Welcome to the Heroin Beltway: Heartland Politics Show Place Still Matters

Why where you live still counts

Politics Features Donald Trump
Welcome to the Heroin Beltway: Heartland Politics Show Place Still Matters

All happy communities are different, but all unhappy communities are unhappy in the same way.

A new study published by a Penn State scholar suggests a mirror-version of Tolstoy’s Anna Karenina principle about happy and unhappy families. We can mark the ascent of the Orangeman by the county mortality rate; in turn, this gives us some insight into what we mean when we speak of jobs, places, and communities, and what they mean to our politics.

As the Washington Post’s James Hohmann notes, Trump’s performance surpassed Romney’s in many ways—clearly so, since he’s about to be sworn in, and Romney is the one hoping for a job—but nowhere did he beat Romney more soundly than in those counties where rates of suicide, drug, and alcoholism are high. The focus of the paper (and this article) is not on the President-elect, but on what, exactly, is transpiring within the core of America.


Shannon M. Monnat, a scholar of rural sociology and the writer of the study, noted the following:

Many of the counties with high mortality rates where Trump did the best have experienced significant employment losses in manufacturing over the past several decades.

Opiate addiction pervades “key campaign issues, including international trade, immigration, and health care,” Monnat wrote. This is one reason why Trump “received so much support in America’s new post-industrial ‘heroin beltway,’” where unemployment and wage stagnation endure.

Trump beat Romney, Hohmann writes, “by an average of 16.7 percent in the quarter of counties with the highest mortality, compared to 8.1 percent in the lowest quartile.” In New England, Hohmann continues, the Orangeman underperformed Willard by an average of 3.1 in low-mortality counties. But look closer: the Donald jumped ahead of Mitt by a swell 10 percent in the highest of the high mortality counties.

Monnat points out that it is not quite accurate to say our fellow citizens are just being killed by addiction. Focusing on Appalachia, the Industrial Midwest, and New England, she writes:

Over the past decade, nearly 400,000 people in the U.S. died from accidental drug overdoses and drug-induced diseases. Nearly 400,000 more committed suicide, and over 250,000 died from alcohol-induced diseases like cirrhosis of the liver. Approximately a fifth of these drug, alcohol and suicide deaths involved opiates (prescription pain relievers or heroin), suggesting that opiates are part of a larger problem. Mortality rates from these ‘deaths of despair’ are much higher among non-Hispanic whites than among other racial/ethnic groups.

In other words, despair did it, not pills or booze. They helped, but another hand pulled the trigger. “Nationally,” Monnat writes, “and in all three regions, Trump performed better than Romney in counties with higher drug, alcohol and suicide mortality rates.”

In America, the richer the place, the longer on average you will live. The difference between the two worlds is, as Monnat terms it, substantial. If you want to die younger, go out to the poor places, the places where you can see the rusted hulk of the American Dream. That was Clinton’s Waterloo.


Our individual well-being is intimately connected to health of the community around us. Depression and anxiety, for example, soar in societies that are wealthy but have low rates of social cohesion and social capital. For instance, the U.S. is about as happy as Costa Rica, despite having 376 times the the GDP ($17.95 trillion divided by $51.11 billion).

All the big negative indicators show up in communities where the bonds of association and affection are frayed. Unhappy communities, of course, can be found in all situations, among all kinds of people. They are not reserved solely to post-industrial cities and shuttered mill towns. The knots of brotherhood can be frayed or nonexistent in suburban communities where nobody knows each other; in neighborhoods with high renter turnover; in close-knit villages where tragedy divides one citizen against another. That is what all unhappy communities have in common—they don’t talk to one another.

The difference between these examples and old mill towns is that prosperity can cover up weak social ties, whereas poor towns, even with the strongest social network, have a much tougher time of it. The rich can afford to be asocial, but the middle class and poor can’t live without their neighbors.

In the Trump towns, the threat is what Monnat calls “economic precarity.” This danger hacks away at all the bonds of familiarity and reciprocity. Economic precarity means less living-wage jobs. It means your job—if you have one—is at McDonald’s, not General Motors. Health insurance and retirement pensions, gone. All of these “diseases of despair” are caused by the social decay which comes from deindustrialization. It means nobody is doing well, anywhere.

“Downward mobility is the new normal,” Monnat says, writing later: “Even when using statistical models that include 14 demographic, economic, social, and health care factors, the drug, alcohol and suicide mortality rate remains a significant and positive predictor of Trump overperformance nationally.”

Where mortality dips, Trump reigns.

Hohmann writes:

Let this sink in: A federal government report released yesterday shows that life expectancy is now declining in America. Besides war, plague and famine, there have been few moments in all of human history when that has happened. This is more troubling because it is not happening in other western countries. The National Center for Health Statistics found that death rates rose for eight of the top 10 leading causes of death in 2015. Death rates rose for white men, white women and black men. This happened despite a drop in the death rate from cancer, thanks to fewer people smoking and better chemo.

I suggest much of this election was about place. Not just your place in line, or place in the social order, but the place where you live. Place has been discussed before, but always in the most condescending terms: as some algebraic equation of adding gun-ownership to NASCAR. The debate is not about Duck Dynasty, but a decent life, and how hard or easy it is to hang on the lowest rung of middle class existence. This is the biggest disconnect between Trump and Clinton country.


This is a world of places. In the economic view of the world, locales do not matter; all is a balance sheet. Everything which is an impediment to the smooth flow of mechanical modernity is to be swept away as anachronism.

Most of us understand the old prejudices are lies: that Russians are not different than the Chinese, who are not different from people in Iowa, or the Inughuit in North Greenland, or the Amondaua in Brazil. All of us are very like the other. We should be; we are part of the same family, after all. Without this similarity, there would be no language, music would have no power, stories have no relevance, and another’s art would fail to move us. Shared humanity is our mother tongue.

But we also know that our circumstances are part of who and what we are; and that these have some say about our day-to-day world. It doesn’t matter if all of our varying accents have seen their velvet rubbed bare by constant contact with the surface of mass media. So what if Kansas, Texas, and Vermont sound closer in speech? If your life is automatically longer in California than it is in Wyoming, place matters. I’ve argued in previous essays that our politics must think globally, and not be caught up by the narrow chauvinism of a single location. Very true; but as bumper-sticker wisdom reminds us, although we think globally, we must act and live locally.

Since the dawn of the post-Cold War world, we have been told that all measures are interchangeable, and one span of ground is the same as another. Yet place matters. There’s a silly libertarian notion that people should go where the jobs are. That’s well and good for the white-collar set, but what if your family has toiled on a plot of Earth for generations? Suppose you helped build a town with your bare hands?

This all makes a kind of fiendish sense, if you actually believe the flow of capital is more important than the well-being of people: in this twisted worldview, humans are one more unit in a business system, similar to trucks and shipping containers. And units—cogs—aren’t supposed to have preferences, or feelings, or history, because this would interfere with smooth economic functioning. Seamless is the word they use for it. But what if the seam makes life worth living?

From the business point of view, we are all units in a pipe, easily moved around, one as good as another. If one worker gets black lung, you swap it out for a replacement. What does it matter? Seen from the height of a skyscraper, the towns of Glendale, and Greensboro, and Skokie are undifferentiated wheels in a vast geographical list of moving parts. To the man in the high castle who says where factories and money goes, all of these settlements are similar, all uniformly unimpressive.

But in reality, these towns are not identical points on maps, separated only by a few numbers on a GPS. They are embodied places, with histories and lineages written in time. For although all humans are equal and similar in so many respects, they are also unique beyond the calculation of marketers. Human beings are not atomized units.

Where we stand matters. Our place matters. And many Americans in the heartland know exactly where they are going: down.

On April 2, 1997, President Clinton said, “This country has been built by generation after generation of immigrants who came to this country and believed that their children would do better than they did.”

Well, that was then. Hohmann notes: “In 1970, 92 percent of American 30-year-olds earned more than their parents did at a similar age. In 2014, that number was just 51 percent.” In a speech to a closer-door audience last February, Hillary Clinton said of the young:

“They’re children of the Great Recession. And they are living in their parents’ basement. They feel they got their education and the jobs that are available to them are not at all what they envisioned for themselves. And they don’t see much of a future … the idea that maybe, just maybe, you could be part of a political revolution is pretty appealing.”

She got the prophecy right, but the agent and voters wrong. Basements? They should have been watching Wisconsin.

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