Public Policy & the Growing Life Expectancy Gap Between Red States and Blue States

On average, Americans living in blue states with more progressive state legislatures can expect to live quite a bit longer than those born in red states, especially those in the Southeast. And that divide seems to be growing. Consider this. A child born in Mississippi has a life expectancy of 71.9 years. But one born in Hawaii, Washington state, California, Massachusetts, Minnesota, or New Hampshire can expect to live 79 years or more. And, of the 10 states with the shortest life expectancy, 9 are red states. Of the 15 states with the longest life expectancy, 13 are blue states.

To provide some context, folks from much of the Southeast including Tennessee, Arkansas, Mississippi, Louisiana, Kentucky, Alabama, West Virginia, and Mississippi have lifespans similar to individuals born in Uzbekistan, Iraq, and other developing nations, while people from the Northeast and West Coast have life expectancies approaching those in Europe.

This gap is a fairly new phenomenon. Through the 1960s and 1970s state life expectancies were fairly uniform across the United States, but that began to change in the 1980s. Since then, medical experts and public policy professionals have been searching for answers.

Why are red states falling so far behind? There seem to be several contributing factors, falling into two broad categories; lifestyle/personal behavior, and public policies, and there is some important overlap between the two.

Lifestyle and Personal Behavior:

The Southeast has the highest obesity and smoking rates in the country. For instance, more than 23% of adults smoke in Kentucky and West Virginia. That's almost twice the rate of Northeastern states like New York, Massachusetts, and Connecticut. The statistics on obesity are even more startling. Nine of the 10 states with the highest rates of obesity are red states, mostly in the Southeast, while eight of the states with the lowest obesity rates are blue states. For example, the obesity rate in Mississippi and West Virginia is about 40% while the rate is 25% or less in Hawaii, Massachusetts, and Colorado.

You see the same type of divergence with murder rates. In 2020, measured by the number of murders per 100,000 people, the seven states with the highest homicide deaths were all red states in the southeast. Mississippi and Louisiana both had more than 19 murders per 100,000, while New Hampshire and Vermont had murder rates close to zero and Massachusetts suffered less than three per 100,000 people.

Public Policies

Recently, researchers have been examining the relationship between a state's public policies and the life expectancy of its citizens. In 2020 the health policy journal Milbank Quarterly published a study that determined that states where residents live the longest "tend to have much more stringent environmental laws, tougher tobacco and firearms regulations, and more protections for workers," like paid medical leave policies.

And, the best-performing states are also those that expanded Medicaid eligibility under Obamacare. Lack of health insurance coverage is associated with lower rates of identification and treatment of health risks like diabetes and high blood pressure and chronic conditions like heart disease and cancer. And, a 2018 study published in the American Journal of Public Health found that Medicaid expansion states also saw larger declines in Infant mortality rates.

Two studies published in 2022 found that public policies are having a profound impact on life expectancy in America. The first study was published in the British Medical Journal [BMJ] and authored by Haider Warraich, a doctor at Brigham and Women's Hospital. He found that people in Republican-leaning US counties are more likely to die prematurely.

Warraich, BMJ: "More broadly, public health spending varies markedly by state, with Republican governors tending to spend significantly less on health than Democratic governors. Overall, our finding that Democratic counties have experienced steeper declines in mortality than Republican counties over the past two decades builds upon previous evidence suggesting that more liberal policies, laws, and regulations may be associated with better health outcomes."

And, other public health professionals who have studied life expectancy data agree.

NPR: "That is basically the argument Dr. Steven Woolf makes. He's a longtime health researcher at Virginia Commonwealth University. He says if you look at policies such as the expansion of Medicaid, so access to health care, policies on minimum wage, tobacco control, gun legislation, drug addiction - a whole range of policies have an impact on health and mortality rates. Democratic states have supported more of these. But Republican states have gone the other direction."

In October, a group of researchers including Jennifer Karas Montez, of Syracuse University published a paper titled U.S. state policy contexts and mortality of working-age adults in the peer-reviewed Journal PLOS ONE. Their research determined that "conservative state policies regarding the environment, gun safety, labor, taxes and tobacco have been associated with higher mortality rates among working-age people relative to liberal policies."

Montez, NBC: "This analysis points to another major player, and that’s state policymakers," she said. "Policymakers may not feel that they’re responsible for our health or think that they’re responsible for our health, but the reality is every decision that they make affects our health and our risk of dying prematurely."

#politics #healthcare #research

By: Don Lam & Curated Content