Dying of Whiteness: How the Politics of Racial Resentment is Killing America’s Heartland (2019) is a work of nonfiction by American writer and psychiatrist Jonathan M. Metzl. The text is based on research that Metzl conducted in Missouri, Tennessee, and Kansas between 2013 and 2018. In these states, he traces gun control, opposition to the Affordable Care Act, and tax reforms—issues that form the core of the Republican Party’s platform. He argues that these policies have negative health effects for conservative lower- and middle-income white Americans. Exploring the connection of whiteness, privilege, and nostalgia along with the effects of racial resentment on public health, Metzl illustrates how and why white voters repeatedly “put their lives on the line” (4) in support of policies and politicians that treat them as expendable.

This guide uses the 2019 Basic Books paperback edition of the text.

Content Warning: The source text includes lengthy discussions of depression and firearm death by suicide.

Summary

In the first section of the text, Metzl travels to Missouri to study the connection between loosening gun restrictions and elevated rates of death by suicide involving guns. Until the early 2000s, Missouri had a long, proud history of gun ownership coupled with relatively tight restrictions on handgun sales. However, in 2007, the state began to repeal these gun restrictions. At the same time, death by suicide rates began spiking. However, a ban on federal funding for research into gun violence has created a “knowledge vacuum” around gun death by suicide and the issue of gun control. Pro-gun white Americans who live in areas with high concentrations of firearms suffer the most from this lack of research.

Metzl explores the historical connections between firearms, white privilege, and masculinity to better understand why this increase in death by suicide remained concentrated among white men. Historically, gun ownership in the United States was a privilege granted only to white men; therefore, guns came to hold significant symbolic meaning, and issues of gun control became politically and emotionally charged. Guns represented white privilege, and white people in states like Missouri were willing to vote in defense of that privilege even as they suffered the consequences of living with unregulated firearms.

The second section takes place in Tennessee, where Metzl gathered focus groups of white and African American men to learn about their perspectives on health, healthcare, and government intervention in healthcare. President Obama signed the Affordable Care Act in 2010, and over the next few years, millions of Americans gained coverage through the bill’s Medicaid expansion. In 2015, Metzl spoke to men in Tennessee—a state that had refused to expand Medicaid—about the ACA. Most of the white men that Metzl spoke with staunchly opposed the ACA, citing concerns about “cost,” even when they themselves were uninsured and suffered from chronic health conditions.

Conversely, the Black men Metzl spoke with generally approved of the ACA, claiming that expanding healthcare would help “everybody.” Metzl argues that expanded access to healthcare put lower-income white people into a “network” with minority and immigrant populations in which individual health also depended on the actions of others. This threatened the white men’s sense of “authority and autonomy,” causing them to oppose the bill that might have improved their health or even saved their lives.

In the final section, Metzl travels to Kansas, where an “experiment” in backlash governance defunded the state’s public schools. Kansas was once known for its high-quality education, and residents took great pride in their schools, feeling like the higher taxes they paid were an investment in their children’s futures. However, in 2011, newly-elected governor Sam Brownback began an austerity plan that cut taxes and slashed state spending. Almost immediately, public schools began to suffer. Urban schools with high concentrations of minority students were hit hardest, but achievement benchmarks fell across demographic groups.

Many Kansans began to express “buyer’s remorse,” and the state legislature even turned against Governor Brownback to reinstate certain income taxes. However, Metzl calculated the connection between high school graduation and life expectancy, arguing that the four years of budget cuts cost Kansans somewhere around 18,550 years of life.

In conclusion, Metzl argues that “dying of whiteness” isn’t just a risk for individuals of certain ideologies. Rather, racial resentment creates policies that negatively affect public health on a societal scale. In their determination to protect the institution of whiteness, white people become the greatest danger to themselves.