The Partisan Divide on Life Expectancy

I have long argued that Republicans use racial hatred and religious bigotry/hatred to induce working class whites and large swaths of the population to vote against their own financial and economic interest.  Now, a study that is covered in a long piece at Politico Magazine documents that Republican/red state policies literally shorten the life expectancy of their residents compared to those in so-called blue states and progressive regions.  Not surprisingly, ranking the worst with a tie for the shortest life expectancy are the Deep South and what the article labels "Greater Appalachia," a region which extends from southwest Pennsylvania all the way down to include the majority of Texas. The longest life expectancy is in the GOP derided "Left Coast" region where life expectancy is almost five (5) years longer than in the Deep South and Greater Appalachia.  Why the large difference?  Simple, red state/GOP policies that under fund public health and public support in general that cause the citizenry to have shorter life spans.  Surprisingly, even the affluent in the Deep South and Greater Appalachia suffer from shorter life expectancy than their  counterparts in Tidewater (the region where I live), the Left Coast and "Yankeedom." One has to wonder when, if ever, red state residents will wake up the reality that the policies their elected leaders embrace are literally killing them.  Here are highlights from the lengthy article:

On paper, Lexington County, S.C., and Placer County, Calif., have a lot in common. They’re both big, wealthy, suburban counties with white supermajorities that border on their respective state’s capital cities. They both were at the vanguard of their states’ 20th century Republican advances — Lexington in the 1960s when it pivoted from the racist Dixiecrats; Placer with the Reagan Revolution in 1980 — and twice voted for Donald Trump by wide margins. But when it comes to how long their residents can count on living, the parallels fall apart. Placer has a Scandinavia-like life expectancy of 82.3 years. In Lexington, the figure is 77.7, a little worse than China’s.

Or take Maine’s far-flung Washington County, the poorest in New England where the per capita income is $27,437. The county is a hardscrabble swath of blueberry fields, forestland and fishing ports that was ravaged by the opioid epidemic and is almost completely white. It has one of the worst life expectancies in the entire Northeast: 75.5 years. But that’s more than six years better than the equally remote, forested, impoverished, white and drug-battered Perry County of eastern Kentucky.

The truth of life expectancy in America is that places with comparable profiles — similar advantages and similar problems — have widely different average life outcomes depending on what part of the country they belong to.

Step back and look at a map of life expectancy across the country and the geographic patterns are as dramatic as they are obvious. If you live pretty much anywhere in the contiguous U.S., you can expect to live more than 78 years, unless you’re in the Deep South or the sprawling region I call Greater Appalachia, a region that stretches from southwestern Pennsylvania to the Ozarks and the Hill Country of Texas. Those two regions — which include all or parts of 16 deep red states and a majority of the House Republican caucus — have a life expectancy of 77, more than four and a half years lower than on the blue-leaning Pacific coastal plain. In the smaller, redder regional culture of New France (in southern Louisiana) the gap is just short of six years. So large are the regional gaps that the poorest set of counties in predominantly blue Yankee Northeast actually have higher life expectancies than the wealthiest ones in the Deep South.

We wanted to answer the bottom-line question: Is your region helping extend your life or shorten it?

The results show enormous gaps between the regions that don’t go away when you parse by race, income, education, urbanization or access to quality medical care. They amount to a rebuke to generations of elected officials in the Deep South, Greater Appalachia and New France — most of whom have been Republican in recent decades — who have resisted investing tax dollars in public goods and health programs.

“We don’t have these differences in health outcomes because of individual behaviors, it’s related to the policy environments people are living in,” says Jeanne Ayers, who was Wisconsin’s top public health official during the Covid pandemic . . . . The social and political determinants of health are overwhelmingly what you’re seeing in these maps.”

I shared these maps with cardiologist Donald Lloyd-Jones, a past president of the American Heart Association who chairs the preventive medicine department at Northwestern University in Chicago, who said they didn’t surprise him at all. “There’s a reason why the Southeastern portion of this country is called the Stroke Belt: It’s because the rates of stroke per capita are substantially higher there and mirrored by rates of cardiovascular disease, diabetes, obesity and other risk factors.”

Maybe the differences between the regions would go away if you compared just rich counties to one another or just the poor ones? Nope.

We used the prevalence of child poverty as our metric and compared the life expectancy of the least impoverished quartile of U.S. counties — the “richest” ones, in other words — across the regions. As you see in the graphic below, the gaps persisted: 4.6 years between the rich counties in the Left Coast and Deep South, for instance. . . . . We saw similar patterns when we repeated the exercise using education levels. When it comes to life and death, some regions are less equal than others.

The same went for relative access to quality clinical care. CHRR assigns every U.S. county a ranking for this based on a combination of 10 factors, including the number of doctors, dentists, mental health professionals, mammography screens, flu vaccinations and uninsured people per capita, as well as how often Medicare enrollees wind up admitted to hospitals with conditions that should be able to be treated on an outpatient basis, an indication the latter services weren’t available. We compared those counties in the top quartiles of this ranking system to one another across the regions and found the gap between them not only persisted, it actually widened, with the Deep South falling about two and half years behind Yankeedom, El Norte and the Far West, 4.4 years behind New Netherland and 5.1 behind Left Coast.

Turns out even the “haves” are not doing better in the “laissez-faire” regions. One of the most arresting facts that emerged from our analysis was that the most impoverished quartile of U.S. counties in Yankeedom (ones where around 30 to 60 percent of children live in poverty) have a higher life expectancy than the least impoverished quartile of U.S. counties (where child poverty ranges from 3 to 15 percent) in the Deep South by 0.3 years.

“There are regions of the country with structural barriers to health, where types of long-standing discrimination and disinvestment have occurred through policies and practices applied and reinforced by people with more power. … Counties in these regions have fewer social and economic opportunities today.”

One example: States that have expanded Medicaid eligibility have seen significant reductions in premature deaths while those that have not have seen increases. At this writing, 11 states still haven’t expanded the state-implemented program even though almost the entire burden of doing so comes from the federal government. All but two of those states are controlled by the Deep South and Greater Appalachia.

Five years ago, University of Cincinnati sociologist Jennifer Malat and two colleagues probed a related question: Given the legacy of white privilege in American society, why do white people have lower life expectancy than their counterparts in Canada and Western Europe, as well as per capita suicide and psychiatric disorder rates far higher than their Black, Asian or Latino peers? Their conclusion: “Whiteness encourages whites to reject policies designed to help the poor and reduce inequality because of animosity toward people of color as well as being unaware that the poor include a great many white people.” Other wealthy countries, they noted, produce poverty rates similar or greater than ours, but they have stronger welfare systems that buffer much of the population from the health problems that often flow from poverty. Whatever the reason, our data definitely show a relationship between social spending and health outcomes for white people across regions.

Again, residents of these less healthy regions have only their own politics and prejudices to blame for their shortened lives.