The way that we vote and the policies our leaders put in place can have significant ramifications for public health, as well as for our own health. Jonathan M. Metzl’s Dying of Whiteness shows how specific policies have negatively impacted public health (and other measurable outcomes). I was fascinated by this read, and wanted to discuss some of the data and subjects Metzl covers here.
Gun Rights and Public Health in Missouri
Missouri was once one of the most restrictive states in the union when it comes to gun laws. Then, after the turn of the century in the early 2000s into today, major support for repealing these gun control laws was stirred up. Now, Missouri boasts some of the greatest “gun rights” in the country, including the “guns everywhere bill” which removed “requirements for training, education, background checks, and permits needed to carry concealed weapons…” and also “annulled most city and regional gun restrictions” while expanding the “Castle Doctrine” against perceived dangers (24). Thus, Missouri can truly act as a kind of measuring stick for whether more guns yields less crime and, for Metzl’s focus, better public health.
Statistics show that since the 2007 repeal of the permit-to-purchase handgun law in the state, there has been a 25% increase in firearm homicide rates. Additionally, “Rates of gun death by suicide, partner violence, and accidental shooting soared as well” to the point that in 2014, for the first time in the state, gun deaths topped motor vehicle accidents for cause of death in the state (25). A common refrain, of course, is that “guns don’t kill people, people kill people.” What such a slogan ignores is that guns make people much more effective at killing people, often including themselves. The statistics and supporting studies suggest that gun laws including things like a permit-to-purchase law, reduces deaths, especially those by suicide.
The Affordable Care Act and Public Health in Tennessee
Tennessee’s politicians and popular voters went against funding the Affordable Care Act after it was passed, and this has had significant outcomes in terms of public health. Because Medicaid wasn’t expanded as it could have been, this meant that between 1,863-4,599 black lives could have been saved but weren’t, and between 6,365 and 12,013 white lives might have been saved as well. I’m not an expert in how they get these numbers, but Metzl draws out both the method and the implications (174-175). Effectively, because people in the state of Tennessee gave into fears about “socialism” as well as racially charged rhetoric of “welfare queens,” they voted themselves into death, sometimes literally dying instead of getting the benefits that may have saved them if they had simply funded the ACA. One telling interview Metzl conducted includes a man who is likely dying from hepatitis C who says that he’d “rather die” than have “my tax dollars paying for Mexicans or welfare queens” (3). Metzl concludes from this and many other conversations that “Trevor voiced a literal willingness to die for his place in this hierarchy [of racially charged superiority], rather than participate in a system that might put him on the same plane as immigrants or racial minorities” (4).
What is even scarier about this is that proposed policies continue to pile on the negative public health outcomes. The number of uninsured Americans is projected to skyrocket back up if the ACA is repealed or replaced with a policy that fails to fund it adequately. Unfortunately, those most in need are the ones projected to suffer most. Learning about the real-world impact of sloganizing health care is something we all ought to do.
Education and Public Health in Kansas
The state of Kansas is a real world example of what happens when libertarian, anti-tax policies are incorporated at a state-level into the education system. When Kansas voted in significant Republican, libertarian-leaning leadership, Kansas became an example of what happens when policies of pro-corporate tax cuts and the notion of trickle-down economics is fully implemented. HB 2117, signed by governor Brownback, reduced taxes on top tax brackets by 25% (201). Along with these, the school finance bills that continued to pass defunded public school while simultaneously declaring that this lack of funds were “a win for Kansas students” (201, quoting Brownback).
What’s remarkable about this is that the public health impact on defunding schools can be measured. Additionally, Kansans of color are demonstrably more likely to be negatively impacted by the tax plans implemented by the government (212). As schools were defunded, graduation rates fell, as did commitment to higher education and post-graduate programs. Measurements that include “all-cause death rates” show a decline as Americans achieve higher education. Thus, a US adult without a high school diploma “can expect to die nine years sooner than college graduates” and the difference between someone with a college degree or a professional degree is five years of life expectancy. Additionally, adults without high school diplomas are more likely to have diabetes and other negative health outcomes (242). So, apart from all questions of whether cutting funding for schools somehow improves their outcomes–itself a highly questionable claim–the ties to public health alone show that Kansas effectively reduced its citizens life expectancy due to these funding cuts.
Quite seriously, the politics of resentment and dogma that has a knee jerk reaction to certain words means that we as a country are voting ourselves into poor health outcomes. Dying of Whiteness is a fantastic read that will challenge readers from all political perspectives to think about possible longer term impacts of the policies they support. I very highly recommend it to you, dear readers.
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