Rising death rates in red America is an underreported story with deep ideological roots.
Very likely, the reader is wearily familiar with one of the memes that American right wingers endlessly repeat. It’s called the Great Replacement: the claim that shadowy but apparently omnipotent elites are deliberately replacing the old stock (meaning white) American population with Third World foreigners.
I have argued before that Republicans have become a death cult, and one can see evidence in the diatribes of conservatism’s faux-intellectual wing.
The notion had its beginnings decades ago in the mental swamps of Southern segregationist policticians and continued in various iterations through white supremicist groups. Trump’s election and the phrase’s popularization by professional jackasses like Tucker Carlson made it into another of the Republican base’s innumerable slogans.
The idea is bunk, and is easily understood as one more of the many myths designed to play into right wingers’ persecution complex. But it is possible also to understand it as a kind of folk psychological projection of something that is indeed happening in the strongly Republican regions of the country inhabited by what Sarah Palin called “real Americans.” It’s not so much the Great Replacement as the Great Die-off. And Republicans are both its chief promoters and its main victims.
The phenomenon first received attention in 2015 from a paper by Anne Case and Nobel Prize laureate Angus Deaton. They detailed first, the stagnation, and then the absolute decline in life expectancy among non-Hispanic white populations, particularly in white rural areas of the country. They charted a significant rise in “deaths of despair” like suicide or drugs (particularly synthetic opioids) among the white working class.
This phenomenon cannot be explained by economic disadvantages in rural areas as compared to cities. Black and Hispanic populations also experience economic disparities, but their rates of midlife mortality are still declining significantly, while those of whites with no college education are rising.
Much has been written about the demographic collapse of Russia. In 2021, Russia experienced a population loss of nearly one million, following many years of decrease after a decline that started in the 1980s. Its population is now smaller than Bangladesh and its per capita income lower than the Maldives. Male life expectancy is also below that of Bangladesh. In 2022, with combat deaths, economic sanctions, and the exodus of at least 900,000 people, most of them young and educated, the demographic decline may have accelerated into free-fall.
Russia’s case is considered singular in the developed world. Yet swathes of America are beginning to replicate it. Owsley County, KY, has a life expectancy similar to that of Russia; from 1980 to 2014, county’s cancer death rate increased by 45.6 percent, the largest increase in the country. In 2020, Donald Trump received 88 percent of the Owsley County vote. This correlation between early death and Republican voting may be one of the biggest stories of the decade
With the onset of the COVID pandemic in 2020, the longevity disparity increased between regions in the United States, a gap that again can be explained by political leanings. Statistical research has consistently shown higher COVID death rates in Republican jurisdictions than in Democratic ones. The gap increased after the rollout of COVID vaccines. A study by Lancet Regional Health-Americas found that the more conservative the voting records of congresspersons and state legislators, the higher the age-adjusted COVID mortality of the district, even after compensating for race, education, income, and vaccination rates.
This partisan difference in death rates also applies to traffic deaths. Some of this might be explained by the fact that Republican areas tend to be rural, which means higher speeds on two-lane roads, worse engineering of those roads, and longer trips from the accident scene to the emergency room. But a sociologist who studies the attitudes of red-state conservatives suggests an additional factor: “. . . a kind of cowboy mentality, a kind of deregulatory, anything goes culture” existing in these places may result in carelessness. The gap in seatbelt use would tend to support this hypothesis.
If we recall the Republican-generated uproar over Michelle Obama’s campaign to encourage schoolchildren to eat healthy food, it might be expected that spinach and KFC would be totems of the culture wars. Sure enough, there is a correlation between political leaning and obesity, a condition strongly associated with early death. There is also a striking correlation between areas that supported Donald Trump and the presence of fast-food chain restaurants.
Could it be that poorer areas cannot sustain more expensive restaurants with healthier fare? Possibly, but their ubiquity in red states may also be connected with the fact that it is overwhelmingly red states that have passed laws prohibiting civil suits against fast-food franchises over obesity. One doesn’t have to be a Republican to think one’s dietary preferences are largely a matter of personal responsibility that generally precludes third-party liability. Nevertheless, it is one more case, like firearms, of Republican politicians immunizing an industry (and potential donors) from lawsuits. How many of us would get a queasy feeling if auto manufacturers were similarly immunized from legal recourse?
This year, Scientific American summarized the result of all these factors: a striking differential in overall death rates in Republican versus Democratic counties, a gap which has been widening for 20 years and which shows no sign of leveling out. The article suggests that policy choices are a factor.
It is easy enough to rationalize the disparity by pointing to external factors, such as poorer quality and less available health care in rural communities where Republicans are more likely to live, along with less developed infrastructure (such as roads) in general. But here, too, conditions may be the result of decades of political choices made by Republican residents in electing state and local officials.
During the pandemic, Florida governor Ron DeSantis prohibited localities from implementing masking and social distancing ordnances. The fact that DeSantis was overwhelmingly reelected demonstrates that a majority approved of his policy, and the resulting additional deaths were “worth it,” (whatever “it” is”).
Social scientists are likely to shy away from drawing admonitory conclusions about behaviors that link to partisan values. But there would seem to be enough evidence to infer that the blue-red gap in the death rate is determined mostly by political attitudes, not external economic factors.
If someone is conditioned by Fox News or an angry voice on AM radio to disbelieve the public health measures for COVID, he is more likely to die of COVID. If someone makes “personal freedom” such an obsession as to defy common-sense safety precautions, he is more likely to drive without a seat belt or engage in risky behaviors hinting at the redneck joke beginning, “hold my beer and watch this.” If he repeatedly elects politicians who demonize government, he shouldn’t expect to get treated at a fully-equipped rural hospital.
Possibly there is also a more indirect, but deeper explanation for the white Republican die-off. If they are fed a steady diet of fear, rage, resentment, and loss, this may condition a fatalistic mental state that has real-world consequences. The Great Die-off is at bottom self-sacrifice to an angry pagan idol that can never be propitiated.
I have argued before that Republicans have become a death cult, and one can see evidence in the diatribes of conservatism’s faux-intellectual wing. In 2016, right-wing operative Michael Anton, writing under the pretentious pseudonym Publius Decius Mus, wrote The Flight 93 Election, a hysterical likening of a low-turnout presidential contest between a toxic bully and a lecturing scold to Armageddon, in which true conservatives were the doomed passengers of a hijacked plane rushing the cockpit.
During the COVID pandemic, First Things, a website which seeks and invariably finds theological justification for its crank political views, published a piece in a similarly apocalyptic vein. R.R. Reno, its editor, wrote “Say No to Death’s Dominion.” Contrary to the title, he argues that death should be embraced, and that those who save lives through medical science are in league with Satan.
This echoes the theology of the Religious Right, which has turned its back on science, progress, and humanitarianism because the Rapture may come at any time. It is but a short step from viewing life as a vale of tears to calling modern medicine junk science and mandatory seat belt use an oppression by Safety Nazis. Given that evangelicals are the largest segment of the Republican base, it is hardly surprising that Republican areas should suffer from higher rates of preventable death.
Paranoid crackpots have been scribbling since the dawn of written language; why should they be so influential now, to the point where they are dragging down American life expectancy? Post-World War II American conservatism always had an apocalyptic, doomsaying strain; one need only think of Whittaker Chambers or James Burnham, whose works were replete with cataclysms and existential catastrophes. Even William F. Buckley, Jr., the putative founder of modern conservatism and a supposedly sunnier, more optimistic philosophy, said that the mission of conservatism was to “stand athwart history yelling stop.” But to do so also means yelling “stop” to science, enlightenment, and the amelioration of human suffering.
What has changed is that the American conservative ecosystem, once a counterculture that people could ignore for days at a time, has been suitably dumbed down, amplified, and infused with the ill-gotten loot of sinister billionaires to the point where it has become a Media-Entertainment Complex fully on par with Hollywood and the mainstream media. Crackpots who were once howling in the wilderness are now the savants of this propaganda empire. The Turner Diaries is now far more influential than it was when it was written in 1978.
Consistent with this development, the Republican Party has evolved into an anti-party. Its agenda largely consists of stunts, trolling, performative cruelty, and gaslighting. Such legislation as it bothers with is mostly designed to negate laws already on the books; its amendments are poison pills intended to doom substantive legislation.
The GOP has become a religious-ideological mashup embodying the worst features of post-World War II conservatism and Religious Right knownothingism. As for the religious part, many religions emphasize “transcendence,” the existence of a purer, better world than the merely material one we temporarily inhabit. Buckley was fond of using the word in hammering home conservatism’s spiritual superiority.
But what we see in the Republican Party, and in the results it has wrought in places where it is entrenched, is not transcendence, but its philosophical cousin: nihilism. It is advocating needless death, either to own the libs or find salvation, and its followers are embracing it, just as they embrace political violence, in a kind of slow-motion Jonestown. If political parties were labeled with consumer information in the manner the Food and Drug Administration mandates that cigarettes be labeled, the GOP would be branded with bold letters: “WARNING: THIS PRODUCT WILL KILL YOU.”
Mike Lofgren is a former Republican congressional staff member who served on both the House and Senate budget committees.
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