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Book Review:
States hold the key to our health

The Growing Influence of State Governments on Population Health in the United States

Steven Woolf, 2022

This article asserts that "The gap in life expectancy between the US and 16 peer countries increased from 1.9 years in 2010 to 3.1 years in 2018 and 4.7 years in 2020." And 'The US health disadvantage is even worse in certain states  with states such as Alabama and Mississippi having the same life expectancy as Latvia (75 years)." Furthermore, "disparities in health across the 50 states are growing, a trend that began in the 1990's. For example, in 1990 life expectancy in New York was lower than in Oklahoma, but the trajectories separated sharply in the 1990s and by 2016, New York ranked third in life expectancy, whereas Oklahoma ranked 45th. By 2019, mortality rates at ages 25-64 differed by a factor of 216% between the states with the highest mortality rate ( 565.1 per 100,000) and the lowest rate (261.9 per 100,000, up from 188% in 1999."


Woolf maintains that the widening  mortality gap among states cannot be explained by changes in racial/ ethnic composition of states, "because the same trend occurred within racial and ethnic groups." Woolf believes the most likely explanation is the growing political "polarization of public policies across states." He asserts that states have become public policy laboratories in which the effects of a wide range of policies on mortality rates can be compared.  He writes: "States with different political priorities and economic circumstances made diverse policy choices, widening the gap across the states in education, wages, taxes, social programs, corporate profits, wealth inequality and infrastructure. Health outcomes changed as states took different approaches to Medicaid, workplace and product safety, the environment, tobacco control, food labelling, gun ownership and needle exchange programs." And: "These policies had predictable consequences.  


"The COVID-19 pandemic  removed any doubt that state policies can affect health outcomes." ... "In 2021, excess deaths were disproportionately concentrated in states where resistance to COVID vaccination was prevalent. ... excess death rates in Florida and Georgia ( more than 200 deaths per 100,000)  were much higher than in states with largely vaccinated populations such as New York  (112 per 100,000, NJ ( 73 deaths per 100,000), and Massachusetts (50 deaths per 100,000).  "Between August and December 2021, Florida experienced more than triple the number of excess deaths (29,252) as New York ( 8786) despite both states having similar population counts."  


Woolf concludes that "States are laboratories for experimentation" that has a major effect on life expectancy. What he does not say directly is that Americans were living almost 5 years less than populations in 16 developed countries before the pandemic, and the gap in life expectancy between the US and many other developed countries has increased still further during the pandemic. A 5 year reduction in life expectancy is a huge cost for social policies that endanger public health.      

-- Dee Wilson

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