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Two data analyses identify health-related variables that may explain why certain counties voted for Trump

REUTERS/Aaron Josefczyk
The data suggest that the ill may have been particularly susceptible to Donald Trump’s message.

Two separate analyses of county-level U.S. health data — one by a pair of American economists and the other by the editors at the London-based news magazine The Economist — offer interesting new theories into why the death rate for white, middle-aged Americans has increased in recent years and how that increase is associated with President-elect Donald Trump’s popularity among white voters. 

First, some background: A year ago, two Princeton researchers made headlines when they reported that, starting in 1998, the death rate for white middle-aged Americans — those aged 45 to 54 — reversed. Instead of continuing a decades-long downward trajectory, the rate began to steadily increase by about one-half percent per year.

That disturbing death-rate turnaround did not occur among black or Hispanic middle-aged Americans (their death rates continued to decline), nor did it happen among middle-aged whites in other wealthy countries.

The authors of the study said they weren’t sure exactly sure why the life expectancy of middle-aged white Americans (particularly men) had shortened, but their leading theory had three suspects: substance abuse (alcohol, prescription opioids and heroin), suicide and chronic liver disease.

An ‘economic shock’

But what triggered the substance abuse, suicide and liver disease?

In a study published in draft form last week, Justin Pierce of the Federal Reserve Board and Peter Schott of the Yale School of Management point to a specific “economic shock”: liberalization of trade between the U.S. and China.

The two economists argue that after President Bill Clinton and Republican lawmakers granted permanent normal trade relations to China in 2000, millions of workers in “factory” communities across the U.S. lost their jobs. Many of those workers never recovered economically and fell into depression and addiction, which led, in turn, to greater rates of suicide and drug overdoses.

Here’s a summary of the study by Slate reporter Jordan Weissman:

[It] shows that, compared to the rest of the country, counties where local manufacturing businesses were more vulnerable to Chinese competition saw their job markets deteriorate more severely, and experienced greater increases in deaths by suicide and “accidental poisoning” — a category that includes drug overdoses. They found “mixed” evidence of increased deaths from alcohol-related liver disease.

The rising mortality rates were concentrated among whites. Pierce and Schott generally found no relationship between the change in China’s trade status and suicide or poisonings among blacks or Asians, for instance. The impact was also stronger in communities where fewer people had gone to college. In other words, trade with China seems to have brought more despair and tragedy to working-class white communities.

The study also found, however, a health-related upside to the opening up of trade with China. As Washington Post reporter Max Ehrenfreund notes, “that exposure to Chinese competition significantly reduced the number of heart attacks, possibly because fewer people were doing strenuous labor.” 

Schott told Ehrenfruend that he believes that free trade offers U.S. workers, as a whole, important economic benefits, but that government officials need to do more to help individuals and communities displaced by such policies. 

“I’m in favor of free trade, but I’m also someone who believes that we should be honest about the consequences,” he said. “It doesn’t benefit everyone equally.”

Illness as indicator

The Economist editors also looked at county-level health data, but with a different purpose in mind. They wanted to see if the data could help explain Donald Trump’s election win.

Their results seem remarkably related to those of the Pierce-Schott study. For they found that health was a strong predictor of how a county voted in the presidential election. The sicker a county’s residents (overall), the better Trump did.

Here is the editors’ explanation of what they looked for and what they found:

Since Donald Trump’s surprising victory in America’s presidential election on November 8th, polling enthusiasts have been poring over the data to try to understand precisely how he won. The single factor that best predicted the amount of votes that Republican’s gained compared to 2012 is the share of voting-age citizens who are both white and do not have a college degree. This variable alone can explain 41% of the county-level swing to Mr. Trump. For many that statistic might provide closure on what was a bitter and forgettable election. But Patrick Ruffini, a pollster, called on “data nerds” to find another variable that matches the explanatory power of this pale pedagogic predictor.

Fighting fit for such a challenge, The Economist has crunched the numbers and discovered a coherent set of variables that beat it: an index of health metrics. Together these variables can explain 43% of the Republican party’s gains over the Democrats. Even when controlling for a battery of other indicators — race, education, age, gender, income, marital status, immigration and employment — these health metrics remain significant and predictive.

The data suggest that the ill may have been particularly susceptible to Mr. Trump’s message. According to our model, if diabetes were just 7% less prevalent in Michigan, Mr. Trump would have gained 0.3 fewer percentage points there, enough to swing the state back to the Democrats. Similarly, if an additional 8% of people in Pennsylvania had engaged in regular physical activity, and the rate of heavy drinking in Wisconsin were 5% lower, Hillary Clinton would have won the electoral college vote and be set to enter the White House.

“Polling data suggests that on the whole, Mr. Trump’s supporters are not particularly down on their luck: within any given level of educational attainment, higher-income respondents are more likely to vote Republican,” the editors add. “But what the geographic numbers do show is that the specific subset of Mr. Trump’s voters that won him the election — those in counties where he outperformed Mr. Romney by large margins — live in communities that are literally dying. Even if Mr. Trump’s policies are unlikely to alleviate their plight, it is not hard to understand why they voted for change.”

FMI: You can read The Economist’s article on the journal’s website. Pierce and Schott’s study was published as a working paper by the nonpartisan National Bureau of Economic Research, where it is, unfortunately, behind a paywall.

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Comments (7)

  1. Submitted by Jim Million on 11/28/2016 - 09:31 am.


    Seems as if we heard this somewhere before last week.

    [will this be the sole comment here this day, as on so many others?]

    • Submitted by elizabeth shanklin on 11/28/2016 - 01:17 pm.

      increased deaths and suicides for men over 50

      This phenomenon is not new…as a therapist working in the western suburbs of twin cities this was painfully obvious 10 years ago. Older workers safety net is shaky at best with loss of affordable healthcare it’s a triple wammy.Of course they voted for Trump, most are still hopeful that manufacturing will return and that the economy will change. Why the democrats didn’t see it coming I don’t know, I would have told them if they asked me. Trumps general statements are easier to handle than the truth….which is take a look at the corporations, banks and international trade and demand a change in tax structure and value added tax. I didn’t hear it mentioned by either party except as generalities. . My job is help people find hope, economically there just isn’t any for the working class in this country. The children of these older working gentlemen are struggling while working two and three jobs to feed their children and find housing that is now priced beyond their reach, increasing the pressure on the older worker to assist at a time they may need assistance themselves. Meanwhile if the worker is ill or injured there is little to help him hold onto his house and his pension, if he has one. The workers are holding on to old beliefs in the America we used to know, unable to develop new skills fast enough, unable to afford healthcare, and its two years to even be considered by social security disability, which the politicians state they want to privatize. What a recipe for disaster. As a well educated feminist democrat I didn’t hear anything that came close to a plan to help the American working class from any direction. The holding onto old beliefs, that unregulated capitalism is the answer, is obviously not the answer, nor is carrying loaded weapons on the front seat of your car to defend against a nameless traumatized immigrant who came to steal the job that doesn’t pay enough to keep anyone above the waterline. Until I see this stated clearly by anyone who is in elected office (other than Bernie Sanders) I can see the death rate for the old American worker will continue to reflect the futility of the American Dream that I grew up to appreciate.

      • Submitted by Jim Million on 11/28/2016 - 04:24 pm.

        I concur…

        I heard only some vague notions about “retooling” those workers for the tech industry. Sure, for some, perhaps. What does a guy who smelted iron or a woman who assembled washing machines do in that line of work? Enter data? Not an easy or even horizontal movement, for sure. Haven’t those who could make such moves already done so, given any realistic opportunity?

        We might look at Europe, and perhaps our coming generations of poorly employed and unemployed people.

  2. Submitted by Connie Sullivan on 11/28/2016 - 02:04 pm.

    People keep saying that it was the newly-impoverished former well-paid white factory workers who elected Trump. But then we read that it really was white voters, most of them college-educated and earning upwards of about $70,000. Middle-class, although feeling shakily middle-class–their problem was their FEAR of falling into the working class.

    So, we’re left with economic FEAR, plus a huge dollop of pure racism and xenophobia and misogyny (among women as well as among men).

  3. Submitted by Jim Million on 11/28/2016 - 04:27 pm.

    By the way…

    Thanks to others for looking through the “Perryscope.”

  4. Submitted by Greg Kapphahn on 11/28/2016 - 06:19 pm.

    How Soon We Forget

    Clinton’s original plans for NAFTA included strong protections for those who would be negatively affected:…

    financial assistance, retraining assistance, etc….

    but while the Republican Congress gladly passed NAFTA,…

    they REFUSED,…

    and have continued to refuse,…

    to fund any of the programs designed to assist those whom “free trade” damaged at the time and continues to damage.

    Clinton didn’t do the damage to these people.

    Newt Gingrich and his fellow “contract on America” Republicans were the ones who did that damage.

    And we STILL haven’t faced up to what we’re going to do about the current reality,…

    which will only get worse,…

    that we ALREADY do not need everyone to work to accomplish all the work that needs to be done in this country.

    When most of the work in the country is being done by machines,…

    and human workers are far less necessary than they once were,…

    which is ALREADY the case,…

    how are folk going to make a decent living?

    Currently, we’re giving all the savings from mechanization/computerization,…

    and the resulting increased profits to the top 1%,…

    and letting the workers we don’t need starve,…

    or die of the side effects of stress caused by what we’re doing to them:…

    addiction and suicide,…

    and feeding them misinformation through the media so they never realize what’s happening,…

    and they keep voting for the people who are doing this to them.

    Will we just keeping doing this until the 1%ers completely destroy American,…

    (which they will because they’re too blinded by the effects of having all that money to see the massive destruction they’re causing)?

    Probably so, especially if the climate hits a “tipping point”,…

    and completely whacks out.

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