“I track the full extent to which these political acts of self-sabotage came at mortal cost to the health and longevity of lower- and, in many instances, middle-income white GOP supporters—and ultimately, to the well-being of everyone else. The white body that refuses treatment rather than supporting a system that might benefit everyone then becomes a metaphor for, and parable of, the threatened decline of the larger nation.”

In this passage, Metzl introduces his argument that lower- and middle-income white Americans commit acts of “self-sabotage” when supporting politicians and policies that defend the superiority of “whiteness,” but which result in negative health outcomes for everyone, including white people. This tendency perpetuates a system that harms everyone and limits society’s potential by concentrating collective efforts on division and polarization. This passage introduces the theme of Privilege, Whiteness, and Nostalgia.

“These histories imbue debates about guns, health care systems, taxes, and schools with larger meanings about race in America and about American whiteness. The history of race in America also helps explain why these topics cut to the heart of present-day debates about what it means to provide resources, protections, and opportunities for everyone in a diverse society versus providing securities and opportunities for a select few.”

Metzl argues that racial histories of issues like gun control, healthcare, and school funding are responsible for the political polarization they create today. These issues are fundamentally linked to white American identity and the place of whiteness in the social hierarchy, leading to The Societal Impacts of Racial Resentment. Therefore, changing these policies to create a more inclusive society threatens fundamental ideals of white identity and superiority.

“Instead, racism matters most to health when its underlying resentments and anxieties shape larger politics and policies and then affect public health.”

This is another key point that Metzl makes throughout the text. While racism is certainly damaging on an individual level, it becomes most dangerous when racist ideology shapes public policy, creating structural systems that negatively impact population-level health.