The Public Health Story Behind Trump's Rise

On November 8, 2016, the majority of the White population in the U.S. voted for a leader who ran a campaign rife with fascist themes of restoring “greatness” through a program of xenophobia, misogyny and racism. What we know about income and Trump voters suggests that they are not the poorest Whites, but those who see their communities losing ground. In the New York City and Long Island metropolitan area, for example, the two counties that went for Trump were Suffolk and Richmond. Suffolk County, on Long Island, has a median family income of $102,125, a family poverty rate of 4.8 percent, and 33.5 percent of residents 25 years or older have a BA or higher degree. Richmond, on Staten Island, is somewhat less well-off but still far from poor, with a median family income of $86,619, a family poverty rate of 9.8 percent, and 30.6 percent of residents holding at least a BA.¹

There has been some debate about the relative places of and interconnections between bigotry, racialized class consciousness, alienation, and economic struggles, in explaining voting patterns among Whites, particularly those outside of major cities. Both before and since the election, there has been a thread of discussion among progressive organizers about the impact of socio-economic dislocation and pain among non-elite Whites, which often leads into very real issues about continuing privilege and relative definitions of “marginality.” Median household income among African Americans in New York City,² for example, is in the middle of the range for median incomes in the largely White, and much less expensive, small cities and rural counties in New York State that voted for Trump.³

Public health data offers a different perspective on the severity of the situation experienced by the primary Trump electorate, although it provides no political analysis or solutions; middle aged Whites are the only population in the U.S. whose life expectancy has decreased in the 21^st Century.⁴ In fact, they are the only population in any wealthy country whose life expectancy has declined,⁵ and might be the only population globally whose life expectancy has declined outside of the context of significant social upheaval such as war, epidemic, or national economic collapse. The increase in both mortality and disability largely comes from drug and alcohol poisoning, suicide, and liver disease.⁶

Middle aged and older Whites who don’t live in major cities are the core population of Trump voters. They are facing declining communities, destructive substance use in themselves and their children, and the literal loss of lifespan—experiences which the Trump campaign effectively channeled into support for a populist demagogue who offered to restore their former privilege while mobilizing racist, xenophobic, and misogynist language and rage. History demonstrates the consequences when loss of status fuels right-wing politics, and the public health data measures the depth of crisis in White middle and working class populations. If progressives do not recognize and respond to the situation in these communities, then the fuel for right-wing firestorms is likely to grow.