The data are clear: Life is getting harder and harder for Americans without college degrees. People with a high-school education or less tend to face worse economic prospects and have poorer health.
There has been a striking rise in mortality among middle-aged white Americans who don’t have four-year degrees. The uptick, say the two Princeton University economists who identified the phenomenon, is due primarily to what they call “deaths of despair,” or deaths caused by alcohol, drugs, and suicide.
Middle-aged, non-college-going white Americans also make up the core voting block that propelled Donald J. Trump to the White House. Mr. Trump won 67 percent of white voters without a college degree.
How are all of these factors connected? Or are they? One Pennsylvania State University sociologist found this bottom line: Mr. Trump, her research shows, performed particularly well in counties with the highest mortality rates from alcohol, drugs, and suicide.
Read the full story: Across America, there’s a new public-health crisis — the lack of a college degree.
You can find a lot of Trump voters in the Bootheel, in the rural southeastern corner of Missouri. In one county, Dunklin, where one in 10 adults has a four-year degree, 76 percent of voters chose Mr. Trump in 2016. His share of the vote was 12 percentage points higher than Mitt Romney’s in the 2012 election and nearly 25 points higher than George W. Bush’s in 2000.
It’s also worth noting that in Dunklin County, life expectancy is 72.6 years, six-and-a-half fewer than the national average.
Ask people in Dunklin how things have been going in recent years, and most of them will point to two related problems: Job losses in the manufacturing and agricultural sectors in the Bootheel have piled up over the past couple of decades, and more people are relying on government assistance.
‘They Don’t Want Anything Different’
Emerson Electric, in the county seat of Kennett, used to be the largest employer. For decades, young men could finish high school and follow their fathers and grandfathers into good-paying, steady jobs at the local plant. Once they got married, they’d be able to provide for their families.
But the Emerson plant closed in 2006, and many of those jobs were sent to Mexico. So when Mr. Trump said that Mexicans are “taking our manufacturing jobs … they’re killing us,” his message resonated. His campaign slogan, “Make America Great Again,” embodies exactly what residents of Dunklin County believe needs to happen. They need jobs to come back.
“I’m not against welfare and helping people who really need it.”
If more people had education beyond high school, employers looking for a pool of skilled workers might be more likely to come to the Bootheel. Many high-school graduates here do go on to college, but they don’t tend to come back. A lot of those who stay are skeptical about the value of higher education. Those high-skill jobs don’t currently exist, their thinking goes, so why is college worth my time and money?
Some families have relied on public aid for multiple generations. “They’ve never known anything different, and they don’t want anything different,” says David Ross, of Senath, which is a few miles south of Kennett.
After graduating from high school, Mr. Ross spent a couple of years in the military and worked for the local phone company. Then he built a business from the ground up, focused on trucking and excavators. At 72 he continues to work full time.
“I’m not against welfare and helping people who really need it,” Mr. Ross says. But he sees many people in their 30s and 40s who seem to have no interest in working. In many cases, he says, they’d be taking a pay cut to get a job because that would mean they’d lose their food stamps and housing support.
Mr. Ross says he has open positions that he can’t fill. If there were less government assistance, he says, maybe more people would be forced to take the jobs that are available, even if the work isn’t glamorous.
It’s not that simple for everyone, of course; people rely on social-services programs for many reasons, including a sudden job loss and serious disabilities. And at the moment, because there are few major employers in the region, the money is helping vulnerable people survive.
Still, the prevalence of government aid is making Mr. Ross, and other local farmers and truckers who often work 12-hour days, angry. They are pleased to hear Mr. Trump say he believes the monthly checks make it too easy not to work.
Missouri state lawmakers sometimes talk about what they call “social-services reform.” Holly Rehder, a Republican whose district is in the northern part of the Bootheel, has no patience for such terms. She calls it welfare. So do most people around here.
Ms. Rehder grew up on it. She quit school at 15 to care for her mother, who had been injured in a car accident, and a younger sister. A year later she was pregnant with her first child. She was 40 before she earned her college degree, fitting in classes on nights and weekends while working as a hotel maid, a fast-food worker, a payments processor at a cable company.
Welfare policy “comes from the right place,” Ms. Rehder says, “but it hurts people more than it helps them. It’s important that we start changing policies so that we don’t trap people in our compassion.” Like many of her constituents, she backed Mr. Trump for president.
There are restrictions on how long people can receive government assistance, but she argues that they should be more stringent — and that recipients should be required to find work, volunteer, or pursue a degree.
The promise of more jobs and less welfare wasn’t the only reason Larry McKuin was excited to cast his vote for Mr. Trump. For one, the president’s lack of a filter makes him relatable, says Mr. McKuin, who lives in Kennett. “That’s how we are around here: plainspoken and to the point,” he says.
He runs a welding shop, and he’s been paying a 35-percent tax rate, which dropped under the new tax law. He’s upset that the president hasn’t yet fulfilled many of his other promises, but he doesn’t think it’s Mr. Trump’s fault. Mr. McKuin believes it’s Congress that’s holding him up.
Access to Health Care
Not everyone in the Bootheel falls on one side of the Trump divide. Abdullah Arshad watched the national health-care debates last year with concern. He’s medical director at Pemiscot Memorial Hospital, in the county just east of Dunklin.
When the Congressional Budget Office estimated that millions of Americans would lose insurance under the Republican proposals, he knew some of them. They were in his waiting room. Many of them were probably Trump supporters. But if they lost their subsidies, they would lose their plans. Few people here have a health-savings account.
“The rhetoric is just terribly discouraging.”
If Republicans’ plans were to become law, emergency-room visits by uninsured patients would skyrocket, Dr. Arshad says.
Steve Pu, a physician in Kennett, is critical of Missouri officials’ decision not to expand Medicaid access under the Affordable Care Act. That would have extended necessary insurance coverage to many people in the Bootheel and elsewhere in the state.
But Dr. Pu, a longtime Republican, is skeptical that state or federal lawmakers will make meaningful progress on health care anytime soon. In the wake of Obamacare’s passage, discussions around health-care access have become polarizing and divisive. “The rhetoric,” he says, “is just terribly discouraging.”
Folks who live in Kennett and the other small towns in the Bootheel are proud of their region. Many of them are hard-working and passionate about what they do. It’s the kind of place where, if someone needs help, the community will rally to fill that need.
Still, as economic opportunities disappear and disadvantages pile up for people without college degrees, it’s easy to feel hopeless. A lot of people here have pinned their hopes on Mr. Trump.
Karin Fischer contributed to this article.