Deaths of Despair

A March 23, 2017 post about the surging rate of death among non-Hispanic white men with no college education, goes a long way towards explaining what drove the political shift towards Trump in 2016, 2020, and 2024 in this voting block.

Another source from a 2020 paper notes that:

From 1992–94 to 2016–18, age-adjusted mortality for whites in the least educated 10% has risen by 69–112% for women and 47–67% for men (2.2–3.2% and 1.6–2.2% per year, respectively).

A published version of what seems to be the same article in 2022 states in its abstract that:

Measurements of mortality change among less educated Americans can be biased because the least educated groups (e.g., dropouts) become smaller and more negatively selected over time. We show that mortality changes at constant education percentiles can be bounded with minimal assumptions. Middle-age mortality increases among non-Hispanic Whites from 1992 to 2018 are driven almost entirely by the bottom 10 percent of the education distribution. Drivers of mortality change differ substantially across groups. Deaths of despair explain most of the mortality change among young non-Hispanic Whites, but less among older Whites and non-Hispanic Blacks. Our bounds are applicable in many other contexts. 

A 2022 NBER report looking at COVID deaths comes to basically the same conclusion. 

A 2024 NBER report expanded on this conclusion noting the importance of different smoking and obesity rates in less educated and more educated areas:

Equally educated people are healthier if they live in more educated places. Every 10 percent point increase in an area’s share of adults with a college degree is associated with a decline in all-cause mortality by 7%, controlling for individual education, demographics, and area characteristics. Area human capital is also associated with lower disease prevalence and improvements in self-reported health. The association between area education and health increased greatly between 1990 and 2010. Spatial sorting does not drive these externalities; there is little evidence that sicker people move disproportionately into less educated areas. Differences in health-related amenities, ranging from hospital quality to pollution, explain no more than 17% of the area human capital spillovers on health. 

Over half of the correlation between area human capital and health is a result of the correlation between area human capital and smoking and obesity. More educated areas have stricter regulations regarding smoking and more negative beliefs about smoking. These have translated over time into a population that smokes noticeably less and that is less obese, leading to increasing divergence in health outcomes by area education.

An October 14, 2024 report notes that:

We find mortality improvement has slowed across the population, with substantial heterogeneity across socio-demographic groups. Notably, working age mortality among high-school graduates rose by around 16% from 1996 to 2019 while working age White mortality had almost no net improvement over the period and rose by a little under 10% from 2010 to 2019. Meanwhile, working age Black and Hispanic mortality fell by nearly 25% and 20%, respectively, from 1996 to 2010, before stagnating.

We estimate that the COVID-19 pandemic increased overall mortality by around 20 percent in 2020 and 2021, with around a 40% increase in mortality among Hispanics adults and an over 25% increase in mortality among working age adults without any college education.

The reductions in black and Hispanic deaths coincide with falling crime rates, which disproportionately impacted black and Hispanic communities.

Ironically, reduced crime rates may have hurt the economic well-being of white men with no college education in relative terms now that they faced more competition from black and Hispanic men without college educations who were no longer in prison or gangs, and were instead part of the less skilled work force (even if they weren't worse off in absolute real income and unemployment rate terms).

Opioid overdose deaths finally leveled off during the Biden Administration (see also here) But this is still a demographic in crisis and Trump is responding to what they believe (mostly wrongly) is the source of their woes.