Republicans Are Hazardous to Your Health

As we approach the November election, I thought it would be a good idea to talk about how our votes affect our health and the health of our communities. In this connection, a new working paper from researchers at Harvard and Drexel universities caught my eye. It’s called Politics, Power, and People’s Health: US Elections and State Health Outcomes, 2012–2024.

While there is an emerging robust literature on the “political determinants” of health, this new work, led by Nancy Krieger, one of the nation’s leading social epidemiologists, frames the debate with a broader than usual definition of political policy at state level. characteristics and uses state-of-the-art data on a set of health outcomes to interrogate the impact of policy on our health.

In addition to the political leanings of voters in the states of the United States, Krieger and his colleagues look at the voting records of US senators and representatives from those states, which parties control each state, and a wide range of economic and social policies enacted at the state level. This provides a more comprehensive picture of the local political environment across the country. The authors then examine eight health consequences: infant mortality; total premature mortality; health insurance status; Vaccination against covid and flu for children and the elderly; desert motherhood and; food security.

Unfortunately, the authors found that greater local political conservatism was associated with worse health outcomes, even after accounting for each state’s poverty level in the analysis, which likely weakened their results because poverty itself is a strong predictor of poor health. .

The authors were quick to point out that this is a descriptive study—it does not establish a cause-and-effect relationship between state policies and health outcomes, and other factors may be influencing the results. However, this paper reinforces ideas of other researchers which considered possible connections between public policy and health outcomes and come to similar conclusions. This is not surprising: government policies on a variety of issues, from health care (such as Medicaid expansion) and health care to other “determinants of health” including taxation, education, the social safety net, immigration, and abortion, will all affect health outcomes.

Politicians make choices for a variety of reasons, not all of them related to health. But some of these decisions will inevitably affect public health. Conservative states are simply making bad choices. As they say, the facts can really be liberal bias. Wishing it were different doesn’t mean it is. As Election Day approaches, Krieger and her colleagues’ article reminds us that non-voting elections are as important to our lives as who enters the White House next January.

At the end of last month, another report by the Commonwealth Fund was released, entitled “Mirror Mirror 2024: A Portrait of the Failing US Health Care System – A 10-Country Comparison.” While the Harvard study points to disparities in state health outcomes across the U.S., the Commonwealth Fund compares our outcomes to those of our wealthier nations. The killer conclusion: “The US continues to be in a class of its own in the underperformance of its healthcare sector. While the other nine countries differ in the details of their systems and performance in domains, unlike the US, they all found a way to meet the most basic health care needs of their residents.”

This is a devastating criticism, but this is not new. This is the biggest thing that nobody talks about in the US. I’ve said it before: We are allowing a public health disaster to unfold in slow motion. We are in the mid-40s for life expectancy compared to other countries and will slide further down over the next few decades if nothing changes. The Commonwealth Fund points to some key challenges for us: lack of investment in primary care; administrative inefficiencies caused by the large number of health insurance products in the US; consolidation of hospitals and medical practices that drive up prices; our weak social safety net and health care system; and social and economic policies that make the situation worse.

Unlike the paper by Nancy Krieger and her colleagues, the Commonwealth Fund report makes no connection between our policies and our health outcomes. Here’s where things get tricky: This isn’t a Republican vs. Democratic dilemma. Both parties contributed to our national downfall.

When conservative states make poor choices compared to more liberal ones, our entire political system makes poor choices relative to the rest of the world. Take this into consideration. This means that even though our elections in November are crucial, we need more radical transformations (radical by American standards, not global standards, as dozens and dozens of countries have made better choices for themselves) to raise us to a healthier future.