![]() Public health people who study guns say gun reform is common sense, that we need background checks and red flag laws. We’ve not realized that the narratives we tell about data really matter. I can show you the charts.” Why doesn’t that work? When I read the stories of your interactions with people on the ACA and gun violence, it seems that having a discussion with them based on data alone wouldn’t be productive for either side. They needed people like Trevor to be martyrs. If somebody like Trevor said, “I demand health care and I want leaders who are going to give me health care,” they couldn’t have afforded tax cuts. He was on a social/political team whose power and authority depended on somebody like Trevor at the bottom of the social hierarchy denying something that would have been good for him. He was telling me, “I’m not signing up for a program if it will benefit people who I see as beneath me on the social hierarchy.” That ideology of not sharing, of worrying about profligate others, caused him to make decisions against his own health. Here’s somebody who wasn’t willing to sign up for a program, even if we would help him, if it would also benefit immigrants and minorities. What do health care workers take from a guy like Trevor? You tell a story about one of those people, Trevor, an ill man who said he’d rather die than get ACA coverage. The narrative about White replacement was so powerful that it caused people to reject a core human drive of health and longevity. I met tons of people who actively, purposefully did not sign up for coverage, even when they were ill. After months of that messaging, we would see people who had been totally for the ACA rejecting the program for these reasons. Then came this relentless messaging that this is going to put the government in your private life, it’s going to take away privileges for you, it’s a handout to minorities. It didn’t matter what their politics were. Someone’s going to help me pay for my checkups or pay for my prescription drugs.” Everybody was for it. In the first couple of months, before it became politicized, people would say, “This sounds great. When I was doing my research in Tennessee, the ACA was starting to take shape. ![]() The way health insurance works and health infrastructure works, you want the most people involved in your network so that you can democratize risk and cost. On an ideal planet, people would want as much access as possible to a social safety net and to physicians. How does racial resentment contribute to the destruction of the health infrastructure? You wrote that the destruction of the health infrastructure contributes to worse outcomes for White people who hold these views. The question is, how did this singular notion of Whiteness as a category of resentment, this victimized notion of Whiteness, get so powerful? There have always been many ways to be White in America. What I mean is the rise of a particular politics of Whiteness that is anti-immigrant, anti-government, ardently pro-gun, bathed in a kind of nostalgia for imagined greatness that is very often racialized. I don’t mean White as a biological category or a genetic category. The interview has been edited and condensed for clarity. Metzl recently discussed his research with AAMCNews. 12 at Learn Serve Lead 2022: The AAMC Annual Meeting, in a session entitled, “Dying of Whiteness: Politics, Policy, and Racial Resentment.” ![]() Metzl, director of the Department of Medicine, Health, and Society at Vanderbilt University in Tennessee, will discuss his observations on Nov. He chronicled his observations, including health data and conversations with residents, in his 2019 book, Dying of Whiteness: How the Politics of Racial Resentment Is Killing America’s Heartland. As a result of these decisions, he contends, gun suicides and school dropouts among White people in those states rose, and their life expectancies fell. The physician and sociologist explored how racial anxieties fueled the repeal of gun control laws in Missouri, dampened enrollments in the Affordable Care Act (ACA) in Tennessee, and spurred education and social services cuts in Kansas. He wanted to know if racial resentment leads some White people to support public policies and make individual decisions that ultimately hurt their own health. While much has been said about how racial anxieties spur public policies that harm the health of people of color, Jonathan Metzl, MD, PhD, hit the road a few years ago with a different question. Photo courtesy of Jonathan Metzl, MD, PhD Jonathan Metzl, MD, PhD, found that “the narrative about White replacement was so powerful that it caused people to reject a core human drive of health and longevity.”
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