Rhea Boyd, MD+ Your Authors @RheaBoydMD A pediatrician and hopeful participant in democracy. Trying to do the right thing by the children of the world, one day at a time. Jan. 10, 2020 3 min read + Your Authors

I’m about to say something you might not be ready to hear.

But I'm going to say it anyways.

Despair isn't killing white Americans. The armed defense of structural whiteness is.

The solution?

Eliminate whiteness all together.


My latest for @TheLancet is the most challenging piece I’ve written to date.

So I’m going to walk through it, point by point.

You can also get the full text here:  https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33147-2/fulltext 

In 2015, Case and Deaton published this striking graph.

White middle-aged Americans death rate was *increasing* (red line) compared to adults in other wealthy nations (other lines). The drivers (suicide, liver disease, and drug overdoses) came to be known as “deaths of despair”

For the last 5 years, scholars, the media, and the public have used "deaths of despair" or "diseases of despair" to try to explain why white Americans are seeming to disproportionately die from the opioid epidemic, suicide, and substance abuse.

But they've got it wrong.

In 2019, @JonathanMetzl penned a brilliant take on what is killing white people in America's "heartland," Dying of Whiteness (highly recommend).

But where Case and Deaton saw despair, Metzl sees "racial resentment" as the problem killing white people. Here, they are both wrong.

A deep political investment in whiteness is killing white Americans.

Metzl tells us how.

To “maintain an imagined place atop a racial hierarchy” some white people politically align and vote to limit the freedoms or resources available to non-white and/or Black people.

But here's the thing, when they do that, white people risk threatening freedoms and resources they, and other white people, also depend on. This is how whiteness harms health. And it is why whiteness is particularly detrimental to poor whites, with limited resources.

Saying those choices are made out of "despair" or "resentment" from being "left behind" erases white agency. The effect is, white choices to advance structural racism become viewed as primarily emotionally driven or disconnected from material reward.

This happens ALL. THE. TIME.

We absolve white perpetrators of mass shootings by decrying abstract "mental illness" and consider their violence idiosyncratic rather than the deadly confluence of white racial terrorism, patriarchy, and liberalized access to guns. (Metzl has an excellent paper on this as well).

And we focus on white people's "fragility" and how they *feel* about their racism, rather than the legacy of DEATH in whiteness's wake.

This matters.

Because while white Americans are dying, they are not the first, or even predominant group with rising death rates in America.

Native Americans (gray line) have had rising death rates since at least 1999.

And Black Americans long held the highest death rate of any race/ethnic group in America, now 2nd only to Native Americans.

And the drivers are also suicide, drugs like opioids, and organ disease.

And if any populations have been "left behind" it is Black (and Native) Americans. Yet we don't say that they are dying of "despair" or "racial resentment."

Black deaths in America are a result of a political economy predicated on Black subjugation, not Black sadness.

So here is what I learned:

1. Death is the inevitable consequence of the full realization of structural racism and the exclusive rights and resources it offers those who can become white.

2. Within a white racial ordering of humans, rights and resources, non-white and/or Black deaths become naturalized and expected. And white deaths appear to be the aberration.

But they evidence the *rule*, not the exception.


The solution is not self-reflection. It is not a difficult conversation. And it is not centering white emotions, however distressing.

The solution is those who can become white must summon the courage to *unbecome* white and then to eliminate whiteness all together.

You can follow @RheaBoydMD.


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