- Oct 17, 2011
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Public health disparities provide an important lens for understanding social and political change in the USA. Using individual-level medical data and death records, this study shows that conservative Americans experienced worsening health and higher mortality than liberals during the 2010s. Here we find evidence consistent with two potential mechanisms. First, demographic realignment within political coalitions brought less healthy individuals into the conservative camp. Yet by the 2020s, demographic change, public policy and COVID-19 do not fully account for the widening gap in mortality rates. Public opinion data are consistent with a second mechanism: declining trust in medical professionals among right-leaning individuals, including lower willingness to seek care, follow clinical advice or believe in medication effectiveness, even for issues unrelated to COVID-19. These patterns suggest that growing ideological divides in health behaviours are leaving conservative Americans increasingly vulnerable to preventable health risks.
By the 2020s, conservatives were dying at significantly higher rates than liberals, with the gap concentrated in internal causes (for example, heart disease, cancer and stroke). The divide since 2020 is substantial: while only 0.2% of ‘very liberal’ respondents died of internal causes between 2020 and 2022, the probability for people who identified as ‘very conservative’ was 1.14 percentage points higher (P = 0.021; 95% confidence interval (CI), (0.18, 2.11)). This gap is not limited to deaths from COVID-19 and is not reducible to demographic or geographic differences between the groups, nor is it a pure function of ageing: previous cohorts’ death patterns in older data did not show a similar correlation between health and ideology before 2010.
We suggest that these growing health gaps are consistent with a mechanism of politically rooted changes in engagement with the health system. Using a large public opinion survey, we find that people on the right, particularly Trump voters and Republicans, express less trust in their personal doctor and are less willing to seek care for non-COVID-19-related health problems18,19. We also find that people on the right with chronic illnesses are more sceptical than people on the left that medicines to treat those illnesses are safe and effective. This political divide in consumption of care may sustain or deepen the health divide that has emerged in recent decades. However, both these findings and those on health outcomes are purely descriptive; more work is needed to uncover causal relationships.
Lay article with quotes from the author.
While the study does not establish causation, the shift is clear: “What we can say is that health outcomes were not correlated with politics as of 2010,” Elder says. “And they are correlated with politics now.”
By the 2020s, conservatives were dying at significantly higher rates than liberals, with the gap concentrated in internal causes (for example, heart disease, cancer and stroke). The divide since 2020 is substantial: while only 0.2% of ‘very liberal’ respondents died of internal causes between 2020 and 2022, the probability for people who identified as ‘very conservative’ was 1.14 percentage points higher (P = 0.021; 95% confidence interval (CI), (0.18, 2.11)). This gap is not limited to deaths from COVID-19 and is not reducible to demographic or geographic differences between the groups, nor is it a pure function of ageing: previous cohorts’ death patterns in older data did not show a similar correlation between health and ideology before 2010.
We suggest that these growing health gaps are consistent with a mechanism of politically rooted changes in engagement with the health system. Using a large public opinion survey, we find that people on the right, particularly Trump voters and Republicans, express less trust in their personal doctor and are less willing to seek care for non-COVID-19-related health problems18,19. We also find that people on the right with chronic illnesses are more sceptical than people on the left that medicines to treat those illnesses are safe and effective. This political divide in consumption of care may sustain or deepen the health divide that has emerged in recent decades. However, both these findings and those on health outcomes are purely descriptive; more work is needed to uncover causal relationships.
Lay article with quotes from the author.
While the study does not establish causation, the shift is clear: “What we can say is that health outcomes were not correlated with politics as of 2010,” Elder says. “And they are correlated with politics now.”
