Dying of Inequality and Republicanness: Questioning Metzl on Whiteness


G.M. Trujillo, Jr., Ph.D.

Publish date

Tag(s): Legacy post
Topic(s): Cultural Health Policy & Insurance Race

by G.M. Trujillo, Jr., Ph.D.

Critics and academics laud Jonathan Metzl’s Dying of Whiteness. But unlike many academic works, it caught public attention. Metzl toured the country to give talks, and white supremacists even tried to shut down one of his events. The book deserves the praise. It enables readers to grasp that no one is immune from the ills of racism, even white people. The book’s thesis is simple: “a host of complex anxieties prompt increasing numbers of white Americans … to support right-wing politicians and policies, even when these policies actually harm white Americans at growing rates. … [E]ver-more white Americans are, then, literally dying of whiteness” (2020 p. 9, original emphasis). In other words, bad policies are killing Americans of all races, including white people.

However, I think the title Dying of Whiteness makes whiteness sound like a terminal illness we can do nothing to treat. Instead, a more direct and honest title might be Republican Policies and Wealth Inequality Kill Americans, which shows there is an agent doing the killing, and it is wholly preventable.

Ultimately, I agree with Metzl’s conclusion. His statistical and anecdotal evidence is exhaustive. He proves that Missourians complete an alarming number of suicides with guns due to lax gun control measures, Tennesseans sicken without state-backed healthcare, and Kansans live shorter lives due to a crumbling education system. Compared to states with more progressive gun, healthcare, or education policies, conservative states fare worse. All three case studies tie the negative effects suffered by white people to policies in their respective states.

But I have one major question for Jonathan Metzl: is “whiteness” the strongest cause or correlate of the consequences detailed in the book? Metzl never explains what he means by “whiteness,” which is troubling because it is a central idea in a long book. He mentions that whiteness is a political and economic system, not biological (2020, p. 16). He is not trying to reduce race to genes or appearances. And he affirms that systemic racism is the focus of his academic scholarship. I understand that.

But this general explanation of race will not do in Metzl’s case. If people are dying of whiteness, then we need a way to identify it. This thesis is about public health, which usually includes quantitative measures, or at least loosely characteristic qualities that help us to fix a problem. Additionally, Metzl’s account should predict that the whitest states will have the worst healthcare outcomes. So, how do we look for the white states?

To identify white states, we could try to use demographic data, but that will not work for him. In the USA, the states with the largest percentage of non-Hispanic white citizens are Maine, Vermont, West Virginia, New Hampshire, and North Dakota. But the findings here diverge from Metzl’s account. Take life expectancy for example. Three of the whitest states are easily in the top half of life expectancy: Vermont is 11th, North Dakota is 14th, and New Hampshire is 17th. Maine’s result is not great, finishing 31st, but that is far from the worst. And only one state of the whitest is bad, West Virginia, which finishes dead last. So, why is it that only one of the top five whitest states finishes so poorly in a simple measure like life expectancy? Metzl needs to explain how states with the most white people are not actually the whitest (in his sense of the term).

Maybe Metzl can rely on his idea that “whiteness” is not biological and does not track demographic categories. But then he owes an explanation as to which policies are white and why. He offers some explanation by saying that whiteness is connected to “backlash governance” and “white racial resentment” (2020, p. 7). But beyond nebulous, affective markers, I do not know how to identify “white policies” with any precision.

This problem is intensified by Metzl’s analysis. According to his own data “whiteness itself is a negative health indicator” (2020, p. 9). That is, policies are making white people sicker. So, if whiteness is a social and economic system, it is actively working against the quality of life of white people. What makes that policy “white” then? By Metzl’s own account, white policies harm white people. So, if the policy is acting against white people, is it “white” because of the psychological backstory of backlash or resentment? And if so, how can we measure that? It will be difficult to explain how white policies actively work against white people.

Maybe Metzl has an out: white policies can cater to white identity or white social control, even though they decrease the physical and psychological wellbeing of white people. With this explanation, it is not that white people are irrational; it is that, when they face a choice between two goods that cannot be had at the same time, they choose one over the other. When white systems choose between white supremacy and health, they choose supremacy.

Beyond this explanation, though, I do not understand what a “white policy” is. In contrast, I do understand what an anti-Black or anti-Latino police is. They lead to higher conviction or poverty rates, for example. They lead to declined mortgage applications and neighborhoods full of heavy industry and interstates. Metzl could mean that policies are anti-white. But again, he would need to explain the whiteness of such an anti-white policy. In other academic works, people can explain things with the blanket concept of white supremacy. But how does white supremacy fit with killing white people, or is it just enough that white people die at slower rates than non-white people? Such a puzzle deserves a discussion longer than the cursory one given in the introduction. This is doubly so because he uses quantitative public health data to make his case, and he places theoretical weight on the concept of whiteness. In other words: I understand what a white person is, but I do not understand what a white policy is, especially since white policies do not actually result in good things for white people.

I do not want to be critical without also providing my own interpretation. So, let me offer an alternative theory that basically agrees with Metzl but has better correlations than “whiteness.” Consider the bottom five states in life expectancy—West Virginia, Mississippi, Alabama, Kentucky, and Tennessee. They are not the whitest states. But they are strongly Republican (as are the rest in the bottom ten—Louisiana, Oklahoma, Arkansas, South Carolina, and Missouri). That is, when I see the data, I do not see people dying of whiteness; I see Republican policies killing Americans. This political analysis also explains why Maine, Vermont, and New Hampshire—decidedly white states—are not sick; they are not Republican, even though they are white.

I suspect that Metzl avoids these issues because he wants to extend an olive branch to Republicans. But it is a curious rhetorical move that he preserves Republicanism by criticizing whiteness; racial discussions seem more polarizing that political ones. So, he chose one hurdle for a higher one. Metzl concludes his book by inviting Republicans to envision a “more progressive form of conservatism” that invests in schools, libraries, parks, daycare centers, and social safety nets (2020, p. 287). These would, according to his research, improve healthcare outcomes. I agree with this treatment plan. But again, these therapies seem to combat conservatism in the contemporary United States rather than systemic whiteness.

Metzl closes the paperback version of his book with this: “I strongly reject the notion that white Americans need to apologize for their whiteness—just as I refute the idea that anyone of any background should be asked to apologize for or ‘unbecome’ who they are” (2020, p. 290). That point seems right to me. We cannot choose our race or whether our communities racialize us. However, we can choose our political affiliation. And if, after analyzing the data, people vote for Republicans as they create policies today, I think shame is the least we can ask of them.

I cannot close this review without wondering where Metzl’s analysis of class is. To me, the examples show that rural Americans, especially, are suffering. The data supports that. But writing about the rural poor in this way makes me wonder whether incautious readers will scapegoat the rural poor.

For example, in discussing the education system in Kansas, there is little mention of rich families sending their children to private schools, which demotivates reform for public school systems. There is little discussion of tying school funding to property taxes, which produces systemic inequalities that rich people do not face.

Additionally, in a discussion about state-backed healthcare and social safety nets, Metzl makes no mention that Americans can pay no more than $9000 per year in supporting social security, effectively leaving income above $150,000 untaxed for this. Or there is little discussion of how the IRS admitted that it is cheaper and easier to audit the poor, so they focus on that.

A surface interpretation of Metzl’s book would portray white people as poor and resentful. But this crops the whiteness family portrait to exclude suburban and elite white people, those who consistently approve voter suppression measures, undermine criminal justice reform, or remain comfortably indifferent in their suburban developments. This omission seems suspect in a book on public health written by a professor at a private, elite, wealthy institution. I wish Metzl would also have interviewed people at country clubs or political fundraisers to ask why they supported racist polices. Missouri, Tennessee, and Kansas have non-poor white people too.

The data and the anecdotes provided in Metzl’s book make it worthwhile. It is a new way of showing how racism has real consequences. But the theory of “whiteness” operative throughout the book is enigmatic. This is especially the case when political affiliation or class can more easily explain what Metzl describes. Republican states do worse at public health. And rich people, of both parties, contribute to the sickening of poor people of all races.

I hope that Metzl’s book gets a second edition. But in it, I hope he takes the problem I found seriously. I think it could easily be addressed by analyzing a state like New Hampshire to explain whether it fits the same pattern. Whenever I read the book in its present form, however, I see that white America might be dying of whiteness. But all the clues in Metzl’s book show wealth inequality and conservative politics are holding the knife.

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