Now, a major new study demonstrates that differences in life expectancy correlate closely with many state policies: Most red states have adopted more policies that correlate strongly with lives cut short, while most blue states have adopted opposite policies.
The new study, conducted by well-known Syracuse University sociologist Jennifer Karas Montez and seven colleagues, notes: “State policies affect nearly every aspect of people’s lives, including economic well-being, social relationships, education, housing, lifestyles, and access to medical care.” Life expectancy is like a social mirror that reflects the overall health of a population. Longevity captures, in a single number, overall social, economic, physical and mental well-being.
In 2017, life expectancy (at birth) in West Virginia was 74.6 years, but in Hawaii, it was 81.6 years — a full 7-year difference. If West Virginia were a nation, it would rank #93 in the world for life expectancy, below Morocco, Tunisia and Honduras — all nations with many fewer resources than the United States. If Hawaii were a nation, it would rank #23 in the world, with life expectancy within 0.7 years of countries with the highest longevity such as Canada, Iceland and Sweden.
Health scientists have known for more than two decades that differences in medical care explain only 10 to 15 percent of the gap in overall health between two populations, and the other 85 to 90 percent can be explained by “the social determinants of health,” including employment, income, education, social insurance (health, unemployment and retirement), the environment (exposure to toxic chemicals, for example), civil rights (fair employment and housing practices, for example), racism, sexism, and other social circumstances. Individual behavior is important, too — how people cope with psychological distress, depression, loneliness and hopelessness sometimes created by social circumstances. All these social determinants of health are made better or worse by state policies. Extensive data indicate that elected officials in red states have chosen policies that worsen the circumstances and shorten the lives of their constituents, whereas blue-state officials have chosen the opposite.
The Montez study examined more than 120 state policies, clustered into 17 main groups or “policy domains.” The policy domains were labeled “liberal” or “conservative.” Liberal policies are those that expand state economic regulation (e.g., minimum-wage laws) or that protect marginalized groups (e.g., prohibit racial bias in housing), or that restrict states from criminalizing nonviolent behavior (e.g., legalizing marijuana). Conservative policies do the opposite.
The longevity gap between U.S. states has been growing steadily larger for several decades. In 1959, people in Connecticut and Oklahoma both had the same life expectancy: 71.1 years. However, by 2017, Connecticut’s life expectancy had grown to 80.1 years — putting it near the top in the U.S. — while Oklahoma had reached only 75.8 years, putting it near the bottom. As time passed, Connecticut’s social policies became increasingly liberal, while Oklahoma’s became increasingly conservative. Oklahomans today are paying a cruel price for Republican policies — a price measured in lives cut short by four years, unnecessarily.
The Montez study reveals that life expectancy in red and blue states began to diverge slowly in the 1970s but accelerated after 1980 when Ronald Reagan propelled the rise of the modern conservative movement. The year 2010 was another “watershed moment,” the study says, when Republicans swept into power in 21 states and aggressively eliminated liberal policies, noticeably shortening the lives of red-state residents.
In 2009, Democrats held complete control of 16 states (governorship, plus legislative dominance) while Republicans controlled only nine. In the 2010 elections, Republicans gained complete control in 21, Democrats in only 11.
In his 2019 book, State Capture, Alexander Hertel-Fernandez describes how the policy environment in red states immediately began to shift in 2010: “What made the 2010 state legislative transition so striking was the speed with which the states began introducing and enacting a near-identical set of very conservative policy priorities,” he writes.
Three radical-right organizations worked hand-in-glove to impose the death-dealing state policy changes after 2010: The American Legislative Exchange Council (ALEC), the State Policy Network (SPN) and Americans for Prosperity (AFP). ALEC writes model state-level legislation; SPN, a network of over 60 state-level think tanks, supports legislation with a steady stream of research and media commentary; while AFP floods state legislatures and governors’ offices with mail, phone calls and emails threatening electoral retribution if they reject ALEC’s proposals. (Democrats and progressives are often simply outgunned, having never developed anything so comprehensive and coordinated. To understand ALEC better, see ALEC Exposed.)
All three radical-right organizations have been heavily funded by the billionaires who make up the Koch brothers’ “dark money” cadre, known as the Kochtopus. Years ago, the founding members of the Kochtopus hatched a plan to eliminate majority rule from the U.S. political system, and arguably they have succeeded. A Princeton University study of how our laws are enacted can be accurately summarized as, “Nobody cares what you think unless you’re rich.”
In addition to changing specific state policies, the Republican billionaire network has also promoted changes in the basic relationships between federal, state and local governments. In 1995, Republican strategist Newt Gingrich, then Speaker of the House of Representatives, announced, “We are going to rethink the entire structure of American society and the entire structure of American government…. This is a real revolution.”
He wasn’t kidding. In 1996, the federal government overturned 30 years of policy, giving states greater authority over programs like welfare and Medicaid, replacing entitlements with “block grants” that had far fewer strings attached. After this “devolution,” states were free to impose more conservative welfare policies, including punitive restrictions on welfare recipients, such as cutting off cash benefits after a certain period of time.
Meanwhile red states began to preempt local control from cities and towns, greatly curtailing local authority. Red states then outlawed local indoor-smoking bans, local minimum-wage statutes and local requirements for paid sick days, for example. Today, 25 states preempt locales from passing minimum-wage laws.
Since the early days of devolution and preemption, states have engineered vastly different health outcomes for their residents. In 1980, life expectancy in blue New York and red Mississippi differed by only 1.6 years. By 2014, the difference had grown to 5.5 years. In life expectancy, New York now resembles Denmark and Mississippi resembles Romania.
The state-level changes were reflected in national health statistics. According to the National Academy of Sciences, in 1980, the U.S. ranked #13 for longevity among 22 rich democracies. By the early 2000s, we ranked at the bottom at #22.
The Montez study reveals that, if all states adopted the policies of the most liberal U.S. states, U.S. men would live an average of 2.1 years longer, women would live 2.8 years longer, and average U.S. life expectancy would rise to the level of other high-income countries. It seems that the main thing standing in the way of better longevity from Maine to California and everywhere in between is the modern Republican Party.
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