Dr. Mark Hayward, University of Texas at Austin, Professor of Sociology
Title of Talk: The Role of Policies and Politics in the Unfavorable Trend in American Life Expectancy
Abstract:
The trend in American life expectancy has increasingly lagged behind other developed countries. The trend began in the 1980s and has continued unabated for almost four decades. Research to this point has largely fallen short in explaining lagging US life expectancy. Here, we argue that a significant part of the explanation is rooted in the states where people live – an argument that has been spotlighted by the COVID-19 pandemic—and that states’ policy environments are key drivers of the long-term national trend in life expectancy.
Data and Methods: Annual state-specific life expectancies for the period 1970-2014 were taken from the U.S. Mortality Database and linked with annual data for 18 policy domains. The policy domains covered a broad swath of the major institutional contexts (e.g., tobacco, labor, immigration, civil rights, and the environment) that allow downstream factors such as individuals’ resources, risks, and rewards to shape a healthy life. The annual nature of the data provided the means to change states’ policy orientations over the 45-year observation period. Controlling for population composition differences across states, joinpoint regression models were used to estimate the associations between life expectancy, historical time, and states’ policies, and state-level fixed effects. Separate models were estimated for males and females.
Results: Liberal policies that increased economic regulations and protected marginalized groups were associated with significantly longer life expectancy. Conservative policies that relaxed regulations and protections of marginalized groups were associated with a shorter life expectancy. Had all states enjoyed the mortality advantages of states with liberal policies, national life expectancy would have increased 2.8 years for women and 2.1 years for men.
Conclusions: The growing polarization of policies and politics across US states appears to have widened inequality in life expectancy and anchored the unfavorable national trend in states where life expectancy increasingly resembles that of developing nations. The devolution of federal responsibility for many programs that started in the 1980s was a fertile ground on which political polarization has accentuated conservative/liberal differences in an array of policies. Conservative states that put into play policies that failed to invest in their constituents – and perhaps de-invested in their constituents -- have cut people’s lives short. Much of this failure reflects policies where policymakers placed the interests of corporations over the health of their populations. On the other hand, there is considerable reason for optimism given the degree to which prioritizing people over profits has lengthened people’s lives
