A MARTÍNEZ, HOST:
America's political divide has generated lots of concern about how polarization might undermine democracy. Medical researchers say the bitter partisan divide can undermine Americans' health as well. A new study concludes that how a state votes in presidential elections helps predict life expectancy for people living in that state. NPR's Allison Aubrey is here to fill us in. Allison, when I think about life expectancy, I think about diet, exercise, environment even. But politics, you got to fill me in on that one.
ALLISON AUBREY, BYLINE: Right. Yeah. Well, it may sound surprising but, yes, political affiliation is one factor shaping the life span of people around the country according to this new study. Researchers went back about 20 years. They analyzed a CDC database that collects death data on, essentially, every individual in the U.S. They linked this data with federal election data, looking specifically at how counties voted in presidential elections and also in state governor's races. Now, overall, mortality rates in the U.S. had been declining in the early 2000s. People were generally living longer. But the researchers found some of those gains have faded away. And when they looked at areas losing ground, they found Republican counties were losing more. Bottom line, people in Republican-leaning counties appear to be more likely to die prematurely. Here is the study author, 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: Now, it's not something as simple as Republican counties being older. The researchers adjusted for age. Nor is it just an urban-rural divide in the country. They found the mortality gap held up in suburban and urban counties that vote Republican, too.
MARTÍNEZ: Wow. All right. Now, what are some of the factors that could help explain this?
AUBREY: Well, the timing of when this gap started gives a clue. Dr. Warraich says when he looked back to 2001, there wasn't much of a difference in mortality between Democratic and Republican-leaning areas.
WARRAICH: Yet, all of that has changed over those last 20 years. And now that gap has widened by almost sixfold between Republican and Democratic areas.
AUBREY: So the effect has been accelerating, he says. Now, this study can't answer why. But the leading theory on what has 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.
MARTÍNEZ: So let me see if I understand this. So the argument here is that Republican policies could be linked to higher death rates, and Democratic policies link to lower ones?
AUBREY: That is basically the argument Dr. Steven Woolf makes. He's a longtime health researcher at Virginia Commonwealth University. He says if you look at policies such as the expansion of Medicaid, so access to health care, policies on minimum wage, tobacco control, gun legislation, drug addiction - a whole range of policies have an impact on health and mortality rates. Democratic states have supported more of these. But 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.
AUBREY: He points to New York and Oklahoma. In the mid-'90s, life expectancy was about the same in these two states. Now New York is near the top of the list when it comes to life expectancy, Oklahoma is near the bottom. He says part of this is likely due to policy differences.
MARTÍNEZ: All right. But diet and exercise has to make a difference somehow, right?
AUBREY: Yeah, of course.
MARTÍNEZ: OK.
AUBREY: I mean, look; people's habits and lifestyles certainly play a role. I mean, you can't overlook that. I mean - and income and education are important, too. Also, changes in a state's economy, changes in its demographics, that matter. Those things all matter as well. But he says, to him, the most convincing evidence that state politics is one factor that does influence 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 and others at NPR have reported on how pro-Trump counties have continued to suffer far higher COVID death tolls.
MARTÍNEZ: So is there any sense at all that people in red states who would like to see more protective health policies would maybe lean on elected officials to change this?
AUBREY: You know, one thing that has fascinated me covering the pandemic is that if you ignore the loud voices that were all fired up, protesting against vaccines or mask mandates and you look at public opinion polls, most people, most Americans, said, hey, if there's evidence that 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. You know, Americans are more moderate in their views compared to the politicians who represent them. The more divided we've become as a nation, the harder it is to see or hear the kind of quiet people in the middle of this big divide. So you ask if people would support policy changes. Well, first, they would have to connect the dots between all the policies that can impact health span or life span. I don't think most people have thought of it this way. Then if they did start thinking of it this way, it may be possible that more people would want to vote in candidates to enact policies that are more protective or supportive of good health and longevity.
MARTÍNEZ: NPR's Allison Aubrey. Thanks a lot.
AUBREY: Thank you, A.
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