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Trevor Hancock: Poor, white, angry and unhealthy

Donald Trump’s supporters are often described as poor, white, poorly educated and angry.

Donald Trump’s supporters are often described as poor, white, poorly educated and angry. This is partly true (others also vote for Trump), but there is a related factor that has been less remarked upon, and that I believe is important: The death rate among poor, white, middle-aged Americans is increasing.

I suspect this poor health is both a symptom of and a contributor to the anger and despair that is being felt in the American working class, and that is translating into a political movement that many are warning is reminiscent of the birth of fascism in the 1930s.

Writing in The Atlantic this month, Derek Thompson suggested there are four characteristics of Trump’s voters: They didn’t go to college, don’t think they have a political voice, want to wage an interior war against outsiders and live in parts of the country with racial resentment.

Thompson cites data showing that for those without a high-school diploma, real earnings fell 20 per cent for men and 12 per cent for women aged 30 to 45 between 1990 and 2013. Those with a high-school diploma or some college also did poorly, although not quite as badly, but the proportion of men in this group working full-time, full-year fell from 76 to 68 per cent in that same period.

On the other hand, employment and real earnings increased for women with a bachelor’s degree (men stayed the same), and even more for men and women with an advanced degree. Thompson notes: “Non-college men have been trampled by globalization, the dissolution of manufacturing employment, and other factors, for the last few decades.”

Thompson’s second characteristic is that Trump voters feel voiceless. He cites a RAND study that found “voters who agreed with the statement ‘people like me don’t have any say about what the government does’ were 86.5 per cent more likely to prefer Trump.”

In a recent CBC Radio interview, American journalist Thomas Frank pointed out that Trump talks a lot about trade deals that have led to unemployment, reduced wages and other harmful impacts. Unsurprisingly, these trade deals are very unpopular with those most affected — the people who are core Trump supporters. Yet Frank notes that both the Democrats and the Republicans have supported free-trade agreements and continue to do so, so they cannot speak for those who have been “trampled by globalization.”

Being voiceless is being powerless, and as discussed in recent columns, being powerless to manage or influence the factors that affect your life is bad for your health. So here we have a toxic combination of poverty and powerlessness, with perhaps predictable health consequences.

In a September 2015 article, Anne Case and Angus Deaton (the latter won the 2015 Nobel Memorial Prize in Economics for his work on health, well-being and economic development) described an increase in the death rate of white non-Hispanic men and women aged 45 to 54 between 1999 and 2013. They note that this is unique to whites, is largely driven by increased deaths from alcohol and drug use and suicide, and is accompanied by declines in self-reported health and mental health and increases in pain and disability.

Moreover, they note that this increase in death rates was not seen in any other rich country, and that “it was driven primarily by increasing death rates for those with a high-school degree or less.” In fact, death rates did not change for those with college education less than a bachelor’s degree, and declined for those with a bachelor’s or higher degree. The parallels with the population said to be core supporters of Trump are striking.

In discussing the factors underlying this “epidemic of pain, suicide and drug overdose,” Case and Deaton note that “ties to economic security are possible.” They cite “widening income inequality,” slow growth in earnings in this group and concerns over future pensions. A less comprehensive social safety net than is found in Europe and Canada is probably not helping.

The lesson here is simple, and should be a warning to Canadian governments that do little to address poverty. Drive people into poverty and despair and you will sow the seeds of premature death rooted in alcohol and drug abuse, leading to social breakdown, anger and extremist politics.


Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

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