The Impact of Elections on Public Health: What the Data Reveal

by Jon Scaccia October 8, 2024

Political decisions shape the health of our communities. It’s not just the policies we vote for that influence public health, but also the elected officials and their broader political ideologies. A recent working papter, “Politicians, Power, and the People’s Health: US Elections and State Health Outcomes, 2012-2024,” shines a light on how political conservatism or liberalism at the state level correlates with key health outcomes.

Spanning from 2012 to 2024, this descriptive study examines the relationship between state-level political metrics—such as political ideology, party control, and state policies—and eight health outcomes that reflect public well-being across different stages of life. The results are clear: states with higher levels of political conservatism often experience worse health outcomes compared to their more liberal counterparts. This trend is visible in every presidential election year analyzed in the study.

The Power of Political Ideology on Health Outcomes

The research investigates four political metrics: the political ideology of Congressional representatives, the partisan makeup of state governments (referred to as “trifectas”), enacted state policies, and voter political lean. The health outcomes examined include infant mortality, premature mortality, health insurance coverage among adults aged 35-64, vaccination rates for children and seniors, maternity care access, and food insecurity.

Across all these metrics, states with more conservative political climates exhibited worse health outcomes. For example, in Republican-controlled states, premature mortality rates were notably higher—by approximately 25.5 deaths per 100,000 person-years—than in Democratic-controlled states. These trends held steady over time, emphasizing how political leadership can have long-term impacts on population health.

Key Findings: Health Outcomes Affected by Politics

Let’s break down the most significant health impacts outlined in the study:

• Premature Mortality: One of the most alarming trends was the spike in premature mortality (death before age 65) between 2018 and 2021. Conservative states saw a sharper rise, with already high premature mortality rates worsening. This suggests that the political climate may have exacerbated factors such as healthcare access, socioeconomic inequalities, and policy responses to public health crises like COVID-19.
• Health Insurance Coverage: A crucial determinant of health, insurance coverage among adults aged 35-64 was consistently lower in conservative states. The percentage of uninsured adults was approximately 2.8% higher in Republican states compared to Democratic ones. This gap widened in every election year studied, reflecting how policy decisions around Medicaid expansion and healthcare reforms have left millions without coverage.
• Vaccination Rates: Both childhood immunization and vaccination rates for seniors were higher in liberal states. Among adults aged 65 and older, flu vaccination coverage was nearly 4.35% higher in Democratic trifecta states. Similarly, COVID-19 booster rates in this age group were 5.95% higher in states with liberal political control. The correlation between political ideology and public health compliance during the pandemic has been widely discussed, but this study offers concrete data illustrating how political leadership can either encourage or discourage public health initiatives.
• Food Insecurity and Maternity Care Deserts: Conservative states had higher levels of food insecurity, with more families struggling to put food on the table. Additionally, women in conservative states were more likely to live in maternity care deserts—regions with no access to maternal healthcare services.

Elections Matter: How Political Leadership Shapes Health

These results show a striking pattern: states governed by more liberal political ideologies tend to implement policies that prioritize public health, resulting in better health outcomes. In contrast, conservative states often experience poorer health outcomes due to policy decisions that may favor the private sector over social equity and public welfare programs.

For instance, Medicaid expansion, a key component of the Affordable Care Act (ACA), was widely embraced by liberal states but rejected by many conservative ones. This decision alone has led to profound disparities in healthcare access and outcomes between states.

Additionally, the study notes the role of external factors such as gerrymandering and voter suppression, which can distort the translation of voter preferences into policy actions. In conservative states, political leaders may prioritize policies that reduce public health protections, delay action on health crises, or cut social services, all of which compound the negative health effects observed in these regions.

Why This Matters for Public Health Practitioners and Researchers

The study highlights the importance of political engagement for public health practitioners. Election outcomes have a direct and tangible impact on the health of populations, from the quality of healthcare to life expectancy. Understanding these political determinants of health is crucial for those working to improve health outcomes, especially in more politically conservative regions where the barriers to progress can be significant.

Public health professionals must advocate not only for evidence-based policies but also for greater political engagement. By raising awareness about the health implications of political decisions, they can help ensure that the public understands the stakes of their votes.

Join the Conversation

• How do you think public health professionals can better communicate the connection between elections and health outcomes to the public?
• What strategies can be employed to bridge the health disparities between conservative and liberal states?

Conclusion

The research is a compelling reminder that elections do more than decide political leadership—they shape the health and well-being of entire populations. The patterns revealed in this study underscore the need for sustained advocacy for policies that prioritize health equity, healthcare access, and public health protections. For public health professionals, the data provides valuable insights into how political factors influence the success of their work, particularly in regions where public health outcomes are most at risk.

As we look toward future elections, the health of the nation is clearly on the ballot. By understanding the political determinants of health, we can better advocate for policies that support healthier, more equitable communities.

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