Death and Dyin' in Muskogee

Here's something else to think about:

In modern times, rising death rates are extremely rare and typically involve countries in upheaval, such as Russia immediately after the collapse of the Soviet Union. In affluent countries, people generally enjoy increasingly long lives, thanks to better cancer treatments, drugs that lower cholesterol and the risk of heart attacks, fewer fatal car accidents, and less violent crime.


But progress for middle-aged white Americans is lagging in many places — and has stopped entirely in smaller cities and towns and the vast open reaches of the country. The things that reduce the risk of death are now being overwhelmed by things that elevate it, including opioid abuse, heavy drinking, smoking and other self-destructive behaviors.

This appeared yesterday in the Post.  Although the article is a bit scattered, one bottom line is this: the health of rural america is declining, particularly among the under-class.   It's probably not wholly surprising that it is occurring in areas that are predominantly religious, predominantly conservative in their political orientation, and predominantly Trump supporters.   As Jeff Guo wrote:

a few weeks ago, following the Republican Iowa caucuses, I pointed out an eerie correlation in the voting data. It seems that Donald Trump performed the best in places where middle-aged whites are dying the fastest.  That wasn't a fluke. The relationship between white mortality and Trump support is real, as the fresh results from Super Tuesday confirmed.

Part of the decline can be, I think, attributed to an "irony deficiency."  Here's one way of thinking about it. Merle Haggard recently passed away, and I have to admit, I like his music, but his most familiar song, Okie from Muskogee,  though dated, points to the deficiency.   There is a self-image of being down-to-earth Americans, who "like livin' right, and bein' free," who still "wave old glory down at the court house."  The prevailing myth is that rural life is more wholesome, and they pride themselves on the ethical superiority of down-home small-town folk, They still like to think of themselves as "living' right, and bein' free" despite tangible evidence to the contrary.  The rising death rate is just one piece of evidence that suggests they are not "living right," but the prevailing myth allows them to go as if everything were fine.  

Anecdotally, one of my "buddies" from the shop, fueled by the delusion that he was going to be the next Merle Haggard, told me he couldn't abide (his word) even Nashville.  Although he isn't obese, he does smoke, and he does binge drink regularly to excess.  He is unemployed, and unemployable because he wouldn't be able to pass a drug test.  He has used meth, but gave that up after "it nearly killed" him, though I suspect the damage done helps him keep the weight off.  He still "smokes marijuana," if not in Muskogee, then in Mountain Home.  There is little about him that is wholesome, or healthy, but at least he's "bein' free."  He supports Trump, and wants to make America great again, though I'm not altogether clear what his vision of greatness might be.

Here's another case of "irony deficiency."   A consumer advocacy group, Wallet Hub, ranked states by most to least dependent on federal aid.   One could point to the greater dependency of conservative rural states on federal assistance, among other things, for additional evidence that they are not self-reliant folks "living free" from assistance.   Having said that, however, they WANT to live with greater freedom from federal dependency, and they have chosen health care as one place to make a stand. As Ben Hallman of the Huffington Post reports,

the most obvious evidence of this trend can be seen in the expansion of Medicaid, the health plan for the poor, under the Affordable Care Act.  Of the 10 states with the biggest dependency gap as determined by Wallet Hub, seven -- Alabama, Mississippi, Louisiana, Maine, Montana, South Dakota and Tennessee -- have decided not to expand their Medicaid programs, even though the funding would come from federal coffers.

I wouldn't go so far as to say that there is a  causal correlation between the increasing death rate among rural whites, but I would go so far as to say that the actions of their elected officials, every last one of them a "conservative," are doing absolutely nothing to help.  On the contrary, they are doing everything they can to resist help.  Perhaps they are, as my wife suggested, trying to thin the herd.   If so, they're succeeding.