Politics and Health : Short Wave Political polarization is affecting Americans' health, according to a new study. Researchers find higher levels of premature death in Republican-leaning counties compared to those in Democratic-leaning ones. The higher mortality in GOP counties is across the board – everything from heart disease to suicide. Allison Aubrey talks to Emily Kwong about what may be causing these disparities.

How Politics And Health Are Intertwined

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EMILY KWONG, HOST:

You're listening to SHORT WAVE...

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KWONG: ...From NPR.

ALLISON AUBREY, HOST:

Hello, SHORT WAVE-rs. Allison Aubrey here.

KWONG: And Emily Kwong.

AUBREY: So, Emily, there's a lot of talk that political polarization in the U.S. can undermine democracy.

KWONG: Yep.

AUBREY: And now medical researchers are saying the bitter divide may actually undermine Americans' health, too. A new study finds that how a county votes in presidential elections helps predict life expectancy for people who live in that county.

KWONG: I don't really get that, though, because when I think about life expectancy and risk factors, I think more about, you know, smoking, exercise, eating - genetics plays a huge role. You're telling me that political affiliation should be added to that list?

AUBREY: Well, according to a recent study in the BMJ, yes. Researchers went back about 20 years. They analyzed a CDC database that collects death data on essentially every individual in the U.S. They then linked this data with federal election data...

KWONG: Whoa.

AUBREY: ...Looking specifically at how counties voted in presidential elections and also state governor races. And they found that while it's true that since the early 2000s people have been living longer, some of those longevity gains have really flattened out in the last 10 years. And when they looked at areas losing ground, they found Republican counties were losing more. Here's the study author. His name is Haider Warraich. He's a doctor at Brigham and Women's Hospital.

HAIDER WARRAICH: Our findings did surprise us because our study does suggest that there are more premature deaths in Republican-leaning counties than Democratic-leaning counties.

AUBREY: And he says this mortality gap held up in both suburban and urban counties that vote Republican. And it can't be explained away by Republican counties being older. The researchers adjusted for age, which means they used a statistical method to kind of compare death rates.

KWONG: So today on the show, Allison and I will talk about why the political leaning of your county may have an impact on your health. I'm Emily Kwong, and you're listening to SHORT WAVE, the daily science podcast from NPR.

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KWONG: OK. We are talking today about partisanship and health. Allison, tell me about this study. Where did it come from?

AUBREY: Well, the author of the study, Haider Warraich, told me that before the pandemic, in 2019, he was working in a rural hospital in Asheboro, N.C., and it went bankrupt. He became very interested in the state of health in rural America, thinking that this sort of urban-rural divide may explain differences in mortality. So he dug into CDC data, and this was really a population study. I mean, the sample size was basically the whole country, 99.8% of the U.S. population across five presidential elections. Now, research may not pick up on a trend like this if it's just a smaller sample of people. So the real value of this study is its size.

KWONG: Yeah. I am so impressed that this study managed to look at the entire country in a way. And what we're going to talk about is just how it determined that people in Republican-leaning counties have higher mortality rates, which suggests that people are dying younger in those places. Do they know why that is?

AUBREY: Well, the timing of when this gap started gives a clue. Now, Dr. Warraich says when he looked back to 2001, mortality rates between Democratic and Republican areas were about the same.

WARRAICH: Yet all of that has changed over those last 20 years. And now that gap has widened by almost sixfold between Republican, Democratic areas.

AUBREY: So the effect has been accelerating. Now, this study can't answer the why, but the leading theory on what - on what has actually changed is that as policymaking has shifted more to the states and as political polarization has intensified, the policies passed by Republican-leaning states compared to those passed in Democratic states have led to this greater divide in health outcomes. Medically speaking, the greatest contributors to the gap were the things people die from in the United States - heart disease, cancer and respiratory tract diseases.

KWONG: So the argument is that in the last 20 years, Republican policies have started to be linked to higher death rates, and Democratic policies were linked to lower?

AUBREY: That's right. Basically, this is the argument Dr. Steven Woolf makes. He is a longtime health researcher at Virginia Commonwealth University. He says, take policies such as the expansion of Medicaid. I mean, the option to expand health insurance to more low-income people became an option for states in 2014, but many Republican-leaning states were slow to adopt or still have not. There are also policies on minimum wage, tobacco control, gun legislation, drug addiction. So many policies have an impact on health and mortality rates. Democratic states have supported more of these; Republican states have basically gone in the other direction.

STEVEN WOOLF: Action in Washington, D.C., is caught in gridlock, but activity in state capitals is robust. And whether we're talking about abortion or gun control or many other issues in the news right now, states are really driving change. And the more conservative the policies, the larger the threat to life expectancy. So increasingly, we're living in a time where your life expectancy will depend more and more on the state you live in.

AUBREY: So he points to New York and Oklahoma. If you go back to the mid-'90s, life expectancy in these two states was about the same. Now New York is at the top of the list; Oklahoma is near the bottom. And he thinks part of this is likely due to policy differences.

KWONG: But other things influence health, too, right? I mean, there's people's just behaviors and habits. Also, I mean, decades of systemic racism and discrimination has clearly harmed the health outcomes of Black and brown populations in the U.S., too.

AUBREY: Of course. I mean, this is another factor to add. You know, look; many, many factors influence longevity - also, you know, education, income within a population, within a state level. There's also changes to a state's economy or demographic shifts. But Woolf says, to him, the most convincing evidence that state politics is one factor influencing longevity is what happened during the pandemic.

WOOLF: States with Republican leaders were pushing back on COVID-19 vaccination and enforcement of public health policies. And what we basically had was a controlled experiment where, you know, some states adopted this proactive approach; other states didn't. And we had an outcome that could be measured within weeks, and we saw massive differences in death rates.

AUBREY: He points out Republican-led states have tended to have lower vaccination rates. And our colleague Geoff Brumfiel, as well as others at NPR, have reported on how pro-Trump counties have continued to suffer far higher COVID death tolls.

KWONG: Allison, I'm thinking about now people in Republican-leaning counties who would like to see more protective health policies. Where are their voices in this mix?

AUBREY: You know, one of the things that has really fascinated me covering this pandemic is that if you ignored all the loud voices, people fired up protesting against vaccine mandates or mask mandates, and you look at public opinion polls, most Americans, most people say, hey, if there's evidence a mask will protect me, I'll wear one in certain situations. If vaccines work, if they protect me, I'll get one. And most Americans did get vaccinated. It's almost like the more politically divided we've become as a nation, the harder it is to kind of see or hear the folks in the middle of this big divide.

KWONG: And does this group you're talking about, the folks in the middle, do you think they recognize this connection between certain health policies and better health, not just COVID ones?

AUBREY: Maybe some. I think there's a narrative in the U.S. that health is all about the individual; it's all about individual choices. And of course, as we just discussed, that's part of it. But there's a lot each of us can't control - the quality of air or water in our area, the availability of healthy, affordable food in our neighborhoods, access to affordable health insurance. I spoke to researcher Jennifer Montez at Syracuse University, who also studies the link between politics and health.

JENNIFER MONTEZ: I think it's possible that if people understood how much each of those policies shaped their own health, the health of their children, the health of their friends, there's good reason that they would vote in policymakers who would enact those policies.

AUBREY: Yet, she says, she's not very optimistic given the ideological divides in this country.

KWONG: You know what I find interesting, too? I find it interesting that researchers did this work in the first place because there's a resistance in science to getting involved with anything political or partisan. I mean, that's been pretty taboo in the past. Why the change?

AUBREY: Well, it was interesting. Steven Woolf told me that he is seeing a change brought about just by the realities on the ground.

WOOLF: I'm in my 60s, so in my career as a academic researcher, it's not been common for politics to be part of epidemiologic research. The custom has been to avoid discussions of politics in scientific research. But we're increasingly living in an era where political affiliation is as important a determiner of health as smoking or obesity or poverty.

KWONG: Allison, thank you for bringing us yet another really, really interesting health segment.

AUBREY: Great to be here. Thanks for having me.

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KWONG: This story was edited by Jane Greenhalgh and Gisele Grayson. Thomas Lu produced, and Rachel Carlson and Margaret Cirino checked the facts. Andrea Kissack runs the science desk. Edith Chapin is vice president and executive editor at large. Terence Samuel is vice president and executive editor. And Nancy Barnes is our senior vice president of news. I'm Emily Kwong. Thanks for listening to SHORT WAVE, the daily science podcast from NPR.

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