ASHTABULA, Ohio — Mike Czup unspooled the hose to wash his hearse. It was time to pick up the body of yet another neighbor who had died in the prime of life.
Since he started working at 15 in the funeral business, Czup has seen plenty of tragedies. But the 52-year-old said he’s still coming to grips with a disturbing fact about the bodies he washes, embalms and entombs: About a quarter of the people he buries are younger than him, as residents in this once-thriving coal town are dying earlier and earlier.
Ashtabula’s problems are Ohio’s problems — and in large part, America’s problems. Americans are more likely to die before age 65 than residents of similar nations, despite living in a country that spends substantially more per person on health care than its peers.
Many of those early deaths can be traced to decisions made years ago by local and state lawmakers over whether to implement cigarette taxes, invest in public health or tighten seat-belt regulations, among other policies, an examination by The Washington Post found. States’ politics — and their resulting policies — are shaving years off American lives.
Ashtabula’s problems stand out compared with two nearby counties — Erie, Pa., and Chautauqua, N.Y. All three communities, which ring picturesque Lake Erie and are a short drive from each other, have struggled economically in recent decades as industrial jobs withered — conditions that contribute toward rising midlife mortality, research shows. None is a success story when it comes to health. But Ashtabula residents are much more likely to die young, especially from smoking, diabetes-related complications or motor vehicle accidents, than people living in its sister counties in Pennsylvania and New York, states that have adopted more stringent public health measures.
That pattern held true during the coronavirus pandemic, when Ashtabula residents died of covid at far higher rates than people in Chautauqua and Erie.
The differences around Lake Erie reflect a steady national shift in how public health decisions are being made and who’s making them.
State lawmakers gained autonomy over how to spend federal safety net dollars following Republican President Ronald Reagan’s push to empower the states in the 1980s. Those investments began to diverge sharply along red and blue lines, with conservative lawmakers often balking at public health initiatives they said cost too much or overstepped. Today, people in the South and Midwest, regions largely controlled by Republican state legislators, have increasingly higher chances of dying prematurely compared with those in the more Democratic Northeast and West, according to The Post’s analysis of death rates.
Ohio sticks out — for all the wrong reasons. Roughly 1 in 5 Ohioans will die before they turn 65, according to Montez’s analysis using the state’s 2019 death rates. The state, whose legislature has been increasingly dominated by Republicans, has plummeted nationally when it comes to life expectancy rates, moving from middle of the pack to the bottom fifth of states during the last 50 years, The Post found.
Public health officials say Ohio could save lives by adopting measures such as a higher tobacco tax or stricter seat-belt rules, initiatives supported by Gov. Mike DeWine, a Republican generally friendly to their cause. . . . But those proposals have repeatedly stalled in a state legislature controlled by Republicans for 27 of the past 29 years and whose leaders show little inclination to move aggressively now.
Thirty years ago, Ohio’s health outcomes were on par with California’s, with nearly identical death rates for adults in the prime of life — ranking in the middle among the 50 states. But the two states’ outcomes have diverged, along with their political leanings, said Ellen Meara, a health economics and policy professor at the Harvard T.H. Chan School of Public Health. She has studied why death rates fell in California, home to some of the nation’s most progressive politics, while they scarcely budged in increasingly conservative Ohio. By 2017, California had the nation’s second-lowest mortality rates, falling behind only Minnesota; Ohio ranked 41st, according to The Post analysis.
Health disparities also show up unevenly across Ohio. . . . Many of the state’s public health outcomes are a direct result of political decisions, Skinner and other experts say, pointing to differences in Medicaid and safety net funding, as well as tobacco taxes and highway safety laws between Ohio and its neighbors. They note that Republicans’ stranglehold on the legislature, after defying repeated court orders to redraw state voting maps, has protected those politicians from the consequences of their votes.
State data shows that seat-belt use has fallen in Ohio to its lowest level in 18 years — with fewer than 81 percent of residents regularly buckling up, compared with 92 percent of Americans as a whole — worrying officials who say the decline is preventable, inexplicable and contributes to greater risk. A Post analysis shows that Ashtabula residents are twice as likely to die of motor vehicle accidents as are people in Chautauqua.
Ohio’s GOP lawmakers have also rebuffed multiple efforts to boost cigarette taxes, a public health measure proven to decrease smoking rates — especially among new and young smokers.
There’s also a notable difference in health outcomes: Smoking-related deaths — including from lung cancer, heart disease and chronic lower-respiratory disease — have declined sharply across the country over the last two decades but increased in Ashtabula, where middle-aged adults are 55 percent more likely to die of those causes than the national average, The Post found. While the rates of smoking-related deaths in Erie and Chautauqua are grim, they are not nearly as bad as Ashtabula’s.
Ohio’s tobacco tax has been raised just once since 2005. Public health experts say the state’s relatively low tobacco tax is a key reason it had the fourth-highest adult smoking rate in the country — and ranked near the bottom of states for life expectancy as of 2019.
In contrast, Pennsylvania’s middle-of-the-pack smoking rate matched its life expectancy ranking, and New York — whose cigarette tax is now more than three times that of Ohio’s — had one of the lowest smoking rates and ranked third in life expectancy.
New York spent an average of $102 per person on public health annually in the years before the pandemic, more than double the $43 per person that Ohio spent, according to an AP-KFF Health News analysis.
Elizabeth Kidder, a Chautauqua native who serves as medical director of a safety net clinic, has seen how state policies can have a direct impact on county residents. The internal medicine specialist said her patients who move out of state often find they don’t have the same quality of Medicaid services
In Ohio, as in much of America, the fate of measures that can save lives boils down to a familiar tension: individualism vs. the public good.
Christine Hill, health commissioner for Ashtabula City, said some constituents have urged her to get government out of their health care.
To health advocates and the legislators, the fight over what’s known as preemption — state lawmakers passing legislation to stop local governments from implementing policies such as harsher cigarette taxes or stricter gun laws — is part of the existential battle over the direction of the state.
Republican lawmakers have increasingly deployed preemption laws to hamstring the ability of cities and counties to make health mandates that could save some residents, according to legal experts.
Read the entire piece. Republican voters are literally harming themselves and their loved ones but are too blinded by calls for "freedom", tax cuts, racism and prejudice towards others to take a look in the mirror and realize that they are their own worse enemies. Virginia voters need to open their eyes and not let Republicans bring similar to Virginia and to the detriment of everyday Virginians.
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