Could where you live dictate how long you live? New research at Syracuse University's Maxwell School, published today in the Milbank Quarterly, shows Americans who live in so called blue states tend to live longer than those in red states, primarily due to state policies. Among the findings:
U.S. state policies since the 1980s have cut short American lives, particularly for women. U.S. life expectancy gains since 2010 would be 25% greater for women and 13% greater for men if states policies had not changed in the way they did, with many becoming more conservative.
Enacting more liberal state policies could raise U.S. life expectancy by over 2 years, whereas enacting more conservative state policies could reduce it by 2 years.
In the greatest gap between states, residents in Connecticut outlive their counterparts in Oklahoma by as many as seven years.
The study examined how state policy environments contributed to U.S. life expectancy trends from 1970 to 2014. It used information on 18 policy domains such as abortion and guns, each measured on a liberal-to-conservative scale, for every state and calendar year. The analysis then predicted U.S. life expectancy trends from all policy domains, controlling for characteristics of states and their residents.
"Americans die younger than people in other high-income countries," said Jennifer Karas Montez, sociology professor at Syracuse University's Maxwell School and lead author of the study. "This gap in life expectancy between the U.S. and other countries emerged in the 1980s and has grown ever since. Since that time, gaps in life expectancy between U.S. states also expanded. The difference between the highest and lowest life expectancy states has grown to 7.0 years--the largest ever recorded. These two trends are related: the dismal life expectancy trends of some states have been an anchor on overall U.S. life expectancy."'
For instance, between 1980 and 2017, life expectancy rose by just 2.2 years in Oklahoma (73.6 to 75.8 years) but 5.8 years in Connecticut (74.9 to 80.7 years). Life expectancy in Oklahoma now falls between that of Serbia and Brazil, while Connecticut falls between Denmark and Costa Rica.
The study found that Oklahoma and Connecticut differ in other ways. While these two states were diverging in life expectancy, they were also diverging in their policy orientation. Oklahoma made one of the largest transitions toward a conservative state policy environment among all 50 states. Conversely, Connecticut made one of the largest transitions toward a liberal state policy environment. This polarization in state policy environments has occurred across the U.S. and helps to explain the growing gap in life expectancy between states and the troubling trends in U.S. life expectancy since the 1980s.
Among the 18 policy domains studied, 10 strongly predict life expectancy. More liberal versions of those policies generally predict longer lives and more conservative versions generally predict shorter lives. This is especially the case for policies on tobacco, immigration, civil rights, labor (e.g., Right to Work laws, minimum wage), and the environment. For instance, by changing its labor laws from the most conservative to the most liberal orientation, a state could experience a large 1-year increase in life expectancy. State policies have particularly important consequences for women's life expectancy. This finding reflects the reality that state policies such as minimum wage, EITC, abortion laws, and Medicaid are more relevant for women's than men's lives.
According to Montez, "During the 1980s and after 2010, overall changes in state policies had a negative impact on U.S. life expectancy. After 2010, the small gains in U.S. life expectancy would have been 13% steeper among men and 25% steeper among women if state policies had not changed in the way that they did, with many becoming more conservative."
If all 50 states enacted either liberal or conservative policies, what would happen to U.S. life expectancy? "If all states enacted liberal policies across the 18 domains, our study estimated that U.S. life expectancy would increase by 2.8 years for women and 2.1 years for men," said Montez. "However, if all states enacted conservative policies, U.S. life expectancy would decline by 2.0 years for women and 1.9 years for men. If all states followed current national policy trends, there would continue to be little improvement in life expectancy. This is partly due to countervailing forces: gains in U.S. life expectancy associated with some national policy trends (e.g., toward liberal policies on the environment and civil rights) would be offset by losses associated with other trends (e.g., toward conservative policies on abortion and guns)."
Montez said that trends in state policies since the 1980s have cut short many lives. "Improving U.S. health and longevity requires changing many of those policies," said Montez. "In particular, it is essential to enact policies that protect the environment, regulate tobacco and firearms, and ensure labor, reproductive, and civil rights." But Montez believes e nacting these changes in state policies will not be easy. "On the contrary: policymakers in many states have put the interests of corporations and their lobbyists--particularly the American Legislative Exchange Council (ALEC)--and wealthy donors over the interests and health of their constituents."
To drive home her point, Montez points out Oklahoma, for example, is one of the most active states in terms of enacting the corporate-friendly and politically-conservative policies promoted by ALEC, while Connecticut is among the least active states.
"Policymakers and the public must recognize," she said, "that putting profits over people cuts lives short."