If You Want To Live Longer, Settle Down In A Blue State With Democratic Governance

drawing by Nancy Ohanian

There's much more to "Black Lives Matter" than police brutality, the tip of the ugliest aspect of American society.

Just 8% of African-American voters cast ballots for Trump in 2016. That seems like an awful lot. But, hey, how many Jews who were fanatical about law-and-order, nationalism or anti-Communism voted for Hitler? Anyway, things have worked out badly for African-Americans in the Trump era. When he was asked about a thousand people dying of COVID daily in the U.S., he shrugged and said, "It is what it is." That may have more than little to do with the same thing that caused the very White House to halt the stop-the-pandemic plan as soon as Trump heard that a disproportionate number of blacks and hispanics were getting COVID and dying from it. "It is what it is."

Most Americans-- other than KKK members and sympathizers-- see the Black Lives Matter movement for what it is: a demand for justice and equality before the law. Trump sees it as a direct attack on him, his agenda and his authority-- and as an opportunity to stoke up the racist sentiments of his base and to instill some fear in his vision of the suburbs.

The CDC reported that in the U.S., 31.8% of cases are Hispanics (as are 17.1% of COVID-related deaths-- a younger cohort), and 20% of the cases are African-Americans (as are 22.4% of deaths). The CDC attributes that to 5 factors:

• Discrimination and racism which "can lead to chronic and toxic stress and shapes social and economic factors that put some people from racial and ethnic minority groups at increased risk."
• Healthcare access and utilization-- including lower insurance rates among minorities, as well as "lack of transportation, child care, or ability to take time off of work; communication and language barriers; cultural differences between patients and providers; and historical and current discrimination in healthcare systems."
• Occupation, minorities being "disproportionately represented in essential work settings such as healthcare facilities, farms, factories, grocery stores, and public transportation [since] people who work in these settings have more chances to be exposed to the virus, as well as not being able to work from home and not having paid sick days.
• Educational, income, and wealth gaps
• Housing, as in overcrowded conditions and multigenerational households.

The CDC concludes that "These factors and others are associated with more COVID-19 cases, hospitalizations, and deaths in areas where racial and ethnic minority groups live, learn, work, play, and worship. They have also contributed to higher rates of some medical conditions that increase one’s risk of severe illness from COVID-19."

Yesterday. L.A. Times reporter Noam Levey wrote about how, generally speaking, people who live in "blue states" live longer. He was specifically speaking about race or about COVID-19. He noted that "Weak environmental protections, safety rules and labor and civil rights protections may be cutting lives short in conservative states and deepening the divide between red and blue states," referencing a new study released yesterday by the Milbank Quarterly, a health policy journal, which concluded that "states where residents live longest tend to have much more stringent environmental laws, tougher tobacco and firearms regulations and more protections for workers, minorities and LGBTQ residents." And the problems can't all be blamed on Trump. The gap between states had been steadily narrowing until Reagan was elected. The toxic neoliberal, pro-corporate agenda pushed by Reagan, both Bushes and Clinton changed the trajectory radically, Obama didn't change it back and Trump has made it worse.

Some states, mostly in the Northeast and the West, have seen average life expectancies rise relatively steadily, placing them on par with the wealthiest nations of Western Europe. Those states tend to have more stringent regulations.

By contrast, the life expectancy in states with more conservative health, labor and social policies-- concentrated in the South and Appalachia-- has stagnated in recent decades, according to the study, which adds to growing research on health and political disparities between states.

California has among the highest average life expectancies in the country, at 81.3 years. It also had the most liberal policies in the nation in 2014, the most recent year the study analyzed, according to the system the authors developed to rank states.

Although the study's authors note that they can't prove that state policies caused the gap in life expectancy, the correlation is a persistent one across multiple states and several decades.

"It's disheartening to see another example of a missed opportunity by policymakers," said David Radley, senior scientist at the nonprofit Commonwealth Fund who studies differences in state health policies and the effects on people's health. Radley was not involved in Milbank report.

..."The overarching conclusion is clear: States that have invested in their populations' social and economic well-being by enacting more liberal policies over time tend to be the same states that have made considerable gains in life expectancy," the study's authors wrote.

Even before the current public health crisis, life expectancy in the U.S. had been declining, setting America apart from most other wealthy nations. That decline has fueled tough questions about domestic policy.

The opioid epidemic, which has had a devastating impact on regions of the country already hit hard by economic stagnation, has been the focus of a lot of the discussion about that shift.

But Syracuse University sociologist Jennifer Karas Montez, the lead author of the new study, said the impact of opioids may be only part of the story.

"When we look at what is happening with life expectancy, the tendency is to focus on individual explanations about what Americans are doing," she said, noting obesity and smoking behaviors as well as drug use. "But state policies are so important."

To assess what role these policies may be playing, Montez and other researchers reviewed more than 120 policies enacted by states over the years and assessed whether each policy choice in each state was more liberal or more conservative.

Policies included housing rules such as rent control; health and welfare policies such as Medicaid eligibility and welfare limits; labor protections such as paid sick leave and minimum wages; and civil rights policies such as gender discrimination bans, hate crime laws and same-sex marriage.

They also looked at state abortion restrictions, tax policy, education spending, immigration rules and gun control laws.

...Through the 1960s and 1970s, for example, state life expectancies generally converged. That trend began to reverse in the mid-1980s, around the same time that a conservative movement, led by President Ronald Reagan and mirrored in many state capitols, became ascendant.

The gap between states accelerated further after 2010, when sweeping Republican victories in state elections shifted policies further to the right in many places.

By 2017, residents of the state with the highest life expectancy-- Hawaii-- were living on average seven years longer than residents of the state with the lowest life expectancy-- Mississippi.

By contrast, the gap between the best- and worst-performing states in 1984 was less than five years.

The gap is not only about policy: States where people live longer tend to be wealthier and have better educated populations, for example.

But Montez noted that decisions by state leaders have helped shape those factors.

"States like Connecticut are investing in their population, investing in schools, setting an economic floor for their workers, discouraging behaviors like smoking that kill people," she explained. "You have other states like Mississippi and Oklahoma that aren't doing any of this."

In Connecticut, whose policies have become steadily more liberal over the last half a century, life expectancy increased 5.8 years between 1980 and 2017 to 80.7 years.

In Oklahoma, which has become markedly more conservative, life expectancy increased only 2.2 years over the same period, reaching 75.8 years in 2017.

Identifying which state policies may have the most impact on how long people live is difficult, the researchers concede. But the study points to a group of policies that appear to correlate most closely with longer lives.

These include some unsurprising candidates such as tougher environmental laws, which the authors note may protect people from toxic substances. The authors also found a correlation between longer life expectancy and labor policies that increase economic security, such as a minimum wage.

Tougher gun laws appear to track with longer life expectancies, the study notes, as do stricter tobacco controls.

The authors also point to civil rights laws, which they suggest may protect residents from ill health related to persistent stress.

And they found a correlation between longer life expectancy and better access to abortion, which the study notes may reflect other research that has linked abortion restrictions to women's poverty and ill health.

As of 2018 these states had the lowest life-expectancy. There are two numbers next to each state-- first their residents' average life expectancy and second the percentage of the vote that went to Trump in 2016. West Virginia is both state state that voted most heavily for Trump and has the lowest life expectancy. Think about cause and effect for a moment.

• West Virginia- 74.79 (68.50%)
• Mississippi- 74.89 (57.94%)
• Kentucky- 75.41 (62.52%)
• Alabama- 75.42 (62.08%)
• Arkansas- 75.93 (60.57%)
• Oklahoma- 75.97 (65.32%)
• Tennessee- 75.99 (60.72%)
• Louisiana- 76.07 (58.09%)
• Ohio- 76.93 (51.69%)
• South Carolina- 77.01 (54.94%)
• Indiana- 77.04 (56.82%)
• Missouri- 77.29 (56.77%)

Those were the states where residents have the lowest life expectancy. The states with the highest life expectancy (along with their Trump vote) are these-- notice that Hawaii is the exact opposite of West Virginia:

• Hawaii- 82.29 (30.03%)
• California- 81.58 (31.62%)
• New York- 81.27 (36.52%)
• Minnesota- 89.94 (44.92)
• Connecticut- 89.87 (40.93%)
• Massachusetts- 80.51 (32.81%)
• Colorado- 80.50 (43.25%)
• New Jersey- 80.43 (41.35%)
• Washington- 80.41 (36.83%)

Conclusion is obvious-- progressive policies-- across the board-- are beneficial and  pro-life; conservative policies are toxic and anti-life. Think about that next time you fill in a ballot. Bob Lynch, a state legislative candidate against Trumpist Daniel Perez in Miami-Dade told us that "Florida might as well be two states, which is why it doesn’t show up on either table.  On the one hand, we have millions of wealthy retirees that are on some combination of former employer pension/healthcare plans, Medicare, or supplemental Cadillac insurance plans. On the other, we have close to 800,000 people who have been denied access to health care because Rick Scott and Ron DeSantis have rejected the Medicaid expansion-- something even the voters of Oklahoma and, as of a few hours ago, Missouri have now approved..."

Bob went on to explain that Florida's state unemployment system is "a debacle and now Ron DeSantis is openly admitting it was designed to be just that. This has led to a situation where Floridians are forced to go back to work in unsafe service economy jobs, at a fraction of the tips, because the alternative is letting their families starve. A large part of the state doesn’t care because they want to be able play golf, have their houses cleaned, and drink martinis for happy hour. Their server’s help be damned. The situation is entirely unsustainable. The impending public health crisis as a result of not being able to safely open schools will bring many of these issues to a head. The results won’t be pretty and are a direct result of over two decades of failed Republican policies."

Chicken Or Egg: People In Trump States Have Lower Life Expectancies

Trump states have lower life expectancy. Is that because they embrace Trumpist policies that make them more likely to die sooner than normal people? Or is it the deleterious impact of those policies that cause them to embrace Trumpism in the first place? Monday, Paul Krugman took a closer look: America's Red State Death Trip. Pointing out a Tom Edsall piece that showed "red and blue voters live in different economies," Krugman's point is that "the political divide is also, increasingly, an economic divide [and] 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.

Americans born in 2017 can expect, on the average, to live to be 78.6 years old. But in bright blue states, people will live longer and in the reddest states with the stupidest people, people will die earlier First the 10 states with the highest life expectancy:

• Hawaii- 81.5
• California- 80.9
• New York- 80.8
• Minnesota- 80.7
• Connecticut- 80.6
• New Jersey- 80.5
• Colorado- 79.9
• Massachusetts- 79.9
• Vermont- 79.9
• Washington- 79.9

Those states are all "blue" and Trump lost them all, some in landslides. In Hawaii, California, and New York, the 3 states with the highest life expectancy Trump only received, respectively, 30.03%, 31.62% and 36.52% of the vote. Now let's look at the ten states with the lowest life expectancy:

• Mississippi- 74.5 (same as Vietnam)
• West Virginia- 74.8
• Alabama- 74.9
• Kentucky- 75
• Arkansas- 75.4
• Louisiana- 75.4
• Oklahoma- 75.4
• Tennessee- 76
• South Carolina- 76.2
• Ohio- 76.6

These wretched states, filled with people who make poor choices about everything in life, from what they eat to whom they vote for, all went for Trump in 2016, many by landslides. The three sickest states-- Mississippi, West Virginia and Alabama-- gave Trump, respectively 57.94%, 68.50% and 62.08% landslide victories. Moral of the story: if you vote for Trump-- and for Republicans-- you will die before your time and so will your children. You want change? Forget Trump and his lies... vote Bernie Sanders; he's offering what you want and need.