GEORGETOWN, Ohio — Here at the Brown County Fair — the biggest event of the year, when schools close for the week — is Donald Trump’s America.
People carry Trump/Pence yard signs across the promenade. Families stop to take pictures with a Trump cutout at the local Republican Party’s cabin.
But beyond the campaign swag is another sign you are in Trump Country.
This is an unhealthy place. Its residents die younger than all but a few other counties in this important swing state. The suicide rate is well above the national average. Brown County saw a 50 percent increase in drug overdose deaths over two years.
In one barn at this year’s fair, people stop to learn how to administer Narcan, the opioid overdose medication. On a wet September afternoon, the booth still had visitors.
About 130 miles west of here, not far from Indiana Governor Mike Pence’s office, nearly 200 people in a town of 4,000 have been diagnosed with HIV, acquired while they injected heroin and liquefied prescription painkillers. In that town, Austin, Ind., a few hundred more have contracted hepatitis C for the same reason.
Like Brown County, Austin and surrounding Scott County is a Trump stronghold. Both areas voted overwhelmingly for Trump in the Republican primary, and he is expected to win by huge margins here against Clinton next month.
But a recent trip to both counties revealed that even Trump’s staunchest supporters don’t see him as a savior, the cure to their ailments. Almost nobody — neither health workers, nor people recovering from addiction, nor regular voters — seems to believe the presidential election will have much consequence for their health.
“Way I look at it, no matter who you get in there, the damage has already been done,” said Ron Snowden, 66, sitting on his porch across from one of Austin’s most drug-ridden streets. “Whoever gets in there, it’s going to take 30 years to fix what’s been done.”
Jacob Howell, a 33-year-old recovering from a heroin addiction, has a familiar story. His mom introduced him to methamphetamine at age 15, then he got hooked on painkillers prescribed for swelling in his leg, then he switched to heroin.
He’s stayed off drugs for a year now. He likes Trump, thinks he has “the business sense” to help the country. But he doesn’t believe Trump — and certainly not Hillary Clinton — is going to improve Austin’s health.
“No,” he said. “I don’t think they care enough about us.”
More than 18 months after one of the worst HIV outbreaks in decades began, Austin is still looking for answers.
“They’re pretty much at the end of the rope,” said Brittany Combs, the public health nurse for the Scott County health department. “Just somebody fix it.”
That attitude evokes Trump’s famous declaration in his July convention speech, while listing the challenges facing America: “I alone can fix it.” On the campaign trail, Trump vows to end the opioid crisis, and he says he wants to help with other health issues, like the wave of post-traumatic stress disorder plaguing veterans.
Some people in these areas want to believe that. But even the most passionate Trump supporters sounded more wistful than confident that their candidate could solve these problems.
At the Brown County Fair, Tony Martin, 57, recalled what he encountered as a paramedic working in southwestern Ohio, less than an hour from Cincinnati.
“I’ve seen such pitiful things,” he said, holding at Trump yard sign. He now works at a funeral home, where he sees people who died of overdoses buried by the county because they have no family to claim them.
“It’s worth a chance because nothing’s happening now. Like [Trump] says, what do you got to lose?” Martin said. “We know what the hell we’ve been having, and it’s been continuing on. It hasn’t gotten any better.”
‘A death sentence’
Brown and Scott are classic examples of Trump’s America, communities in the heartland that are strongly pro-Trump and staggeringly unhealthy. They are also two of the unhealthiest counties in their respective states, according to rankings by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.
In these counties, as in other places that have seen stagnating life expectancy among white Americans, drug and alcohol have claimed countless lives, along with conventional killers like cancer and heart disease. Some political analyses have argued that Trump’s unexpected rise can just as easily be traced to poor health as economic hardship or racial anxiety, as voters flock to a candidate promising to revive their dying towns.
Dr. William Cooke was Austin’s only doctor when he arrived in 2004. He saw untreated cervical cancer — “which we should never see these days” because of pap smears, he said — and people with unmanaged diabetes. One man had a tumor growing on his tongue so big that he couldn’t close his mouth.
In 2014, when the HIV outbreak exploded, Cooke watched helplessly. Pleas for more assistance from the state had gone unanswered for years.
That same year, the only hospital in Brown County closed abruptly when creditors came to collect.
If you ask around, you hear a few recurring explanations for the health crisis. The economy is bad. The canning factory in Austin can’t sustain the economy alone, and Brown County once relied on tobacco farms along the Ohio River. People say there isn’t enough for kids to do because a sense of community has broken down, so they turn to narcotics.
These problems have simply become a way of life, as they get passed down across generations.
“It’s basically like a death sentence for the kids. They have to fall into what their parents fall into,” said Michael, 36, who decided to give up his heroin habit four months ago. “It’s a vicious unending cycle.”
Even after all they’ve seen, many of the people in these Indiana and Ohio towns don’t seem to connect their health to their politics.
“So many people are wrapped up in their everyday lives,” said Chris Albertson, the Scott County Republican Party chairman. “They don’t take time out of their day to sit and think about something like that and think about that connection.”
Paul Hall, the former GOP party chair in Brown County, summarized the feelings of many people here.
“Either one of the presidential candidates, I don’t think the drug issue is going to be on their radar,” he said.
Clinton has proposed a $7.5 billion drug addiction recovery program, as well as detailed plans for mental health and other health care issues. But that doesn’t seem to be winning her many votes here, even among those acutely aware of these challenges. People looking for change don’t expect to get it from Clinton.
Trump hasn’t been very specific about what he would do about addiction or other health problems afflicting these areas. He promises to build a wall on the Mexican border to stop the flow of heroin into the United States and to provide treatment for addicts.
“Either one of the presidential candidates, I don’t think the drug issue is going to be on their radar.”
Paul Hall, former GOP party chair in Brown County
But Trump’s supporters don’t seem to expect much help from him when it comes to their health. “I don’t know how much he would do with that,” said D.J. Allen, 36, who was walking through the Brown County Fair in a Trump-Pence sweatshirt.
At most, they hope Trump would improve the economy and then money would trickle down to state and local governments for their work on the crisis.
“If you have money, you can do things. If you don’t have money, it just doesn’t get done and people fall through the cracks,” said Rusty Vermillion, the Brown County health commissioner. “At least he has a track record of being able to generate lots of money.”
Some people who otherwise support Trump fear what he would mean for them and their health problems. Michael, recovering from his addiction, called Trump “the golden boy” with a great business record, but then added that he worries about Trump’s anti-crime rhetoric. He spent time in jail on a drug conviction, so he can’t get government assistance for housing. For now, he’s homeless.
Michael believes Trump, if he follows through on his law-and-order pledges, could make life more difficult for him as someone in recovery.
“I think we’re in trouble,” he said.
‘You have a very long way to go’
Instead, the people in Brown and Scott counties think they will have to fix their health problems themselves.
Work has already started. Jacob Howell is helping construct a new commercial kitchen at the Church of the New Covenant in Austin. The church feeds as many as 200 people some nights; Michael met Howell there, and Howell convinced him to drop his heroin habit.
Lori Croasdell, who leads an anti-substance abuse group in Scott County, is planning to talk with business owners about hiring people in recovery. She envisions a workplace where people can come to work and make a decent living, while attending a 12-step program during their lunch break.
But she knows that won’t be an easy sell. Croasdell and many others described two different communities inside their counties, one living a mostly comfortable life and the other riddled with poverty and bad health. It has been a struggle to convince the former to care about the latter.
“When you have a business community that says we just need to stop talking about it,” she said, “you know you have a very long way to go.”
In Brown County, there is talk about turning the closed 32-bed hospital into a rehabilitation facility. Right now, anyone who wants to check into rehab might have to travel 20 miles or more to find a facility.
There are also individual stories of redemption. Deanna Vietze, who has lived in the area for 15 years, was at the fair last month manning the booth for the Coalition for a Drug-Free Brown County. She said a woman had stopped by earlier and said she’d stayed away from drugs for two years after 11 years of addiction.
“I jump to stories of success,” she said. “I hold onto the few stories of people sharing that this worked for me.”
As for the presidential campaign, however, she shares the same frustrations. She isn’t satisfied with what she’s heard from Trump or Clinton. Brown County depends on state and federal support for these programs, she said. It all comes down to dollars.
“That’s going to take quite a while before [funding’s] impacted significantly, I think,” she said.
Everybody seems to realize this is going a long time to fix. Brown County’s drug problem could continue to deteriorate until at least 2019, according to estimates seen by those working in the area.
Scott County has hopefully endured the worst and the HIV outbreak seems to be in check. But Cooke believes it could still take another generation before Austin has truly recovered.
“There’s no outside group that’s going to come in here and fix things,” Cooke said. “It has to be developed from within.”