Why People In Republican-Leaning Areas Seem More Likely To Die Prematurely : The NPR Politics Podcast One theory: as polarization pushed policy-making out of Congress and toward states, divergent policies passed in red and blue-leaning states may have caused a big — and growing — gap in health outcomes.

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This episode: political correspondent Susan Davis, White House correspondent Franco Ordoñez, and health correspondent Allison Aubrey.

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Why People In Republican-Leaning Areas Seem More Likely To Die Prematurely

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NANCY: Hi. This is Nancy (ph)...

SISSY: And Sissy (ph).

NANCY: ...And baby Allister (ph). We're about to drive away from our house in Richmond, Va. This show was recorded at...

SUSAN DAVIS, HOST:

1:08 p.m. on Tuesday, June 14.

NANCY: Things may have changed by the time you hear it, but hopefully we'll be at our new house in...

SISSY: Kansas City.

NANCY: ...Kansas City. Here's the show.

(SOUNDBITE OF THE BIGTOP ORCHESTRA'S "TEETER BOARD: FOLIES BERGERE (MARCH AND TWO-STEP)")

DAVIS: Kansas City - I wish you luck moving. I hate moving so much. When we moved into our house, I told my husband I'm never doing it again.

FRANCO ORDOÑEZ, BYLINE: Oh, I'm a big advocate for change. Good luck in Kansas City. I think it's exciting - hard - hard but good excitement.

DAVIS: Hey there. It's the NPR POLITICS PODCAST. I'm Susan Davis. I cover Congress.

ORDOÑEZ: I'm Franco Ordoñez. I cover the White House.

DAVIS: And Allison Aubrey from NPR Science Desk is back with us again. Hey, Allison.

ALLISON AUBREY, BYLINE: Great to be here - thanks for having me.

DAVIS: So we have you on to talk about some reporting you just did on some pretty remarkable findings about how political views and death rates are related. But before we get into that, I have to ask you about some news which - full disclosure - I have a lot of personal interest in, that we could be just...

AUBREY: Let me guess. Let me guess.

(LAUGHTER)

DAVIS: You must have been listening to the podcast recently. There's news that we could be just a week or so away from young kids under the age of 5 being able to get vaccinated against COVID. So tell me everything you know about that.

AUBREY: OK. Well, the FDA has done its analysis, and they have found that both the Pfizer and the Moderna vaccines appear to be safe and effective for kids under 5, or under 6 in the case of Moderna. A panel of FDA advisers will meet this week to vote. If the agency authorizes these kid-sized doses, there are roughly 18 million babies, toddlers, preschoolers in this age group that could be eligible. I know it feels like it has taken a long time, but early in the process, Pfizer found a two-dose regimen wasn't enough, so they went back to the drawing board to a three-dose regimen. And if the agency gives a green light, vaccinations could start within days.

DAVIS: How quickly does it take to get those vaccinations out to pediatricians' offices and other places because I know that the dosage for the kids under 5 is different?

AUBREY: Yeah, right. So it's a different shot, if you will. And if you think back to when they authorized the shot for 5- to 11-year-olds back in the fall, it took about 10 days between, you know, the FDA authorizing and then CDC giving its green light and just shipping out these new vaccines so that they were in place. But there is a plan. They are on it. And there will be enough doses for all the parents of little ones who want them. I think people need to be patient, but it'll happen pretty quickly.

DAVIS: All right - on to these findings. So political polarization, as we've talked about so many things in this podcast, is affecting American life. But in this study, it also looked at how it's affecting Americans' health. Before we get into the details of it, I do think it's important to note, as you did in your reporting, that this is a pretty huge sample.

AUBREY: Yes - basically the entire country, 99% of the U.S. population.

DAVIS: So what the study did was, it basically concluded that there is higher mortality in Republican counties across-the-board in the country, and this includes everything from heart disease to suicide. So how is this possible?

AUBREY: So, yeah, it is surprising. I mean, the study, which, by the way, is published in the BMJ medical journals - it's a peer-reviewed study. It basically found that, you know, how a county votes in presidential elections is one factor that seems to be influencing lifespan. So to document this, researchers - they went back about 20 years, and they basically analyzed this huge CDC database that collects death data on, essentially, everyone in the United States. Then they linked this data with federal election data, and they looked specifically at how counties voted in presidential elections. They also looked at state governor races. So what they found is that, while it's true that since the early 2000s people have been living longer - this has been part of this long progress in longevity in the United States - some of the longevity gains have flattened out in the last 10 years. And when they looked at a more granular level at areas losing ground, they found that Republican counties were losing more. So I talked to the study author. His name is Haider Warraich. He's a doctor at Brigham and Women's Hospital in Boston.

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 the data suggests that this trend appears to be accelerating.

ORDOÑEZ: How much does this have to do, though, with the fact that Republicans tend to be older or, you know, many Republicans are in rural areas where there's less access to health care?

AUBREY: Well, Warraich told me that he used a statistical method to adjust for age. So it's not just that Republicans tend to be older, and it's also not just a kind of urban-rural divide. I mean, in fact, that was kind of his hunch. Just before the pandemic, he was working at a rural hospital in Asheboro, N.C., he told me, and that hospital went bankrupt. So he became very interested in the state of health in rural America. He thought maybe this urban-rural divide might explain differences in mortality. But when he dug into the data, he saw it was more than this. Now, keep in mind, as we just mentioned, this was this huge sample size - the entire country - looking at population across five presidential elections. So if you were looking at, say, a thousand people in Asheboro, N.C., and a thousand people in New York metro area, you might not see any kind of differences - right? - in mortality. You might not be able to detect a mortality gap. But with the sample size this huge, you can pick it up. And he saw that even in urban and suburban counties that voted Republican, this mortality gap held up.

DAVIS: One of the things I thought was so interesting is how, in the report - about how red state and blue state policies could actually be a factor here. And the two states that you highlighted, I thought, really drove that home. Can you talk about the New York versus Oklahoma example?

AUBREY: Yeah. So if you go back to the mid-1990s, life expectancy in those two states was about the same. But then they began to diverge. And a lot of researchers think that the divergence is the effect of basically Democratic states enacting a whole bunch of policies that Republican states didn't. So, you know, we'll get to that in a minute. But I spoke to Dr. Steven Woolf. He is this longtime population health researcher at Virginia Commonwealth. And he says, just take, for example, the expansion of Medicaid. I mean, the option to expand Medicaid to more low-income people became an option for states back in 2014, so about eight years ago. Many Republican-leaning states were slow to adopt that or still haven't adopted that. There are also policies like minimum wage policies, tobacco control, gun legislation, drug addiction. There's this whole range of policies that can have an impact on health and mortality. And by and large, Democratic states have supported more of these; Republican states have gone 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.

DAVIS: Just trying to understand what this data is saying - is it saying that Republicans aren't living as long as they should be or Democrats are living longer than traditional life expectancies?

AUBREY: OK. What it is saying is that if you look at traditional life expectancy - as a nation, life expectancy has been on the rise for decades. There's been a blip amid the pandemic where life expectancy decreased. What we're talking about goes back to 2010, where there was a flattening out of this long-term process. And if you look at, well, why did life expectancy stop rising and kind of flatten out there, you have to look at, more granularly, what was happening in each state, each county. And that's where they see the differences, right? They start to see the differences that the Republican-leaning counties start to lose ground on this long trajectory up.

DAVIS: All right. Well, let's take a quick break, and we'll talk more about that when we get back.

And we're back. And we're talking about a new study that examines how your political affiliation could affect how long you live. Now, the COVID-19 pandemic - our colleague Geoff Brumfiel looked into this. And his reporting showed that residents of counties that voted heavily for Donald Trump in the last presidential election were more than twice as likely to die from COVID-19 than those that lived in areas that went for President Biden. Is that a fair analysis of it, Allison?

AUBREY: That's basically it. I mean, this was a very detailed analysis by Geoff Brumfiel and our colleague Daniel Wood as well. And they looked at COVID deaths in about 3,000 counties across the U.S., beginning May 2021, which was the time that vaccines were pretty much open to all adults who wanted one. What they found is that counties that voted 60% or higher for Trump in November 2020 had a death rate that was about 2.26 times the rate compared to those who voted for Biden by the same margin. And basically, the higher it went, the counties with the higher share of Trump votes had even higher mortality rates. So if you think of it this way - I mean, we just passed the million-death milestone last month. And if you think about these million deaths, nearly a third of these deaths were among unvaccinated people who died after vaccines were open to everyone, all eligible adults. That was an analysis by Brown University. And when Brown looked at this sort of partisan divide, they found it too. States that went most heavily for Trump, including Wyoming and West Virginia, have had among the highest rates of preventable deaths, while states that voted heavily for Biden, such as Vermont, Massachusetts, have had among the lowest.

ORDOÑEZ: It's so amazing to me just how political vaccines have gotten. Remember, in December, Trump was speaking at an event where he said he had taken a vaccine and he encouraged others to take a vaccine and he was booed?

AUBREY: Yeah, he got booed.

ORDOÑEZ: It's like - it's just so amazing that even President Trump has to balance, you know, his, you know, supporters' resistance to the vaccine, while also trying to encourage them to take it and, as he says - often - tries to take credit for, you know, the rapid production of them.

DAVIS: Franco, but this is to be the intersection of science and politics. That's so fascinating...

ORDOÑEZ: So fascinating.

DAVIS: ...Because the science is telling us one thing, but I'm thinking about, you know, governors that were far more permissive with COVID policies in their states - governors like Kristi Noem, a Republican from South Dakota, or Florida Republican Governor Ron DeSantis - and yet saw really good ratings for their handling of the pandemic. So there's certainly sort of a disconnect, at least among voters, of how they view these two things.

ORDOÑEZ: No, absolutely. I mean, I think there's definitely, depending on where you are and what type of, you know, electorate - and Florida and DeSantis is a perfect example where, you know, pushback - repeatedly pushed back on vaccines, downplayed the danger of the COVID virus and, in many ways, was rewarded for it by his supporters and in much of the Florida electorate.

DAVIS: Allison, one of the points you made in your reporting that I thought was so fascinating was about how the science community has tended to sort of avoid politics, that they don't like to get involved in these kind of debates. But there was a line in your piece that literally sort of made my - I physically reacted to where one of the experts says that political affiliation is now becoming as sort of critical to your health metrics as things like smoking or poverty.

AUBREY: Mm, mm. You know, to me, what's really fascinating is that there is a narrative in the United States that health is all about the individual; it's about your individual choices. But think about it. We just named all of the policies that can influence your health and then going back to just whether or not you have access to health care, sort of Medicaid expansion. But there's so many things. I mean, clean air, clean water, the availability of healthy, affordable food in your neighborhood - all of this health is largely determined by what happens at the community level. There's a big push now to understand the huge extent to which social determinants of health - meaning where you go to school, where you wake up in the morning - these social determinants of health are the things that define our health and those shape longevity. And we're pretty much becoming sort of a tale of two Americas. I think that that's something that these researchers have captured. One question that researchers have is if people started to connect the dots more and they realized how much policy is voted in by local officials and federal officials influence their health, would they make different decisions?

DAVIS: All right. Let's leave it there for today. Allison, as always, thank you for coming on the podcast.

AUBREY: Thanks for having me.

DAVIS: I'm Susan Davis. I cover Congress.

ORDOÑEZ: I'm Franco Ordoñez. I cover the White House.

DAVIS: And thanks for listening to the NPR POLITICS PODCAST.

(SOUNDBITE OF THE BIGTOP ORCHESTRA'S "TEETER BOARD: FOLIES BERGERE (MARCH AND TWO-STEP)")

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