Dying of Whiteness is What’s the Matter with Kansas but with an emphasis on public health. In the backlash conservatism of the Trump era, physician Jonathan M. Metzl argues that lower- and middle-class white Americans who vote for policies that promise to protect their embattled way of life, in fact damage their own health and well-being. Through focus groups and interviews with ordinary Americans and statistical analysis of population health and life expectancy, Metzl shows how anti-government and pro-gun policies win support due to white racial resentment, and how such policies raise mortality risks for white Americans and for our society as a whole.

Metzl’s quest to understand the health implications of what he calls backlash governance focuses centrally on three hot-button issues: the spread of pro-gun laws supported by the NRA, efforts to oppose and repeal of the Affordable Care Act (ACA), and sweeping cuts to taxes and public spending. Raised in Missouri and Kansas and a long-time resident of Tennessee, he focuses on these three states, each of them once known for bipartisan cooperation but more recently dominated by conservative ideologues. In Missouri, a state that dramatically relaxed once-strict handgun laws, he speaks with families of gun suicide victims and documents soaring rates of death and injury by gun. In Tennessee, once a pioneer in healthcare provision, he examines the ramifications of the state’s intense resistance to the ACA’s Medicare expansion, embodied by one man who refused to sign up for Obamacare even as he was dying of Hepatitis C. And in Kansas, he shows how enormous income tax cuts led to extreme austerity in the state’s public schools, increasing drop-out rates and reducing life expectancy among black and white alike.

With President Trump’s election and other Republican victories in 2016, these state-level controversies have become national flashpoints-and, Metzl argues, the health risks that accompany a politics warped by racial resentment have only grown. To move forward, we must understand how systems of racial hierarchy hurt us all, and that policies promising to shore up the position of whites at the expense of minorities will only hasten our demise.