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Liberal State Policies Improve Life Expectancy

Jennifer Karas Montez, Jason Beckfield, Julene Kemp Cooney, Jacob M. Grumbach, Mark D. Hayward, Huseyin Zeyd Koytak, Steven H. Woolf, and Anna Zajacova

Introduction

The life expectancy of people in the United States compares poorly to populations in high-income countries: the U.S. ranked 13th in life expectancy in 1980 among 22 such countries and fell to last place by the early 2000s. Life expectancy is a composite measure that captures overall social, economic, physical and mental well-being in a population. The U.S.’s low ranking relative to other rich countries paints a troubling portrait of Americans’ prospects of life and death.

More troubling still is that these national averages obscure large differences across the states, which in 2017 ranged from a high of 81.6 years Hawaii to a low of 74.6 years in West Virginia. Moreover, the life expectancy of residents in different states has diverged in recent decades. For example, as shown in Figure 11, residents of Connecticut and Oklahoma had the same life expectancy in 1959 (71.1 years) but by 2017, people who lived in Connecticut – a state which has implemented more liberal policies – enjoyed a life expectancy of 80.7 while those in Oklahoma – which has implemented more conservative policies – had a life expectancy of 75.8, a difference of 4.9 years.

Figure 1. Differences in life expectancy at the state level have grown over time with more gains for states that have implemented liberal policies

Data source: United States Mortality Database

Because of these state differences in life expectancy, many researchers argue that it is important to evaluate the impact of state policies that affect health outcomes, and therefore the life expectancy of states’ residents. State policies influence economic well-being, environmental impacts on health, medical care access, and individual behaviors. Policies also shape opportunities for state residents to attain education, housing, and other factors that impact the ability to live a healthy life. 

In this study, the authors used annual data on life expectancy in U.S. states from 1970 to 2014 and merged it with annual data on 18 state-level policy domains, for example those concerning labor, tax, environment, abortion, gun control, and tobacco. They then modeled the association between state policies and female and male life expectancy, controlling for differences in the characteristics of states and their populations. They also explored a hypothetical question: if all states were to implement the most liberal – or the most conservative – policies over the period 1970-2014, what impact would this have had on national estimates of life expectancy for women and men?

Key Findings

  • States that implemented more liberal policies during the 1970-2014 period that expanded economic regulations and protected marginalized groups saw a rise in their life expectancy while states that implemented more conservative policies were more likely to see a lowering of life expectancy for its residents.
  • If all states had implemented the most liberal policies during the 1970-2014 period, U.S. women would have lived 2.8 years longer and men 2.1 years longer by 2014. See Figure 2.
  • On the other hand, if all states had implemented the most conservative policies during the 1970-2014 period, U.S. women would have lost 2.0 years of life expectancy and men would have lost 1.9 years by 2014. See Figure 2.
  • Liberal policies on tobacco, labor, immigration, civil rights, and the environment predicted a nearly 1-year increase in that state’s life expectancy.
  • Other policies also mattered. For example, more liberal policies on abortion and gun control predicted longer life expectancy among women, while more conservative marijuana policies predicted longer lives for both women and men

Figure 2. If all states had implemented liberal policies during the 1970-2014 period, U.S. life expectancy would have been higher for both women and men in 2014 while life expectancy would have been lower if all states had implemented conservative policies

This figure shows the outcomes of models comparing the impact on actual life expectancy at birth if all U.S. states had implemented the most liberal policies during the 1970-2014 (blue lines) and if all U.S. states had implemented the most conservative policies over the same period (red lines). We see that by 2014, life expectancy is estimated to be 2.8 years longer among women and 2.1 years longer among men if all residents of U.S. states enjoyed the health advantages of states with more liberal policies.
Note: In these figures, the health advantages or disadvantages are assumed to gain or lose equally over time.

Policy Implications

State-level policies that protect the environment, regulate tobacco and firearms, and ensure labor, reproductive, and civil rights likely improve life expectancy. And while those might not be the only important policies that positively impact life expectancy at the state level, it is clear that when states invest in their residents’ social and economic well-being by enacting liberal policies, life expectancy rises. On the other hand, states prioritizing corporate interests and politically conservative policies over the health and well-being of their residents cut people’s lives short.

These results also show the importance of understanding U.S. life expectancy – and consequently populations’ health and well-being – at the state as well as national level. States have become important battlegrounds for population health that are reflected in the nation’s overall trend in life expectancy. Unless more states begin to significantly invest in their populations, the long-term trend in U.S. life expectancy is unlikely to improve.

Reference

1 Montez, J.K., Beckfield, J., Cooney, J.K., Grumbach, J.M., Hayward, M.D., Koytak, H.Z., Woolf, S.H. & Zajacova, A. (2020). US state policies, politics, and life expectancy. Milbank Quarterly 0(00):1-32.

Suggested Citation

Montez, J.K., Beckfield, J., Cooney, J.K., Grumbach, J.M., Hayward, M.D., Koytak, H.Z., Woolf, S.H. & Zajacova, A.. (2020). Liberal state policies improve life expectancy. PRC Research Brief 5(8). DOI: 10.26153/tsw/9811.

About the Authors

Jennifer Karas Montez (jmontez@maxwell.syr.edu), who received her PhD from The University of Texas at Austin, is a professor of sociology at the Maxwell School of Citizenship and Public Affairs, Syracuse University. Co-authors are listed alphabetically: Jason Beckfield is a professor of sociology at Harvard University; Julene Kemp Cooney is a graduate student in the Department of Sociology at the Maxwell School of Citizenship and Public Affairs, Syracuse University; Jacob M. Grumbach is an assistant professor of political science at the University of Washington; Mark D. Hayward (mhayward@prc.utexas.edu) is a professor in the Department of Sociology, Centennial Commission Professor in the Liberal Arts; faculty research associate, Population Research Center, and director, Population Health Initiative, The University of Texas at Austin; Huseyin Zeyd Koytak is a graduate student in the Department of Sociology at the Maxwell School of Citizenship and Public Affairs, Syracuse University; Steven H. Woolf is a professor in the Department of Family Medicine and Population Health at Virginia Commonwealth University, and Anna Zajacova is a professor of sociology at the University of Western Ontario and a former PRC postdoctoral fellow.

Acknowledgements

This research was supported in part by grant R01AG055481, “Educational Attainment, Geography, and U.S. Adult Mortality Risk,” awarded by the National Institute on Aging (PI: Montez), and an Andrew Carnegie Fellowship awarded by the Carnegie Foundation of New York (PI: Montez). This work was also supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2C HD042849), awarded to the Population Research Center at The University of Texas at Austin. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging or the National Institutes of Health.


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