How Long-Term Economic Decline Fueled Deaths of Despair and Trump's Electoral Success

This podcast episode features Shannon Monnat, a public health promotion and sociology expert, discussing "deaths of despair"—a category encompassing self-harm, unintentional and intentional drug overdose deaths, alcohol-related deaths, and suicide. Monnat's research highlights that these mortalities are not random but are deeply linked to underlying drivers such as depression, anxiety, frustration, and dislocation from social institutions, including unemployment and family distress. Crucially, her work reveals significant geographic disparities, with the most salient predictors of high rates being not just current economic distress but a long-term transition into economic decline, particularly in areas that were once economically stable due to manufacturing and unionization in the 1980s.

The discussion then pivots to the surprising electoral outcome of 2016, where Monnat observed a striking correlation between counties where Donald Trump over-performed and those with high rates of drug, alcohol, and suicide mortality. Beyond mortality, Trump's support was strongest in places experiencing broad distress, including economic hardship, higher divorce rates, and lower social capital. Drawing from her own experience in rural upstate New York, Monnat explains the frustration felt by working-class residents who perceive the Democratic party as having forgotten them in favor of the poor, witnessing a decline in local opportunities, an exodus of talent, and an increasing burden on local resources due to drug overdoses. This sentiment of neglect and a desire for radical change contributed to the appeal of Trump's message.

Monnat addresses the debate between economic distress and racial resentment as drivers of political shifts, arguing that they are not competing but rather intertwined; economic decline makes communities more vulnerable to messages of racial resentment, especially when resources are perceived as a zero-sum game. She also contextualizes Trump's victory within the framework of the Electoral College, noting that while he lost the popular vote and under-performed Mitt Romney in vote share, his narrow wins in key swing states like Pennsylvania, Wisconsin, and Michigan were decisive. Specific examples, such as Luzerne County, Pennsylvania, illustrate how regions with decades of significant economic decline and high rates of non-working prime-age adults became critical battlegrounds.

Ultimately, the episode argues that the 2016 election outcome was not a sudden anomaly but the culmination of decades of economic and social trends. Since the 1980s, the vast majority of the country has not benefited from economic gains, leading to massive income and wealth inequality. The devaluing of trade skills and manufacturing work, coupled with an increased emphasis on technology and finance, has left large segments of the population feeling disconnected from their labor, their work devalued, and their lives lacking meaning. This "basket of decline"—encompassing economic, social, and psychological distress—has manifested in voting behavior and the opioid crisis, which Monnat asserts is a symptom of deeper foundational problems related to a loss of meaning and connection, rather than just a drug problem solvable by treatment alone.

"The deaths of despair have generally been defined as self harm, which includes unintentional and intentional drug overdose deaths, alcohol related deaths like cirrhosis of the liver, and of course suicide."

"drug, alcohol, and suicide mortality seem to have an underlying link in terms of main drivers of them are things like depression and anxiety and frustration, and dislocation from social institutions..."

"the most salient predictors of county level high rates of drug, alcohol, and suicide mortality is not only current economic distress... but more of a long-term transition into economic distress."

"the places where Donald Trump was winning, especially places where he wasn't predicted to win, that map looked an awful lot like my drug overdose mortality map."

"he over-performed the most in counties where drug, alcohol, and suicide mortality rates were high but even more than that, he performed the most in places that were distressed upon all kinds of indicators."

"the Democratic party has really helped the poor people the most, and kind of forgotten working class folks in small towns..."

"when the economy is doing poorly and it feels like it's a zero sum game and there's a limited number of resources available, then racial resentment tends to increase."

"Trump won those three states [Pennsylvania, Wisconsin, Michigan] by a combined 77,000 votes spread across three states."

"the cues have been there for a long time. That since the 1980s the overwhelming majority of places in this country have not received any of the economic gain."

"the problem is bigger than opioids, it's bigger than drugs, the problem is a result of long-term economic decline and social decline."

"We have traded space and houses, which have continued to get bigger, for friendship, which has continued to decline. We've given up connection for stuff in the United States..."