If Americans were in better health, Donald Trump might not have become president

The Economist carried out an analysis comparing Donald Trump’s levels of support in 2016 with Mitt Romney’s in 2012 and found “the better physical shape a county’s residents are in, the worse Mr Trump did relative to Mr Romney.”

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.

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