Trump Country marked by 'deaths of despair'

Medical study finds Trump strength among voters concerned with rising death rates, lower life expectancy

 President Trump as the lights were inadvertently turned off during a speech at the White House earlier this year. (Twitter)

President Trump as the lights were inadvertently turned off during a speech at the White House earlier this year. (Twitter)

By Ted Cox

Donald Trump thrived in areas suffering from rising death rates in the 2016 election — especially “deaths of despair” — according to a study published this month in a medical journal.

“President Trump targeted populations at higher risk of mortality,” according to the paper, “Independent Relationship of Changes in Death Rates With Changes in U.S. Presidential Voting,” published online in the September issue of the Journal of General Internal Medicine.

To be clear, Trump didn’t seek out populations more likely to die, but found his strongest support in areas suffering more than they had eight years before — a correlation previously pointed out earlier this year in a study on opioids and voting patterns published in the Journal of the American Medical Association.

Key to the findings was a comparison of votes cast by county in the 2008 presidential election, won by Barack Obama over John McCain, and the the 2016 election in which Trump lost the popular vote to Hillary Clinton but prevailed in the Electoral College. Over that same time span, the study pointed out, “Mortality rates among lower-income, rural, non-Hispanic white Americans have been rising, even as they are declining in blacks and Hispanics.”

The study found: “Counties with a net gain in the percentage of individuals who voted for the Republican candidate had a 15 percent higher 2015 age-adjusted death rate than counties with a net gain in Democratic voters. The increase in death rates due to alcohol, drugs, and suicide was also 2.5 times higher in counties where Republicans made gains compared with counties where Democrats made gains.”

“Although life expectancy is increasing in many parts of the country, especially in urban areas, we're not seeing nearly the same gains in rural and middle America,” said study leader Lee Goldman of Columbia University in New York City. “We shouldn't underestimate the degree to which some portions of the country have been left behind in terms of their health. And it's not surprising that health disparities correspond with voting behavior.”

The study labeled “deaths of despair” as those related to alcohol, drugs, and suicide.

We shouldn’t underestimate the degree to which some portions of the country have been left behind in terms of their health. And it’s not surprising that health disparities correspond with voting behavior.
— Dr. Lee Goldman of Columbia University

Most pointedly, it suggested that a candidate like Trump, asking if voters were better off four or even eight years before, would have found support with voters who clearly were not better off. It stated: “A person’s happiness is less dependent on their current status than on recent changes in that status.”

“It's commonly argued that President Trump won by receiving more votes from people who have been left behind economically — especially older, less-educated, and less-urban, white voters," Goldman said. "Based on our data, we can also say that changes in life expectancy were an independent factor in voting choices. Reduced health prospects are an important marker of dissatisfaction, discouragement, hopelessness, and fear — sentiments that may have resonated with voters who sided with President Trump.”

Goldman posited that “deaths of despair,” typically afflicting younger people far short of their life expectancy, would have had an exponential effect on surviving family and friends in how they thought U.S. society was faring. He told the publication HealthDay, however, “People in the counties that shifted to President Trump died from pretty much everything more often.”

“Regardless of your political persuasion, our paper suggests that if health disparities were important enough to influence presidential voting, they may have an even broader impact on our country's future than we had imagined," Goldman said. "It also highlights how much work remains to reduce health disparities.”

The study also found: “Health insurance coverage, which might save lives but cannot fully offset the effects of lifestyle and poverty, increased in counties that became more Democratic and that had greater reductions in death rates. Conversely, counties with higher death rates voted for a Republican presidential candidate whose party promised to repeal the Affordable Care Act.” It labeled that phenomenon “counter-intuitive,” but also suggested it was key to addressing the core issue.

“Although correlation does not imply causality, our findings also suggest that plausible improvements in life expectancy in Michigan, Pennsylvania, and Wisconsin might have shifted their electoral votes to Secretary Clinton,” Goldman said.

The study concluded: “Secretary Clinton hypothetically could have carried Michigan if its prevalence of diabetes was 7 percent lower, Pennsylvania if an additional 8 percent of its residents engaged in regular physical exercise, and Wisconsin if its rate of heavy drinking was 5 percent lower. Death rates may be important markers of the dissatisfaction, discouragement, hopelessness, and fear of cultural displacement that contributed to President Trump’s appeal, especially to the non-urban, white working class.”

That has powerful implications for how to treat Illinois communities that feel abandoned and left behind — and why some politicians might be content to leave them there.