Food and Health Fact #179

Fact #179: The unhealthy party divide in America's public health outcomes

November 11, 2022

By Matthew Rees

Food and Health Fact #179:

The unhealthy party divide in America's public health outcomes

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Republicans are mostly in despair about their underperformance in the elections held earlier this week. As angst sets in about their 2024 prospects, here’s a radical thought: the party should prioritize efforts to help improve the health of their constituents.

It’s an uncomfortable (and largely overlooked) fact that when breaking down states and counties along party lines, Republican areas tend to have worse health outcomes – often much worse. (The outcomes in Democratic areas are nothing to brag about – they just look better by comparison.)

The 19 states with the highest obesity rates have been firmly Republican for at the least the past 20 years (though one of them, Kansas, just re-elected its Democratic governor). And the 12 states with the lowest obesity rates – though still 25 percent or higher – are all traditionally Democratic states.

The story is similar with age-adjusted Covid death rates (with the age adjustment made to reflect that senior citizens have faced a greater risk of dying from Covid). Among the top 17 states, 14 are firmly Republican (the outliers are Nevada, New Mexico, and Arizona). And most of the 15 states with the lowest death rates are traditionally Democratic.

Similarly, when looking at counties, those that Donald Trump won in 2020 had a much higher mortality rate from Covid than those won by Joe Biden – 326 deaths per 100,000 people versus 258.

It follows that most of the 15 states with the highest life expectancy are traditionally Democratic (New Hampshire, Utah, and Idaho are outliers), while the bottom 13 are traditionally Republican (except for New Mexico).

The reasons for these disparities are complex, and there’s no single explanation. Many of these poor-performing states have historically had lower incomes than other states – as well as both higher smoking rates and lower tobacco taxes. And one recent study has found the higher percentage of Trump voters there were in county, the greater the prevalence of chain restaurants (which typically translates to unhealthy fast food).

What’s striking is how much the disparities have expanded in just the past two decades, according to a study published earlier this year in BMJ.

In 2001, age-adjusted mortality rates were roughly similar in Republican counties and Democratic counties. Mortality have rates declined throughout the country since then, but they only declined 11 percent in Republican counties, while declining 22 percent in Democratic ones. If only looking at white residents of these counties, a fourfold difference in the mortality rate disparities has opened up between Republican and Democratic counties.

These trends can also be traced back further than two decades, according to a study published in the American Journal of Public Health. From 1980 to 2014, U.S. life expectancy increased 5.3 years. In counties with gains of less than three years, Donald Trump’s share of the vote in 2016 increased more than 9 percentage points relative to John McCain’s share in 2008. By contrast, in the counties where life expectancy increased more than 7 years, Hillary Clinton’s support in 2016 increased 3.5 percentage points over Barack Obama’s share in 2008.

Portraying health disparities in partisan terms obscures the bigger issue, which is that health outcomes throughout the United States are extremely poor. Even the top performing states on obesity and life expectancy fare worse than other developed countries.

Amid the prolonged and polarized debate over health-care policy, let’s remember that access to health care is only one component of human health (albeit an important one). There is a complex web of other interrelated factors – the so-called “social determinants of health” – which include education, income, and lifestyle.

Could a health-focused initiative help the political fortunes of either party? In other words, do significant numbers of Americans want to hear that message?

The evidence is not encouraging. Pre-Covid, a Gallup poll showed 71 percent of Americans believed their physical and mental health was good or excellent. We know that assessment is sadly divorced from reality on the physical side – and it probably is on the mental side as well. And the litany of Covid rules highlighted the risks of one-size-fits-all policies – the sad legacy of which is high levels of distrust of policymakers and public health professionals.

But I’m going to hold out hope that some prominent public official – regardless of party – will be willing to talk about the remarkably high rates of disease, disability, and death that are dragging down the United States. There’s even a ready-made campaign slogan for that official: Make America Healthy Again.

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