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. 2024 Nov 27;2(12):qxae163.
doi: 10.1093/haschl/qxae163. eCollection 2024 Dec.

Politicians, power, and the people's health: US elections and state health outcomes, 2012-2024

Nancy Krieger  1 , Soroush Moallef  1   2 , Jarvis T Chen  1 , Ruchita Balasubramanian  3   4 , Tori L Cowger  2 , Rita Hamad  1 , Alecia J McGregor  5 , William P Hanage  3   4 , Loni Philip Tabb  6 , Mary T Bassett  1   2
Affiliations

Politicians, power, and the people's health: US elections and state health outcomes, 2012-2024

Nancy Krieger et al. Health Aff Sch. .

Abstract

Our descriptive study examined current associations (2022-2024) between US state-level health outcomes and 4 US state-level political metrics: 2 rarely used in public health research (political ideology of elected representatives based on voting records; trifectas, where 1 party controls the executive and legislative branches) and 2 more commonly used (state policies enacted; voter political lean). The 8 health outcomes spanned the life course: infant mortality, premature mortality (death at age <65), health insurance (adults aged 35-64), vaccination for children and persons aged ≥65 (flu; COVID-19 booster), maternity care deserts, and food insecurity. For the first 3 outcomes, we also examined trends in associations (2012-2024). For all political metrics, higher state-level political conservatism was associated with worse health outcomes, especially for the metrics for political ideology and state trifectas. For example, in 2016, the premature mortality rate in states with Republican vs Democratic trifectas was higher by 55.4 deaths per 100 000 person-years (95% CI: 7.7, 103.1), and the slope of the rate of increase to 2021 was also higher, by 27.0 deaths per 100 000 person-years (95% CI: 24.4, 29.7). These results suggest elections, political ideology, and concentrations of political power matter for population health.

Keywords: COVID-19 boosters; childhood vaccination; electoral politics; food insecurity; health insurance; infant mortality; maternity care deserts; political conservatism; political determinants of health; political liberalism; political polarization; poverty; premature mortality; state policies; state trifecta.

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Conflict of interest statement

Conflicts of interest Please see ICMJE form(s) for author conflicts of interest. These have been provided as supplementary materials.

Figures

Figure 1.
Figure 1.
Maps of current state-level data for the political exposures, health outcomes, and covariates (2022–2024): political metrics (A-E), poverty (F-G), and health outcomes (H-O). Darker colors denote higher values. Adverse health outcomes are shown in grayscale (darker color, worse health outcome); beneficial outcomes use a purple color scale (darker color, better health outcome). Abbreviations: Cook PVI, Cook Partisan Voting Index; ICE, Index of Concentration at the Extremes.
Figure 1.
Figure 1.
Maps of current state-level data for the political exposures, health outcomes, and covariates (2022–2024): political metrics (A-E), poverty (F-G), and health outcomes (H-O). Darker colors denote higher values. Adverse health outcomes are shown in grayscale (darker color, worse health outcome); beneficial outcomes use a purple color scale (darker color, better health outcome). Abbreviations: Cook PVI, Cook Partisan Voting Index; ICE, Index of Concentration at the Extremes.
Figure 2.
Figure 2.
Trends in state-level health outcomes by stratified by state-level political metrics (state liberalism; state trifecta; DW-Nominate House; DW-Nominate Senate), for the 50 US states and the District of Columbia (2012–2024): premature mortality (A-D), infant mortatliy (E-H), and percent uninsured (I-L).
See this image and copyright information in PMC

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