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State policies are increasingly affecting the health of Americans

Life expectancy, and COVID-19 outcomes, may be closely tied to state policies, according to an article in the Journal of the American Medical Association written by a VCU researcher.

Stethoscope atop the reflection of an American flag on a desk Photo: Getty Images

By Laura Rossacher

An individual’s life expectancy in the U.S. increasingly depends on the state in which they live, according to an editorial by Steven Woolf, M.D., director emeritus of VCU’s Center on Society and Health, published Friday in the Journal of the American Medical Association.

For decades, the U.S. population has experienced shorter life expectancy and higher disease rates than populations in other high-income countries. The gap is widening — not only between the U.S. and other countries, but also among the 50 states. One reason for the widening gap, Woolf suggests, could be the growing polarization of public policies across states.

“The COVID-19 pandemic showed us in real time that the choices states make affect our health, but the pandemic is only the latest example of a trend that has been underway for years,” Woolf said. “State governments produce vastly different health outcomes when they take different approaches to Medicaid, workplace and product safety regulations, the environment, tobacco control, and gun ownership, just to name a few.”

Perhaps for this reason, the health gap among states has widened dramatically since the 1990s. In 1990, life expectancy in New York was lower than in Oklahoma. But, Woolf explained, those states made very different policy choices. By 2016, New York ranked third in life expectancy, whereas Oklahoma ranked 45th.

“The growing polarization of red and blue states in recent years has widened the divide on policies even more, and that has affected our health and safety,” said Woolf, a professor in the Department of Family Medicine and Population Health at the VCU School of Medicine. “While other countries mounted a national response to COVID-19, the U.S. was hobbled by 50 response plans, and it shows.”

States that spent decades resisting public health policies were among the most resistant to restrictive COVID-19 policies and vaccination mandates. As a result, their residents were more vulnerable to COVID-19 variants, and more likely to die. For example, Woolf’s data shows that Florida, Georgia and Texas experienced much higher death rates in 2021 than states like New York and Massachusetts. Between August and December 2021, Florida had more than triple the number of excess deaths (29,252) as New York (8,786), even though both states have similar populations (21.7 million and 19.3 million, respectively). 

Woolf, who serves in a community engagement role with VCU’s C. Kenneth and Dianne Wright Center for Clinical and Translational Research, expects states to exert even greater control over the health of their populations and, in turn, how long they will live, in the future.

“The Texas abortion bill and dozens like it are part of a flurry of new laws being passed across state capitols that could affect health and health care in a major way,” Woolf said. “While state governments have the right to set their own paths and policies, the public should decide whether life expectancy should be part of that experiment.”  

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