is occurring across all education levels and among all working-age whites. Over the past two decades, for example, even some of the most educated groups of whites experienced a rise in mortality. (Incidentally, despite media images of the downtrodden blue-collar white male, women experienced a greater increase in mortality than men.)
Last November, a team of researchers led by epidemiologist Arjumand Siddiqi at the University of Toronto released a study in which they reexamined mortality data across all white groups and challenged Case and Deaton’s narrow focus. They conclude that patterns of white mortality follow “a gradient of sorts: the worst out- comes are concentrated in the lowest education group; the middle education group has slightly less damaging trends; and the least damaging trends are found [in] the highest education group.”13 So, if the rise in white mortality extends well beyond the least educated and covers more than the middle-aged, then a broader phenomenon must be at play. This led them to focus on race rather than class as the primary factor.
Citing public health theory, national survey work, voting trends, and political scientists like Diana Mutz and others, Siddiqi and colleagues concluded that rising white mortality rates are driven primarily by whites’ anxiety about losing their dominant racial status. Their anxiety manifests in “multiple forms of psychological and physiological stress,” which can lead to increased alcohol consumption, opioid use, and suicide.14 To a lesser extent, it is also responsible for rising rates of chronic conditions like obesity and hypertension.
Even more interesting perhaps is that despite their becoming a decreasing percentage of the U.S. population, there is no evidence that whites as a whole are being displaced from the top of the heap, financially, socially, or otherwise. As Siddiqi and colleagues write, “the anxiety of whites is coming from a perception—a misperception—that their dominant status in society is being threatened.”15
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So how can large numbers of a majority population be dying of a threat that doesn’t exist? The answer to that question would seem to lie in the very definition of whiteness.
Historically, to be white in America meant simply that you were not black. Neither a culture nor an ethnic group, whiteness is an agglomeration of largely European-origin Americans who have, for the most part, shed the traditions, social networks, and belief systems of their families’ countries of origin. Different European origin groups have successfully assimilated into whiteness at different times based on their ability to prove that they had sufficiently cut ties to their ancestral pasts.
In other words, whiteness is a negative identity that says more about what you’re not than what you are. Whites who still maintain vestiges of their ethnic origins are subject to accusations of being less than fully white. To be fully white, then, means not only to not be black, but also to be beyond whatever ethnicity one’s ancestors once claimed. Vestiges of ethnicity, any behaviors or beliefs that derive from foreign or aboriginal origins, can subject a person to accusations of savagism, of being less than civilized, and therefore dangerous. The further a person is away from whiteness, in the racial and ethnic status of “none of the above,” the more vulnerable one is to such accusations.
On occasion, money and education can buy nonwhites entrée into the anteroom of whiteness, but their status, particularly if their physiognomy betrays them, can be revoked at any time for any reason. Visibly nonwhite foreigners, of course, are the most vulnerable of all. In his attempt to deflect blame for his party’s poor handling of the coronavirus pandemic, U.S. Senator John Cornyn of Texas committed what was perhaps the most egregious recent act of savagism when he blamed China for the global pandemic, because there, “People eat bats and snakes and dogs and things like that.”16 Savages.
So, if whiteness is a negative identity, what exactly is its value? Well, it means you are at the top of the social hierarchy and your presence on these shores and civilized status cannot be seriously questioned. It means that you are the norm and that you don’t have to waste energy justifying your presence in whatever system you enter. It means that if you become president, no one is likely to demand to see your birth certificate.
The problem with whiteness, however, is that because it is a negative identity, it is fragile and cannot stand on its own. Because it is constructed on contradistinctions, it always needs a class of people against whom it can gauge its sense of superiority. If that sense of superiority is threatened, whites can flail in despair and anger at the prospect of losing their dominant status in society. The white mortality crisis isn’t merely an epidemiological or a political crisis. It is an existential one, not only for whites, but also for the United States—blue as well as red. As whites’ numerical majority status continues to shrink, the more they will feel threatened and the more likely they’ll be to punish themselves and others.
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1. “Fauci, Governors Get Highest Marks for Response to Coronavirus,” Quinnipiac University Poll, April 8, 2020.
2. “Health Concerns from Covid-19 Much Higher Among Hispanics and Blacks Than Whites,” Pew Research Center, April 14, 2020.
3. Anne Case and Angus Deaton, “Rising Morbidity and Mortality in Midlife Among White Non-Hispanic Americans in the 21st Century,” Proceedings of the National Academy of Sciences 112, no. 49 (2015): 15078.
4. Guillermo Bonfil Batalla, México Profundo: Reclaiming A Civilization, trans. Philip A. Dennis (Austin: University of Texas Press, 2004), 82.
5. Michelle A. Parsons, Dying Unneeded: The Cultural Context of the Russian Mortality Crisis (Nashville, TN: Vanderbilt University Press, 2014), 2.
6. Bernard Guyer et al., “Annual Summary of Vital Statistics: Trends in the Health of Americans During the 20th Century,” Pediatrics 106, no. 6 (2000): 1308.
7. Anne Case and Angus Deaton, “Mortality and Morbidity in the 21st Century,” Brookings Papers on Economic Activity (2017), 438–39.
8. Carol Graham and Sergio Pinto, “Unequal Hopes and Lives in the USA: Optimism, Race, Place, and Premature Mortality,” Journal of Population Economics 32, no. 2 (March 28, 2018): 665.
9. Opioid Overdose Deaths by Race/Ethnicity, Kaiser Family Foundation, www.kff.org.
10. David T. Courtwright, “The Hidden Epidemic: Opiate Addiction and Cocaine Use in the South, 1860–1920,” Journal of Southern History 49, no. 1 (1983): 66.
11. Diana C. Mutz, “Status Threat, Not Economic Hardship, Explains the 2016 Presidential Vote,” Proceedings of the National Academy of Sciences 115, no. 19 (May 8, 2018): E4330.
12. Durkheim, Émile, Suicide: A Study in Sociology (New York: The Free Press, 1951), 285.
13. Arjumand Siddiqi et al., “Growing Sense of Social Status Threat and Concomitant Deaths of Despair Among Whites,” SSM – Population Health 9 (2019): 4.
14. Ibid., 18.
15. Ibid.
16. Todd J. Gilligan, “Cornyn Defends Trump’s Use of Term ‘Chinese Virus,’ Citing Markets That Sell Bats Dogs as Meat,” Dallas Morning News, (March 19, 2020).
[Top Photo by Lorie Shaull/Liberate Minnesota Protest in St Paul ,MN]
