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‘There Are Two Americas Now: One With a B.A. and

One Without’
Thomas B. Edsall ⋮ ⋮ 10/5/2022

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The Republican Party has become crucially dependent on a segment of white voters suffering
what analysts call a “mortality penalty.”

This penalty encompasses not only disproportionately high levels of so-called deaths of despair
— suicide, drug overdoses and alcohol abuse — but also across-the-board increases in several
categories of disease, injury and emotional disorder.

“Red states are now less healthy than blue states, a reversal of what was once the case,” Anne
Case and Angus Deaton, economists at Princeton, argue in a paper they published in April,
“The Great Divide: Education, Despair, and Death.”

Case and Deaton write that the correlation between Republican voting and life expectancy
“goes from plus 0.42 when Gerald Ford was the Republican candidate — healthier states voted

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for Ford and against Carter — to minus 0.69 in 2016 and minus 0.64 in 2020. States classified
as the least healthy voted for Trump and against Biden.”

Case and Deaton contend that the ballots cast for Donald Trump by members of the white
working class “are surely not for a president who will dismantle safety nets but against a
Democratic Party that represents an alliance between minorities — whom working-class whites
see as displacing them and challenging their once solid if unperceived privilege — and an
educated elite that has benefited from globalization and from a soaring stock market, which was
fueled by the rising profitability of those same firms that were increasingly denying jobs to the
working class.”

Carol Graham, a senior fellow at Brookings, described the erosion of economic and social
status for whites without college degrees in a 2021 paper:

From 2005 to 2019, an average of 70,000 Americans died annually from deaths of
despair (suicide, drug overdose, and alcohol poisoning). These deaths are
concentrated among less than college educated middle-aged whites, with those out
of the labor force disproportionately represented. Low-income minorities are
significantly more optimistic than whites and much less likely to die of these deaths.
This despair reflects the decline of the white working class. Counties with more
respondents reporting lost hope in the years before 2016 were more likely to vote for
Trump.

Lack of hope, in Graham’s view, “is a central issue. The American dream is in tatters and,
ironically, it is worse for whites.” America’s high levels of reported pain, she writes, “are largely
driven by middle-aged whites. As there is no objective reason that whites should have more
pain than minorities, who typically have significantly worse working conditions and access to
health care, this suggests psychological pain as well as physical pain.”

There are, Graham argues,

long-term reasons for this. As blue-collar jobs began to decline from the late 1970s
on, those displaced workers — and their communities — lost their purpose and
identity and lack a narrative for going forward. For decades whites had privileged
access to these jobs and the stable communities that came with them. Primarily
white manufacturing and mining communities — in the suburbs and rural areas and
often in the heartland — have the highest rates of despair and deaths. In contrast,

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 more diverse urban communities have higher levels of optimism, better health
indicators, and significantly lower rates of these deaths.

In contrast to non-college whites, Graham continued,

minorities, who had unequal access to those jobs and worse objective conditions to
begin with, developed coping skills and supportive community ties in the absence of
coherent public safety nets. Belief in education and strong communities have served
them well in overcoming much adversity. African Americans remain more likely to
believe in the value of a college education than are low-income whites. Minority
communities based in part on having empathy for those who fall behind, meanwhile,
have emerged from battling persistent discrimination.

Over the past three years, however, there has been a sharp increase in drug overdose deaths
among Black men, Graham noted in an email:

The “new” Black despair is less understood and perhaps more complex. A big factor
is simply Fentanyl for urban Black men. Plain and simple. But other candidates are
Covid and the hit the African American communities took; Trump and the increase of
“acceptance” for blatant and open racism; and, for some, George Floyd and
continued police violence against blacks. There is also a phenomenon among urban
Black males that has to do with longer term despair: nothing to lose, weak problem-
solving skills, drug gangs and more.

The role of race and gender in deaths of despair, especially drug-related deaths, is complex.
Case wrote in an email:

Women have always been less likely to kill themselves with drugs or alcohol, or by
suicide. However, from the mid-1990s into the 20-teens, for whites without a four-
year college degree, death rates from all three causes rose in parallel between men
and women. So the level has always been higher for men, but the trend (and so the
increase) was very similar between less-educated white men and women. For Blacks
and Hispanics the story is different. Deaths of Despair were falling for less educated
Black and Hispanic men from the early 1990s to the 20-teens and were constant over
that period (at a much lower rate) for Black and Hispanic women without a B.A. After
the arrival of Fentanyl as a street drug in 2013, rates started rising for both Black and
Hispanic men and women without a B.A., but at a much faster rate for men.

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In their October 2014 study, “Economic Strain and Children’s Behavior,” Lindsey Jeanne
Leininger, a professor at Dartmouth’s Tuck School of Business, and Ariel Kalil, a professor of
public policy at the University of Chicago, found a striking difference in the pattern of behavioral
problems among white and Black children from demographically similar families experiencing
the financial strains of the 2008 Great Recession:

Specifically, we found that economic strain exhibited a statistically significant and

qualitatively large association with White children’s internalizing behavior problems
and that this relationship was not due to potentially correlated influences of objective
measures of adverse economic conditions or to mediating influences of psychosocial
context. Furthermore, our data provide evidence that the relationship between
economic strain and internalizing problems is meaningfully different across White and
Black children. In marked contrast to the White sample, the regression-adjusted
relationship between economic strain and internalizing behaviors among the Black
sample was of small magnitude and was statistically insignificant.

Kalil elaborated on this finding in an email: “The processes through which white and Black
individuals experience stress from macroeconomic shocks are different,” she wrote, adding that
the “white population, which is more resourced and less accustomed to being financially
worried, is feeling threatened by economic shocks in a way that is not very much reflective of
their actual economic circumstances. In our study, among Black parents, what we are seeing is
basically that perceptions of economic strain are strongly correlated with actual income-to-
needs.”

This phenomenon has been in evidence for some time.

A 2010 Pew Research Center study that examined the effects of the Great Recession on Black
and white Americans reported that Black Americans consistently suffered more in terms of
unemployment, work cutbacks and other measures, but remained far more optimistic about the
future than whites. Twice as many Black as white Americans were forced during the 2008
recession to work fewer hours, to take unpaid leave or switch to part-time, and Black
unemployment rose from 8.9 to 15.5 percent from April 2007 to April 2009, compared with an
increase from 3.7 to 8 percent for whites.

Despite experiencing more hardship, 81 percent of Black Americans agreed with the statement
“America will always continue to be prosperous and make economic progress,” compared with
59 percent of whites; 45 percent of Black Americans said the country was still in recession
compared with 57 percent of whites. Pew found that 81 percent of the Black Americans it

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surveyed responded yes when asked “Is America still a land of prosperity?” compared with 59
percent of whites. Asked “will your children’s future standard of living be better or worse than
yours?” 69 percent of Black Americans said better, and 17 percent said worse, while 38 percent
of whites said better and 29 percent said worse.

There are similar patterns for other measures of suffering.

In “Trends in Extreme Distress in the United States, 1993-2019,” David G. Blanchflower and
Andrew J. Oswald, economists at Dartmouth and the University of Warwick in Britain, note that
“the proportion of the U.S. population in extreme distress rose from 3.6 percent in 1993 to 6.4
percent in 2019. Among low-education midlife white persons, the percentage more than
doubled, from 4.8 percent to 11.5 percent.”

Blanchflower and Oswald point out that “something fundamental appears to have occurred
among white, low-education, middle-aged citizens.”

Employment prospects play a key role among those in extreme distress, according to
Blanchflower and Oswald. A disproportionately large share of those falling into this extreme
category agreed with the statement “I am unable to find work.”

In her 2020 paper, “Trends in U.S. Working-Age Non-Hispanic White Mortality: Rural-Urban and
Within-Rural Differences,” Shannon M. Monnat, a professor of sociology at Syracuse
University’s Maxwell School, explained that “between 1990-92 and 2016-18, the mortality rates
among non-Hispanic whites increased by 9.6 deaths per 100,000 population among metro
males and 30.5 among metro females but increased by 70.1 and 65.0 among nonmetro (rural
and exurban) males and females, respectively.”

Monnat described these differences as a “nonmetro mortality penalty.”

For rural and exurban men 25 to 44 over the same 28 years, she continued, “the mortality rate
increased by 70.1 deaths per 100,000 population compared to an increase of only 9.6 among
metro males ages 25 to 44, and 81 percent of the nonmetro increase was due to increases in
drugs, alcohol, suicide, and mental/behavioral disorders (the deaths of despair).”

The divergence between urban and rural men pales, however, in comparison with women.
“Mortality increases among nonmetro females have been startling. The mortality growth among
nonmetro females was much larger than among nonmetro males,” especially for women 45 to
64, Monnat writes. Urban white men 45 to 64 saw death rate per 100,000 fall from 850 to 711.1
between 1990 and 2018, while death rates for rural white men of the same age barely changed,

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894.8 to 896.6. In contrast, urban white women 45 to 64 saw their death rate decline from 490.4
to 437.6, while rural white women of that age saw their mortality rate grow from 492.6 to 571.9.

In an email, Monnat emphasized the fact that Trump has benefited from a bifurcated coalition:

The Trump electorate comprises groups that on the surface appear to have very
different interests. On the one hand, a large share of Trump supporters are working-
class, live in working-class communities, have borne the brunt of economic
dislocation and decline due to economic restructuring. On the other hand, Trump has
benefited from major corporate donors who have interests in maintaining large tax
breaks for the wealthy, deregulation of environmental and labor laws, and from an
economic environment that makes it easy to exploit workers. In 2016 at least,
Trump’s victory relied not just on rural and small-city working-class voters, but also
on more affluent voters. Exit polls suggested that a majority of people who earned
more than $50,000 per year voted for Trump.

In a separate 2017 paper, “More Than a Rural Revolt: Landscapes of Despair and the 2016
Presidential Election,” Monnat and David L. Brown, a sociologist at Cornell, argue:

Work has historically been about more than a paycheck in the U.S. American
identities are wrapped up in our jobs. But the U.S. working-class (people without a
college degree, people who work in blue-collar jobs) regularly receive the message
that their work is not important and that they are irrelevant and disposable. That
message is delivered through stagnant wages, declining health and retirement
benefits, government safety-net programs for which they do not qualify but for which
they pay taxes, and the seemingly ubiquitous message (mostly from Democrats) that
success means graduating from college.

Three economists, David Autor, David Dorn and Gordon Hanson of M.I.T., the University of
Zurich and Harvard, reported in their 2018 paper, “When Work Disappears: Manufacturing
Decline and the Falling Marriage Market Value of Young Men,” on the debilitating consequences
for working-class men of the “China shock” — that is, of sharp increases in manufacturing
competition with China:

Shocks to manufacturing labor demand, measured at the commuting-zone level,

exert large negative impacts on men’s relative employment and earnings. Although
losses are visible throughout the earnings distribution, the relative declines in male
earnings are largest at the bottom of the distribution.

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Such shocks “curtail the availability and desirability of potentially marriageable young men along
multiple dimensions: reducing the share of men among young adults and increasing the
prevalence of idleness — the state of being neither employed nor in school — among young
men who remain.”

These adverse trends, Autor, Dorn and Hanson report, “induce a differential and economically
large rise in male mortality from drug and alcohol poisoning, H.I.V./AIDS, and homicide” and
simultaneously “raise the fraction of mothers who are unwed, the fraction of children in single-
headed households, and the fraction of children living in poverty.”

I asked Autor for his thoughts on the implications of these developments for the Trump
electorate. He replied by email:

Many among the majority of American workers who do not have a four-year college
degree feel, justifiably, that the last three decades of rapid globalization and
automation have made their jobs more precarious, scarcer, less prestigious, and
lower paid. Neither party has been successful in restoring the economic security and
standing of non-college workers (and yes, especially non-college white males). The
roots of these economic grievances are authentic, so I don’t think these voters should
be denigrated for seeking a change in policy direction. That said, I don’t think the
Trump/MAGA brand has much in the way of substantive policy to address these
issues, and I believe that Democrats do far more to protect and improve economic
prospects for blue-collar workers.

There is some evidence that partisanship correlates with mortality rates.

In their June 2022 paper, “The Association Between Covid-19 Mortality and the County-Level
Partisan Divide in the United States,” Neil Jay Sehgal, Dahai Yue, Elle Pope, Ren Hao Wang
and Dylan H. Roby, public health experts at the University of Maryland, found in their study of
county-level Covid-19 mortality data from Jan. 1, 2020, to Oct. 31, 2021, that “majority
Republican counties experienced 72.9 additional deaths per 100,000 people.”

The authors cites studies showing that “counties with a greater proportion of Trump voters were
less likely to search for information about Covid-19 and engage in physical distancing despite
state-level mandates. Differences in Covid-19 mortality grew during the pandemic to create
substantial variation in death rates in counties with higher levels of Trump support.”

Sehgal and his colleagues conclude from their analysis that “voting behavior acts as a proxy for
compliance with and support for public health measures, vaccine uptake, and the likelihood of

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engaging in riskier behaviors (for example, unmasked social events and in-person dining) that
could affect disease spread and mortality.”

In addition, the authors write:

Local leaders may be hesitant to implement evidence-based policies to combat the

pandemic because of pressure or oversight from state or local elected officials or
constituents in more conservative areas. Even if they did institute protective policies,
they may face challenges with compliance because of pressure from conservative
constituents.

For the past two decades, white working-class Americans have faced a series of economic
dislocations similar to those that had a devastating impact on Black neighborhoods starting in
the 1960s, as the Harvard sociologist William Julius Wilson described them in his 1987 book,
“The Truly Disadvantaged: The Inner City, the Underclass, and Public Policy.”

How easy would it be to apply Wilson’s description of “extraordinary rates of black joblessness,”
disordered lives, family breakdown and substance abuse to the emergence of similar patterns of
disorder in white exurban America? How easy to transpose Black with white or inner city and
urban with rural and small town?

It is very likely, as Anne Case wrote in her email, that the United States is fast approaching a
point where

Education divides everything, including connection to the labor market, marriage,

connection to institutions (like organized religion), physical and mental health, and
mortality. It does so for whites, Blacks and Hispanics. There has been a profound
(not yet complete) convergence in life expectancy by education. There are two
Americas now: one with a B.A. and one without.

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