Why are rural white Americans willing to prioritize cultural whiteness above all else?

What do white people in America’s heartland think about guns, health care, and education? How are these beliefs connected to racial and cultural identity? And how do they influence community life and health? Jonathan Metzl answers these questions with a compelling mix of scientific inquiry, medical data, and personal interviews. Writing about whiteness as a cultural phenomenon with identifiable traits, he pushes against the traditional conflation of “white” with “American.” His book is  particularly important at a time when white resentment is politically resurgent.

Metzl, who grew up in Kansas City and now lives in Tennessee, is a physician and sociologist. He writes movingly about the powerlessness felt by families in Missouri whose loved ones have died by gun violence, often by suicide. Through his conversations with these families, Metzl learns that guns are a powerful marker of belonging in white rural midwestern culture. In this context, guns are “double-edged swords” that serve as symbols of family, privilege, and trauma. The cultural pressure to maintain whiteness, he concludes, makes it hard for people to heal from the effects of gun violence—and just as hard for them to have nuanced conversations about gun control.

In Tennessee, Metzl investigates attitudes about health care and comes to a similar conclusion: whiteness both shapes opinions and sabotages community health. In this section of the book, the author’s experience in medicine shines. He writes in detail about the Affordable Care Act, piercing through the complex categories and verbiage of the insurance industry. Why do states like Tennessee reject federal funding attached to the ACA although that funding would benefit its residents? The answer has a lot to do with the connections people make between whiteness and self-reliance. From a public health perspective, Metzl concludes, “the policies and sentiments that aim to bolster the identity of whiteness also effectively turn whiteness itself into a heightened, perilous, and ever-more-costly category of risk.”