How Do State Policies Impact Life Expectancy?

Since 1970, changes in US state policies have played an important role in the stagnation and recent decline in life expectancy, while some policies appear to be key levers for improving life expectancy, a new study published in The Milbank Quarterly found.

“In 2016, life expectancy of American women was 3 years below the female average of high-income countries and 5.8 years below the leader,” authors wrote. In males, life expectancy was 3.4 years below the average and 5.2 years below the leading country for life expectancy. “Given that life expectancy captures overall social, economic, physical and mental well-being, such trends paint a troubling portrait of life and death in the United States.”

When it comes to root causes of these disparities, one major contributor is a rise in so-called “deaths of despair,” or deaths due to suicide or drug and alcohol abuse. Different regional policies on firearm use and availability of substance abuse rehabilitation programs can alter expectancy gains or declines across state lines.

“In 2017, life expectancy ranged from 74.6 years in West Virginia to 81.6 years in Hawaii,” authors write. If the 2 states were separate nations, West Virginia would rank 93rd in the world for life expectancy while Hawaii would rank 23rd.

Local policies also affect nearly every aspect of an individual’s life including economic well-being, social relationships, education, housing, lifestyles, and access to medical care, authors point out.

To better understand how shifts in state policy contexts predict life expectancy and how US longevity may change if all states enacted liberal or conservative policies, researchers merged annual data on life expectancy from states between 1970 to 2014 with annual data on 18 state-level policy domains. Previous research has shown state policy contexts began to hyperpolarize after 1970.

The 45 years’ worth of data, collected from the United States Mortality Database, was controlled for differences in state characteristics and populations. Each policy was scored on a 0 to 1 scale to represent the actual range of the policies during the 1970-2014 period on a conservative-to-liberal continuum.

Liberal policies were defined as “expanding state power for economic regulation and redistribution, or for protecting marginalized groups, or restricting state power for punishing deviant social behavior.” Conservative policies were classified as the opposite.

Researchers then calculated a state’s annual score for each policy domain as the sum of liberal policy scores minus the sum of conservative policy scores. Regression models of life expectancy were estimated as a function of time, the 18 policy domain measures, and state-level fixed effects.

Analyses revealed the following results:

• Altering all of the state policies to attain maximum liberalism scores predicted the US longevity would be 2.8 years longer among women and 2.1 years longer among men
• Altering all policies to have the minimum liberalism score predicted a 2-year reduction in life expectancy among women and a 1.9 year reduction among men
• Among the 10 policy domains with a statistically significant association with life expectancy, a more liberal version of 8 domains was associated with longer lives (tobacco, immigration, civil rights, private labor, environment, gun control, LGBT, and abortion, with exceptions of marijuana and voting)
• Female life expectancy would be 2.5 years higher within a state if it had the most liberal policies on the environment (environment policy score = 1) than if it had the most conservative
• If all states’ policies were identical to Connecticut’s in 2014, (Connecticut made the largest shift toward liberal policies from 1970 to 2014), US life expectancy would be 2 and 1.3 years longer among women and men, respectively
• If all states’ policies were identical to Oklahoma in 2014 (it saw the greatest shift toward conservative policies) US life expectancy would be an estimated 1 and 0.5 years shorter among women and men, respectively
• From 2010-2014, the shallow upward trend in US life expectancy would have been 25% steeper for women and 13% steeper for men had state policies not changed as they did

If the status quo is maintained, thereby allowing the current policy direction of states to continue, researchers found the results would yield minimal improvements in longevity (0.4 and 0.3 years higher among women and men, respectively).

The inclusion of states’ annual unemployment rates in supplementary analyses yielded the same results, likely reflecting the large amount of information included in the models.

However, authors caution the analyses do not prove state policies have a causal effect on life expectancies.

“Taking these findings together, the slow gains in US longevity may partly reflect the national shift toward some conservative policies that are negatively associated with longevity (eg abortion restrictions, reductions in gun control),” researchers conclude, while this trend offset the national shift toward some liberal policies that are positively associated with longevity (eg environment and civil rights protections).

Reference

Montez JK, Beckfield J, Cooney JK, et al. US state policies, politics, and life expectancy. Milbank Q. Published online August 4, 2020. doi:10.1111/1468-0009.12469