U.S. death rates show how politics are affecting public health
statnews.com
statnews.com
"In this national analysis, we found that Americans living in counties that voted Democratic during presidential elections from 2000 to 2016 experienced lower age adjusted mortality rates (AAMRs) than residents of counties that voted for a Republican candidate, and these patterns were *consistent across subgroups (sex, race and ethnicity, urban-rural location).*"
I.e. many of the tried and true methods of "explaining away" a study's result does not apply.
20 years ago a heart attack had a very high chance of death, even if you’re close to a hospital. These days, you’re much less likely to die if you get to a hospital / medic in time.
> Current smoking has declined from 20.9% (nearly 21 of every 100 adults) in 2005 to 12.5% (nearly 13 of every 100 adults) in 2020 (CDC)
Or it could be completely irrelevant. Who knows? (Note: Looks like the article authors controlled for the distance from hospitals)
Doubtful. Widespread use of statins, I should think, are a better match for that data.
It seems like everybody I know above 55 are on statins.
Or perhaps just have better treatments?
What about income/economic class?
I grew up in a "deep red" area of the Midwest. It wasn't always like this, but it seems obesity is the norm now. And obesity has many health consequences. It's probably more cultural than political, though.
If it's cost, healthy home cooked food is as cheap or even cheaper than unhealthy fast food. But so many people I talk to think it's cheaper to get fast food. If you have a shred of common sense you can make really tasty and cheap healthy food at home.
I suspect it's also something like 5x cheaper to compose healthy meals 5x healthier at home, IF one has a home in which such can be done.
* BS Leaf (some worthless lettuce)
* Mostly filler of BS Leaf
* Poor in vegetables
* Poor in seeds / nuts
* Frequently small or cheap protein
* A 'shelf stable' dressing for flavor
No, I can't go out and just buy one. Most places (there might be 1 or 2 out of like 30-40 restaurants 'car drive') near me only make a 'BS salad'.
What I could really use is a sort of 'ghost kitchen' that takes relatively simple recipes based on bulk ingredients that are in stock at fair prices and makes a meal. Or maybe even just reusable snapware packs individual ingredients at sane sizes.
[1] https://www.scrapehero.com/location-reports/Sweetgreen-USA/
Vegetables and cheeses tend to rotate every week.
I often times do my protein on the side but that's preference.
I currently have a love affair with Kewpie's onion and garlic dressing but normally go for some olive oil and vinegar, a pinch of salt and black pepper.
Clocking in at 1,570 calories: Applebee's Oriental Chicken Salad With Crispy Chicken
Then, on top of it, the weather's miserable 9 months out of the year. Oppressively hot & humid, or bitter cold. You're inside, you're in a pool/manmade-lake, or you're eagerly counting the minutes until you can get back to one of those places. Because of the first paragraph, incentive to brave the elements and go outside anyway, is practically zero.
IOW our natural environments and climates also discourage outdoor activity, pretty damn effectively.
[EDIT] Oh, and regarding this:
> Obviously it's not profitable to own a healthy restaurant out there, but why? Is it a lack of healthy eating education? Is it a "harder" life and junk food is a reward? Or is it cost?
It's a combination of cost and population density, mainly. Food culture plays in, but it's a feedback-loop sort of situation, not the case that food culture's purely driving the problem. Restaurants that optimize to avoid ingredients that spoil fast can charge less. Healthy ingredients tend to spoil faster than unhealthy ones (not universally true, but broadly so, especially for fruits and veggies). Higher prices (relative to local competition) mean a smaller customer base, which increases the population density required to support a restaurant.
Honestly I've been to SF a lot and I find California down right dreary and boring!
Many in our area are farmers and they are a lot tougher than your post suggests.
The truth is healthy food is insanely expensive. We spend over $1000+/mo for two people. I know families with kids that eat on less than half that by eating less healthy.
Heh, I come very directly from extremely country stock, so I'd never disparage their hardiness.
... However, even the farmers are rocking fancy trucks and climate-controlled combines & tractors with GPS guidance, these days :-)
AFAIK you still have to step out of your air conditioning to shoo loose cattle back in their pens, or mend a fence, though.
https://www.nass.usda.gov/Publications/AgCensus/2017/Online_...
The winter clothes you wear when traveling from one indoor place to another are not appropriate for extended outdoor use, and the other way around. Many people need years or even decades to accept that they have to dress differently for the outdoors. Until that, they often think that cold temperatures are automatically unpleasant.
Freezing temperatures are rarely a problem as such. Wind and humidity can make them a problem. Inland forests tend to be more pleasant than open coastal areas in the winter.
Darkness makes everything much worse. Snow makes everything much prettier.
Finnish residential areas almost always have forests with walking trails nearby. I haven't been to the Midwest, but my impression is that American urban planning doesn't like leaving large undeveloped areas everyone is free to roam near developed areas. That often leaves the residents with nowhere to go by foot.
That's the case where I am. 15 minute bike ride to reach the nearest park of any kind. There are no publicly-accessible forests within reasonable walking or biking distance (20+ minutes by car, largely on highways) and the ones that exist are few, tiny, and crowded because there's very little else around to do outside, as far as being-in-nature sorts of activities.
Most of our forests were destroyed decades ago by agriculture, and when we build housing developments we take all the plants off the land first, destroying any surviving trees and even stripping much of the topsoil (yes, seriously).
The nearest large region of sort-of-OK outdoor space we have is about 5 hours away by car. It's comparable to the worst parts of the Appalachian Mountains. You're looking at 12+ hours of driving to reach anything better than that.
Winter's definitely nicer than Summer, here. Uglier, but nicer. You can always wear more clothes. There's no beating the humidity, except to go indoors or get in water. Plus the mosquitos and ticks aren't out in Winter.
It's a little better if you own some rural land. At least you can go plink cans with a rifle or mess around on four-wheelers. Our forests have a way of developing nasty, thick, poison-and-thorn-filled underbrush that make them pretty miserable to be in if they're truly undeveloped, but if you manage to get some land with some trees on it and don't mind using some light-weight farm equipment to create and maintain some walking paths, that can be an alright time in Spring and Fall.
[Yes, it's possible to make food in bulk on the weekends. There is no need to spam that helpful suggestion in the replies.]
Is it? You can get a double cheeseburger, small fries and a large soda (the worst part arguably of the whole meal health wise) for 4 dollars at McDonalds. You can skip the fries, and get 2 double cheeseburgers for the same price. The McDonalds app will often give you a large fry for free for the 4 dollar purchase.
Whats the comparable food you can be making for 4 dollars at the grocery store?
Cooking only helps when you can get economy of scale going. And only when you can use up all the ingredients you can bought effectively. Also you need the energy to make the food, if you are getting up at 7am to get your kids to school, then pick them up at 6 (when after school ends) and get home at 630, and then need to cook for 30 minutes, then another 15 to get dishes and everything put away. Your looking at not even being "done" with "work" until 715pm when you started the day at 7am. Acting like the time to cook and clean is free is not productive.
But for example...
1lb ground 90/10 turkey $3.69 1 bag of frozen mixed veggies $1.99 1/2 of a 1lb bag of rice. $.60 2 tablespoons of oil. ~$.05 1 tablespoon of soy sauce ~$.10
Total: $6.43
Throw rice plus water in a pan for 30 minutes. Add turkey, veggies, rice, ~2TBS. of butter/oil, 1TBS. of soy sauce. Done. Healthy fried rice. High in protein, healthy carbs/fiber from the rice and veggies, and low in sugar.
Should feed at least 3 people, all cooked in one pan and only requires 5 minutes of prep work. For $6.43. That's less than your one $4 meal at Mcdonalds costs, and it's significantly healthier (it has actual vegetables!). If you're just one person, It can be saved for later and re-heated in the microwave in 1 minute.
I'm sympathetic to Warraich's position, but its weak that he combines the conclusions of the voter patterns and access-to-care study in an opinion article and not in a peer reviewed paper. Hopefully one is in preparation.
https://www.usatoday.com/story/news/politics/onpolitics/2016...
>In fact, Silver parsed the data to discover the average Trump voter makes $72,000 per year — a middle-class income solidly above the typical American.
>As compared with most Americans, Trump’s voters are better off. The median household income of a Trump voter so far in the primaries is about $72,000, based on estimates derived from exit polls and Census Bureau data.
>That’s lower than the $91,000 median for Kasich voters. But it’s well above the national median household income of about $56,000. It’s also higher than the median income for Hillary Clinton and Bernie Sanders supporters, which is around $61,000 for both.
>> But it’s well above the national median household income of about $56,000
That's household.
And the Fed wants LOWER wages. What is wrong with people!? Pay more!
In the 90s I would have considered $56,000 per year as rich. In the 2000s it would have been upper-middle class, or "senior white collar professional". In the 2010s probably down to "office job" or "good blue-collar job".
There's something funny about seeing people point to a salary that I grew up thinking was a best-case scenario dream as being insufficient. Maybe if our policies focused more on quality of life rather than nominal wages, we could help people instead of just having decades of inflation.
If you look at historical income, $56k in 1995 is roughly where $100k is now, in terms of where it put you in the income distribution.
> In the 2000s it would have been upper-middle class, or "senior white collar professional"
In 2005, it's like a little under $85k today, again, by where it puts you on the income distribution, not buying power.
I think that the farther back you go, the more you are overstating what $56k was.
Stop blaming the working class when the rich keep taking a larger portion of the pie. Just stop.
Are you trying to suggest that the working class is the root cause of inflation, and that by me pointing out inflation it was an attack on that group? I genuinely can't figure out why you're angry here. Is this trolling? I'm confused.
I agree that if you go only at the top decile, the median democrat voter could make a bit more than the median republican voter (idk really), but if you take the whole population? I remember 2016 Sanders campaign funding.
Also, i went to West Virginia, an know the people there, happen to meet the local democrat (pro blue water, proponent of the redneck movement, basically a communist compared to the average american) and saw his electorate. I mean, they do live the good life, they eat venison and a lot of homegrown vegetables, they ride horses and sell lilies (no joke), brew their (mostly) bad beer and throw day-long parties on sunday where you jam from one PM to eleven (i improved more in two weeks there than in the last five year). But their income? i'd be surprised if they aren't in the last decile (or almost there).
It's not really this simple anymore.
Americans are sorting into the party of college grads (Democrats) and the party of non-college-grads (Republicans). This doesn't translate as neatly to income as you might think, but it's definitely a factor.
> they eat venison and a lot of homegrown vegetables, they ride horses and sell lilies (no joke), brew their (mostly) bad beer and throw day-long parties on sunday
This is not typical of any large group of voters, including in West Virginia. As someone who grew up there, I can tell you that most people buy food from Walmart. They don't grow it. There is certainly eating of venison, but frozen pizza is certainly more popular. Horses (and the riding of them) is uncommon.
In 2016, Trump beat Hillary in white college-educated women, despite all the claims about gender and education popular in certain sections of media.
I think one big problem with discussion about American politics today is that we all pretend like "Republican" and "Democrat" are in any way logically consistent groups representing two opinions. The truth is, they're both completely absurd coalitions of diverse groups, bound up out of necessity by America having a two-party system.
Instead of trying to split people into two groups along whatever line - education, income, urbanization, race, religion, we should just accept that the parties are a hodgepodge of many different groups. For instance, the Democrats have as a coalition both Black voters and LGBT voters, despite the fact that Black Americans have been far less progressive on LGBT issues than White Americans. Republicans have as a coalition both "small government" fiscal conservatives and Christian social conservatives, despite these groups often having polar opposite policy goals.
I agree with this, it’s been my experience that most of the most intelligent and highly educated people I know are solidly GOP…except those who work in higher education. Although…some of them in higher education I know vote GOP, but claim they don’t, or don’t disclose it publicly.
Said another way, maybe counties with poor medical facilities, poorer people, etc. are more attracted to voting Republican. The title might read "The downtrodden are more attracted to Republican ideas"
Not saying this is true either it's just that the causal factors may not be part of the study. They tried to include race/color and gender but the effect is still visible across the board.
They did not study obesity or income level, which I suspect would show even stronger correlation to an increase in AAMR than what the county voted in the last election.
> Conclusion: The mortality gap in Republican voting counties compared with Democratic voting counties has grown over time, especially for white populations, and that gap began to widen after 2008.
That’s it.
[1] https://www.nbcnews.com/politics/meet-the-press/gop-rapidly-...
[2] https://www.washingtonpost.com/politics/2022/01/11/democrat-...
The author's based their analysis on data; is there data for your claim? There is plenty of poverty in cities.
EDIT: Quoting another commenter who quoted the OP: "[r]egardless of whether we looked at urban or rural areas, people living in areas with Republican political preferences were more likely to die prematurely than those in areas with Democratic political preferences"
with the emotion being the health outcome response, I would tend towards Yes, demagogue.
[0] I don't currently have time to verify this myself.
Any real studies in health sciences rely on statistics, so the treatment of the stats has to be defensible. That specifically is where they lose me, but that is how it is done.
I do not subscribe to the partisan politics world-view, in many, many ways.. so I was motivated to disparage the idea that this study is adequate to learn by the reader. I also am not going to take the time to really read this one. hth
Are the parties causative? Or are they just the labels that we have to describe the two groups currently? We don’t know.
Or is it the other way around? Commenters occasionally often point out the "red states" are the biggest recipients of welfare in spite of being the ones that vote most against it. To me, it seems that the most likely explanation for this is that the voters there see the negative effects of welfare and the ones who are voting for it are insulated most from the unintended consequences. It could just as easily be that the voters who see the most death are voting for the party they most feel will enact policies that will lead to less of it.
I skimmed this paper to see if the authors did any of the facepalm-obvious things you'd do to control for covariates if you were serious about doing an observational analysis (e.g. multi-factor regression), but saw nothing. They're literally just looking at differences in slopes in the lines:
> Trends in mortality were examined to identify changes in slope using Joinpoint Regression Program version 4.8.0.1, which models consecutive linear segments on a log scale, connected by joinpoints, and can measure when slopes of annual percentage change (APC) undergo a statistically significant change
This is a...well, let's just call it non-conventional...analysis method.
So, yes, probably, but. I went in a rural area in West Virginia for some personal reasons. And i mean rural. One hours and a half from Charleston, and half an hour of the nearest town (population: 728). I think i met all the democrat voters there(four dozen or so :P). Mountain guides, kayak/raft guides, musicians(a lot), old hippies living off the land, a lily farmer, a lot of organic farmers too (And the first goat farmer who convinced me than US cheese is at least as good as french/italian goat cheese). Some of them without running water, almost half of them off grid. I think the "fatest" one was barely over my weight, so between 27 and 29 BMI. I also went to the organic farmer market in Hungtington (Clearly not republican leaning, as the sticker against mountain top mining, pro-unions and "Freedom Industries = Lexycon, protect our water" could show) and to a city music festival (were i met all those communist hippies again). Frankly, the overall health and shape of those people, i thought i was back in europe.
Poverty and health care access, yes. Addiction: not that much. Some are alcoholics, i think i met one meth user, but no one tried to sell to us, and their social life is way too full to have time for this shit. Obesity: clearly not. Less than in Paris.
Also, these people were clearly aware of the Elk river incident (it was four years after, still had banners and stickers warning about water quality) and did flush/replace their pipes, and could very well be the only ones who did.
Usually framed as "blue states are paying for the red states' welfare". But this isn't true.
First, the state of California does not pay a cent to another state or to the federal government. It is residents of California that pay federal taxes, which in turn provide funding and services to states and individuals.
Second, the Rockefeller Institute (<https://rockinst.org/issue-areas/fiscal-analysis/balance-of-...>) shows that, as of 2018 (the last time I checked this data; I see that 2019 is now available), the 10 states at the bottom of the per capita list—that is, the states that benefit from the most federal spending per person compared to how much each person pays in federal taxes—are
2016/2020 Hillary/Biden-voting states: VA, NM, MD, HI, 1/2 of ME
2016/2020 Trump-voting states: KY, AK, AL, WV, MS, 1/2 of ME
It's not so much "blue states" as per the above-mentioned claim, but taxpayers of four very wealthy Northeast states (the Tri-State area plus Massachusetts) that account for the vast bulk of citizens paying more than they receive from the federal government. After them come CO, NE, UT, and MN, of which half voted for Hillary/Biden and half for Trump. All other states, including CA, are net beneficiaries of the taxpayers in the top eight (and, again, really, it's the top four).
This may be just a classical correlation =/= causation error or it is campaign fodder for the upcoming elections.
Understanding the outcomes of political choices isn’t inherently political. It’s completely reasonable for someone to say yes this saves lives but it’s still not worth the money.
Only thing I can think of that is (sort of) a political decision to “limit health care” is refusing to expand Medicaid.
I know that didn’t happen across the board for Republican counties/states, though, so what in the world are you claiming?
Credit where credit is due, Iowa and Hawaii actually rank very highly in terms of healthcare affordability and outcomes.
https://abcnews.go.com/Health/red-blue-america-glaring-divid...
https://www.nytimes.com/2021/11/08/briefing/covid-death-toll...
https://www.pewresearch.org/politics/2022/03/03/the-changing...
Isn't the entire point of politics and political parties to change social outcomes? "Your policy X will negatively impact social outcomes because reason Y while my policy Z will positively impact them" is a huge chunk of politics.
Besides, I don't see how actually trying to measure outcomes of specific policies is "demagoguery"? The author(s) of this paper may be wrong (I didn't look too deeply at the study), but that's not the same as "demagoguery".
As I see it:
A) The paper is primarily a study of numerical trends.
B) Some potential policy causes for this difference are listed in the discussion section. While this is not the primary focus of this paper, the discussion links to several other prior studies regarding particular policies and their impacts.
C) However, more specific details (other than the above postulates) is not part of the paper's focus. This is acknowledged as a limitation in the study, and it is also acknowledged that other factors aside from policy (such as poor health or social and economic factors that may also motivate political preference) explain some of the hap. So it is important not to read too much detail into the cause of this gap at this time.
It's very easy to specify hypothetical laws, that if enacted and enforced, would have dramatic public health benefits. A tyrrany of health, if you will. But that doesn't mean it would be ethically acceptable. Conversely, a great many military and other actions, ethically justified, are not healthy at all for its participants.
The problem with these political appeals based on public health is that physical health per se, or even health in general, is just one of many values to be weighted in decision making. I think there's been a general creep in what "health" encompasses, while being selective in other ways. I do think this is part of the reason for pushback from certain quarters, a reaction against trying to dress up politics in the disguise of science without being honest about it.
Science is always political to some extent, I think. So trying to argue that some phenomenon is a "scientific" issue, and therefore best addressed by qualified scientists seems disingenuous to me. It's not so much that expertise isn't real, it's that it has to have limits or it's meaningless.
Tragic.
ADI was a little harder, landed on https://www.ahajournals.org/doi/10.1161/JAHA.120.020466 after a few searches.
The current iteration: https://www.neighborhoodatlas.medicine.wisc.edu/
Not sure if this is what OP meant, but I read ADI as acceptable daily intake. Area deprivation index might also fit.
ADI: Area Deprivation index
edit: hah- I said "obesity" and "massive factors" .. B&B score
https://www.amazon.com/Dying-Whiteness-Politics-Resentment-H...
The correlation can be meaningful in and of itself.
And a link to the paper ("Political environment and mortality rates in the United States, 2001-19: population based cross sectional analysis") that the article describes: https://www.bmj.com/content/377/bmj-2021-069308
> There was no single cause of death driving this lethal wedge: The death rate due to all 10 of the most common causes of death has widened between Republican and Democratic areas.
Wealthier people live longer than poor people.
https://www.brookings.edu/blog/the-avenue/2020/11/09/biden-v...
The current republican party provides a hate machine with no actual solutions other than tax cuts for the rich and culture war for the rubes.
All that is left for the Red counties is anger and despair delivered nightly via Fox news and the right wing lie machine.
Doesn't this prove that it is something other than who your county voted for in the last presidential election causing an increase in AAMR?
> Rural Republican counties experienced the highest AAMR and the least improvement
What if living in a rural area is more of a factor than being a "Repulican county"?
This study seems like it is bending over backward to try to tie the risk of death to who you voted for in the presidential election.
>What is perhaps most telling in our study is that while both Black and Hispanic Americans experienced largely similar gains in health regardless of what political environment they lived in, with Black residents of Democratic areas experiencing the greatest reduction in deaths rates of any major racial-ethnic group, the sharpest divide is seen among white Americans. In fact, the fourfold growth in the gap in death rates between white residents of Democratic and Republican areas seems to be driving most of the overall expanding chasm between Democratic and Republican areas.
The study controlled for that.
"The study period covered five presidential elections from 2000 (673 Democratic counties, 132 833 397 population; 2439 Republican counties, n=147 957 141) to 2019 (490 Democratic counties, n=176 971 611; 2622 Republican counties, n=145 413 920) (supplementary tables 1 and 2)."
democrat 143 counties, n=91 809 974 to 156 counties, n=133 796 619 And republican 292 counties, n=61 407 202 to 280 counties, n=46 244 883
So overall health is improving, but it is improving more when increasing sample size. It is normalized, but still different things are compared.
Thanks I didn't know all that about democrats and counties, seems more involved then I thought.
This is also happening at the state level, and is causing the Senate to become ridiculously radical. It only takes the support of 5.1% of US voters to filibuster a bill, and 12% to defeat a filibuster:
https://www.reddit.com/r/politics/comments/2jnmbe/i_did_the_...
The "supervoters" making up that 5.1% and 12% are mostly in Republican states, and this has led to the Republican party drifting farther and farther right of the mainstream over time. For example:
74% of Americans want action on climate change: https://www.pewresearch.org/fact-tank/2021/09/14/americans-a...
69% of Americans want to keep Roe v Wade: https://www.marketwatch.com/story/what-percentage-of-america...
Yet neither can get 50 votes in the Senate, let alone the 60 required to pass.
In his case he was willing to point this discrepancy out, though he immediately blamed the victims.
So if it sounds like it will sort itself out, it may end up doing so on the backs of the least enfranchised.
This example of pseudo logic is very popular in politics because most voters struggle with logic, but love to look smart, so pseudo logic aopeals to them.
I believe it is a benefit as a matter of faith, but I couldn't prove it to a skeptical person.