America’s Red State Death Trip
Why does falling life expectancy track political orientation?
“E pluribus unum” — out of many, one — is one of America’s traditional mottos. And you might think it would be reflected in reality. We aren’t, after all, just united politically. We share a common language; the unrestricted movement of goods, services and people is guaranteed by the Constitution. Shouldn’t this lead to convergence in the way we live and think?
In fact, however, the past few decades have been marked by growing divergence among regions along several dimensions, all closely correlated. In particular, the political divide is also, increasingly, an economic divide. As The Times’s Tom Edsall put it in a recent article, “red and blue voters live in different economies.”
What Edsall didn’t point out is that red and blue voters don’t just live differently, they also die differently.
About the living part: Democratic-leaning areas used to look similar to Republican-leaning areas in terms of productivity, income and education. But they have been rapidly diverging, with blue areas getting more productive, richer and better educated. In the close presidential election of 2000, counties that supported Al Gore over George W. Bush accounted for only a little over half the nation’s economic output. In the close election of 2016, counties that supported Hillary Clinton accounted for 64 percent of output, almost twice the share of Trump country.
The thing is, the red-blue divide isn’t just about money. It’s also, increasingly, a matter of life and death.
Back in the Bush years I used to encounter people who insisted that the United States had the world’s longest life expectancy. They hadn’t looked at the data, they just assumed that America was No. 1 on everything. Even then it wasn’t true: U.S. life expectancy has been below that of other advanced countries for a long time.
The death gap has, however, widened considerably in recent years as a result of increased mortality among working-age Americans. This rise in mortality has, in turn, been largely a result of rising “deaths of despair”: drug overdoses, suicides and alcohol. And the rise in these deaths has led to declining overall life expectancy for the past few years.
What I haven’t seen emphasized is the divergence in life expectancy within the United States and its close correlation with political orientation. True, a recent Times article on the phenomenon noted that life expectancy in coastal metropolitan areas is still rising about as fast as life expectancy in other advanced countries. But the regional divide goes deeper than that.
A 2018 article in The Journal of the American Medical Association looked at changes in health and life expectancy in U.S. states between 1990 and 2016. The divergence among states is striking. And as I said, it’s closely correlated with political orientation.
I looked at states that voted for Donald Trump versus states that voted for Clinton in 2016, and calculated average life expectancy weighted by their 2016 population. In 1990, today’s red and blue states had almost the same life expectancy. Since then, however, life expectancy in Clinton states has risen more or less in line with other advanced countries, compared with almost no gain in Trump country. At this point, blue-state residents can expect to live more than four years longer than their red-state counterparts.
Is this all about deaths of despair in the eastern heartland? No. Consider our four most populous states. In 1990, Texas and Florida had higher life expectancy than New York and almost matched California; today, they’re far behind.
What explains the divergence? Public policy certainly plays some role, especially in recent years, as blue states expanded Medicaid and drastically reduced the number of uninsured, while most red states didn’t. The growing gap in educational levels has also surely played a role: Better-educated people tend to be healthier than the less educated.
Beyond that, there has been a striking divergence in behavior and lifestyle that must be affecting mortality. For example, the prevalence of obesity has soared all across America since 1990, but obesity rates are significantly higher in red states.
One thing that’s clear, however, is that the facts are utterly inconsistent with the conservative diagnosis of what ails America.
Conservative figures like William Barr, the attorney general, look at rising mortality in America and attribute it to the collapse of traditional values — a collapse they attribute, in turn, to the evil machinations of “militant secularists.” The secularist assault on traditional values, Barr claims, lies behind “soaring suicide rates,” rising violence and “a deadly drug epidemic.”
But European nations, which are far more secularist than we are, haven’t seen a comparable rise in deaths of despair and an American-style decline in life expectancy. And even within America these evils are concentrated in states that voted for Trump, and have largely bypassed the more secular blue states.
So something bad is definitely happening to American society. But the conservative diagnosis of that problem is wrong — dead wrong.