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Trump over performed the most in counties with the highest drug, alcohol and suicide mortality rates

This article originally appeared in the Washington Post.

THE BIG IDEA: new study from Penn State University suggests a relationship between the opioid epidemic and support for Donald Trump. 

The president-elect performed better than Mitt Romney in many places, but he fared best compared to the Republican nominee four years ago in the counties with the highest drug, alcohol and suicide mortality rates.

Shannon M. Monnat, an assistant professor of rural sociology and demography, created a data set with numbers from 3,106 counties. She found this trend to be true nationally but especially so in two regions: In the industrial Midwest, which is how academics refer to the Rust Belt, Trump ran ahead of Romney 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, Trump did worse than Romney by an average of 3.1 percent in the lowest mortality counties but better than the former Massachusetts governor by an average of 10 percent in the highest mortality counties.

— Overdoses, alcoholism and suicide are known by experts collectively as “the diseases of despair.” People often (but not always) turn to pills, syringes, the bottle and other self-destructive behaviors when they lose hope, when they don’t have the means to live comfortably or when they don’t get the dignity that comes from work.

It is intuitive that the least economically distressed counties also tend to have the lowest mortality rates, and vice versa. In this way, alcoholism, overdoses and suicide are symptoms of the deeper social decay that was caused by deindustrialization. This decay led to the fears and anxieties which Trump so effectively capitalized on.

Correlation is not causation, of course. But while the places with the biggest mortality problems are usually the places that have been hit hardest economically, Monnat points out in a footnote: “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.”

 I saw this firsthand on the campaign trail all year, in countless interviews with folks who were down in the dumps and struggling to get ahead (or, quite frankly, just get by). Many supported Barack Obama eight years ago because they were desperate for hope and change. They’re still desperate, and now they’re hopeful Trump can bring the change they’re looking for.

— This really ought to be one of the biggest storylines that everyone takes away from 2016. One big reason that elites along the Acela Corridor were so caught off guard by Trump’s victory is that they’re so insulated from the stomach-churning scourge of addiction and cycle of brokenness. Washington has never been richer or further removed from the pain of everyday Americans, as Hillary Clinton called them in the video announcing her candidacy. Trump’s solutions may not actually help the “the forgotten man” that he talked so much about on the stump. In fact, his administration may very well push policies that ultimately only add to their pain. The tax cuts he wants will disproportionately benefit the most affluent people in the bluest states, for example. But the system has failed them. Trump promised to blow it up; Clinton represented more of the same.

— Three glaring illustrations from the Penn State report:

Scioto County, Ohio: This is the setting for Sam Quinones’s book “Dreamland,” a blue-collar place with a once-thriving manufacturing base that became the pill-mill capital of America after the nation’s first large “pain clinic” opened. The drug, alcohol and suicide mortality rate more than doubled from 32.9 (per 100,000 people) in 1999 to 74.8 in 2014, Monnat notes, and Trump received 33 percent more of the county’s vote than Romney.

Mingo County, West VirginiaThe drug, alcohol and suicide mortality rate spiked from 53.6 in 1999 to 161.1 in 2014, making it the seventh highest in the U.S. Trump’s share of the vote was 19 percent higher than Romney’s.“Mining and related industries employed nearly 40 percent of the county’s workers in the 1980s and accounted for two-thirds of the county’s earnings. Since then, mining has dropped to 20 percent of employment and a third of wages, and household income has declined by 10 percent. Mingo County now has an adult poverty rate of 23 percent and a disability rate of 32 percent,” per Monnat.

Coos County, New Hampshirewhich has the highest drug, alcohol and suicide mortality rate in New England, swung from Obama to Trump: “The share of jobs in manufacturing there declined from 38 percent to 7 percent, and payroll wages from manufacturing dropped from 49 percent to 9 percent since the mid-1980s,” Monnat explains.

This article originally appeared in the Washington Post.