I know at this point that we're supposed to consider the data-driven pollster model dead (because garbage-in, garbage-out as far as people who said they weren't going to vote for Trump overwhelmingly breaking to him) but if the polls do have a last gasp, it's this: The Economist has found that the biggest indicator of Trump voters wasn't being non-college educated and white, the most likely Trump voters are Americans who are the least healthy.
The two categories significantly overlap: counties with a large proportion of whites without a degree also tend to fare poorly when it comes to public health. However, even after controlling for race, education, age, sex, income, marital status, immigration and employment, these figures remain highly statistically significant. Holding all other factors constant—including the share of non-college whites—the better physical shape a county’s residents are in, the worse Mr Trump did relative to Mr Romney.
For example, in Knox County, Ohio, just north-east of Columbus, Mr Trump’s margin of victory was 14 percentage points greater than Mr Romney’s. One hundred miles (161 km) to the east, in Jefferson County, the Republican vote share climbed by 30 percentage points. The share of non-college whites in Knox is actually slightly higher than in Jefferson, 82% to 79%. But Knox residents are much healthier: they are 8% less likely to have diabetes, 30% less likely to be heavy drinkers and 21% more likely to be physically active. Holding all else equal, our model finds that those differences account for around a six-percentage-point difference in the change in Republican vote share from 2012.
The data suggest that the ill may have been particularly susceptible to Mr Trump’s message. According to our model, if diabetes were just 7% less prevalent in Michigan, Mr Trump would have gained 0.3 fewer percentage points there, enough to swing the state back to the Democrats. Similarly, if an additional 8% of people in Pennsylvania engaged in regular physical activity, and heavy drinking in Wisconsin were 5% lower, Mrs Clinton would be set to enter the White House. But such counter-factual predictions are always impossible to test. There is no way to rerun the election with healthier voters and compare the results.
The public-health crisis unfolding across white working-class America is hardly a secret. Last year Angus Deaton, a Nobel-prize-winning economist, found that the death rate among the country’s middle-aged, less-educated white citizens had climbed since the 1990s, even as the rate for Hispanics and blacks of the same age had fallen. Drinking, suicide and a burgeoning epidemic of opioid abuse are widely seen as the most likely causes. Some argue that deteriorating health outcomes are linked to deindustrialisation: higher unemployment rates predict both lower life expectancy and support for Mr Trump, even after controlling for a bevy of demographic variables.
Polling data suggests that on the whole, Mr Trump’s supporters are not particularly down on their luck: within any given level of educational attainment, higher-income respondents are more likely to vote Republican. But what the geographic numbers do show is that the specific subset of Mr Trump’s voters that won him the election—those in counties where he outperformed Mr Romney by large margins—live in communities that are literally dying. Even if Mr Trump’s policies are unlikely to alleviate their plight, it is not hard to understand why they voted for change.
Ohio, Kentucky, and Indiana in particular were hit hard in the last four years over a growing opioid epidemic. Various state plans were tried to address the problem with varying results: Kynect and Medicaid expansion in Kentucky being dismantled by Matt Bevin, Indiana's Medicaid-hybrid "everyone has to pay something" approach from Mike Pence, and Ohio's "quiet" Medicaid expansion pushed through by John Kasich.
But none of those programs could deal with the Ohio Valley's drug problem. In fact, Mike Pence as Indiana's governor made the problem much worse when by fighting drug abuse he effectively destroyed Indiana's ability to deal with a massive HIV outbreak in 2015 when he discontinued the state's needle-exchange program.
In conclusion, the study found that Scott County's public health crisis -- which left 181 people in Southeastern Indiana HIV positive -- was caused by a "close network" of residents injecting opioid Opana and sharing needles. It suggests that Indiana and other largely rural states should focus on prevention measures such as more HIV testing, identifying networks of intravenous drug users, increasing access to treatment, considering syringe-exchange programs and education.
"Although the magnitude of the outbreak was alarming, the introduction of HIV into a rural community in the United States was not unexpected when considered in the context of increasing trends in injection use of prescription opioid (painkillers)," the study says.
Dr. William Cooke, the lone physician in Austin, Ind., the town at the epicenter of the outbreak, said Scott County had every indication for years that the spread of HIV was possible. Cooke pointed to poverty, high unemployment, a steady flow of opioids into the community, high hepatitis C rates and adverse childhood experience.
"If we knew there was a population at risk based on the indicators mentioned, why wait for HIV to hit?" Cooke said Thursday. "... That's what we see right now with Clark and all of these other counties."
Republican governors made things worse by refusing to embrace Medicaid expansion and Obamacare. And the people hurt the most by those Medicaid decisions by Republican governors overwhelmingly voted for Trump.
Killing thousands through denial of health care dollars and programs paid off for the GOP. Big time.