Skip to main content

Does politics matter for health?

Does politics really matter when it comes to our health?  Labour or Tory, Democrat or Republican, does it have an impact?  Of course, those who campaign for change would assume that it does. The progressive welfare policies of the Labour government after WW2, and particularly the creation of the NHS, have had a lasting impact on health and wellbeing.  The austerity imposed during the last decade under Tory-led governments has had a deleterious effect on life expectancy. Yet, we often hear that 'it doesn't matter whose in power, they are all the same.' as a political mantra.  It feeds into the narrative of general disillusion with politics and democracy.  But now, the results of a  study from the USA also suggests that party politics matters. 

A new study in the American Journal of Preventive Medicine shows significantly higher infant and postneonatal mortality rates under Republican-controlled state legislatures than under non-Republican–controlled ones. Moreover, the effects may be more significant for black infants than for white infants.

“These findings support the politics hypothesis that the social determinants of health are, at least in part, constructed by the power vested in governments,” said lead investigator Dr Javier M. Rodriguez, of the Department of Politics & Government, Claremont Graduate University, Claremont, CA, USA.

Many social and health obligations depend on the decisions state representatives make. State legislatures are responsible for safety-net programs, the state’s minimum wage and many other public goods and services that influence the social determinants of health. The influence of state governments on population health followed decentralisation patterns since the 1970s, when states started to expand their independence from federal jurisdiction over welfare programs, including those directly affecting infant health, such as Medicaid.

The investigators examined how changes in the party composition of state legislatures and the upper and lower houses and governorships affected infant mortality rates, neonatal mortality rates, and post-neonatal mortality rates from 1969 to 2014. They also analysed annual state unemployment rates, the average age of female individuals, birth rates and other sociodemographic data.

They found that net of history, infant mortality is consistently higher under Republican-controlled state legislatures than non-Republican–controlled ones. Going from a non-Republican–controlled state Congress to a Republican-controlled one is associated with a 4.2% increase in infant mortality and an 8.1% increase in postneonatal mortality. Their findings show more significant estimates for Black than White infants, although the differences were not effective at conventional levels. Research has found that the introduction of Medicaid was associated with an 8% decline in non-White infant mortality between 1965 and 1980 (Goodman-Bacon, 2018). The annual increase in Black infant mortality under Republican legislatures found in this study is 5.9% — that is, equal to about 75% the magnitude of the 15-year benefit attributed to the introduction of Medicaid.

The party that controls state legislatures is powerfully associated with fluctuations in infant mortality rates and racial disparities in infant health, scientists report in the American Journal of Preventive Medicine (Credit:

Aside from party control of legislatures, the investigators found no clear evidence that Republican governors impact infant mortality rates. The investigators suggest that this may reflect variability in the balance of power between legislative and executive branches across the states. In addition, some governors’ health policy positions seem to be more synchronised with state-level culture than with national party ideological stances. For example, some Republican governors who are not highly conservative in the conventional sense may be more aligned with a Democratic legislature on healthcare issues.

However, the authors caution that it may not account for unobserved differences across states that may change at the same time as the party control change of state legislatures. Nor could it account for other mechanisms not included in the study that may connect Republican administrations and increases in infant mortality rates.

Nevertheless, the findings emphasise the power political institutions and governments have on writing and executing the policies and programs that shape the social determinants of health, including infant health.

“Unfortunately, in a drastically polarized political environment, it is often difficult for Americans to notice the underlying mechanisms that distribute the production of illness and human suffering that ultimately decide who lives and who dies of preventable reasons,” commented Dr Rodriquez. “As political decisions are a matter of life and death, the parties, politicians and policies that Americans support should be evidence-based and incorruptible. A deep understanding of political processes and institutions at the state level is necessary for improving overall population health and promoting health equity.”

Perhaps, none of this should surprise us. It demonstrates that setting health goals with clear health policies makes a difference.  The significant divide in politics is between those who believe economic goals alone are sufficient and those who believe in establishing a framework for social justice.  We cannot buy an ounce of social justice in a 'free market'.  Another way to describe the divide is between interventionist and non-interventionist strategies. 

Photo by Christian Bowen on Unsplash

About the author: Ray Noble is a Chartered Biologist and Fellow of the Royal Society of Biology. 


Popular posts from this blog

Ian Duncan-Smith says he wants to make those on benefits 'better people'!

By any account, the government's austerity strategy is utilitarian. It justifies its approach by the presumed potential ends. It's objective is to cut the deficit, but it has also adopted another objective which is specifically targeted. It seeks to drive people off benefits and 'back to work'.  The two together are toxic to the poorest in society. Those least able to cope are the most affected by the cuts in benefits and the loss of services. It is the coupling of these two strategic aims that make their policies ethically questionable. For, by combining the two, slashing the value of benefits to make budget savings while also changing the benefits system, the highest burden falls on a specific group, those dependent on benefits. For the greater good of the majority, a minority group, those on benefits, are being sacrificed; sacrificed on the altar of austerity. And they are being sacrificed in part so that others may be spared. Utilitarian ethics considers the ba

The secret life of Giant Pandas

Giant pandas, Ailuropoda melanoleuca , have usually been regarded as solitary creatures, coming together only to mate; but recent studies have begun to reveal a secret social life for these enigmatic bears.  GPS tracking shows they cross each others path more often than previously thought, and spend time together.  What we don't know is what they are doing when together.  Photo by  Sid Balachandran  on  Unsplash For such large mammals, pandas have relatively small home ranges. Perhaps this is no surprise. Pandas feed almost exclusively on bamboo. The only real threat to pandas has come from humans. No wonder then that the panda is the symbol of the WWF.  Pandas communicate with one another through vocalization and scent marking. They spray urine, claw tree trunks and rub against objects to mark their paths, yet they do not appear to be territorial as individuals.  Pandas are 99% vegetarian, but, oddly, their digestive system is more typical of a carnivore. For the 1% of their diet

A time for every purpose

All life moves. Or, more precisely, all life moves purposefully.  This is true even for trees and plants.  Movement is essential for maintaining life.  Animals migrate; plants disperse.  Some form of migration is an ingredient of all life.  For many organisms, it is a key function of reproduction.  We don't reproduce merely to create a new organism, but also to disperse the population - finding new fertile ground, or resources. Reproduction is a form of migration. Reproduction isn't merely to replicate. Reproduction produces change and diversity.  While we may have strong resemblences in families, we also have differences.  Creating a difference is how evolution works.  In this sense, nature is a continuous exploratory process, finding what works best.  Nature senses change and responds.  Some of this is immediate and physiological or behavioural; some of it is over generations.  If we look at a forest over long periods of time, we would see that it shifts. There is a movement