Does Rory Stewart think Hillbilly Elegy's picture of Appalachia is accurate?

Rory Stewart set out to test whether J.D. Vance's Hillbilly Elegy overstated Appalachia's plight and concluded it was, if anything, worse than he expected. In Eastern Kentucky and West Virginia he found hours of steep valleys with trailers and few services, unlike pockets of poverty in Britain. He linked it to Angus Deaton's deaths of despair: premature deaths among white people without degrees tripled, driven by drugs, alcohol and suicide.

• Stewart cited 88 million pills shipped into Huntington, West Virginia, a town of about 80,000.
• He said US overdose deaths rose from about 30,000 to over 100,000 in a decade.
• Some counties there swung from moderate Democrat to 80% Trump.

▸In their words

“88 million pills flooding into a place of 80,000 people.” Rory Stewart · at 10:00 — open in the transcript →

Source: our own transcription of the episode. The full conversation is on The Rest Is Politics (2026-11-03). Read the whole episode summary →

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