And to build on this: classist and racist results do not require bad people to be involved, even if some are. The structure of the system, the nature of the inequality in sorts of coverage, in access, in environments, as well as in wealth and income, perpetuates even when those with best intentions are in charge and delivering care.
Very much so. The ‘red’ parts of that map correspond very neatly with what is considered ‘east’ Texas (Piney woods, Lakes, and on down to the Gulf coast region), which are culturally and historically more connected with the traditional South than the rest of Texas. That was the half of the state where slaveholding was practiced (not being economical elsewhere). Even the accents are distinct. And if you consider a population density map, guess which side of the state has the most people by far?
To toss the whole thing into “well, those are factors but the real reason is likely more complicated than a state by state comparison” seems like a bit of sophistry.
Nobody has said there’s a 100% correlation at the state level but to ignore the dense mass of people represented by the southern states very much loses the forest for the trees.
The rich get richer and the poor get poorer. In QALYs just as much as in Quatloos. It was ever thus.
Whether we’re finally civilized enough to lean against this tide is the question. Clearly for about half of the USA the answer is “No F***ing Way! We lurves us our inequality. (As long as we’re on the winning end of the stick).”
Well that’s the odd thing: many of the people lurving them their inequality, lower SES whites, often rural, are on the losing end of the stick. They just feel better if “the other” doesn’t get a chance to be above them, and resent that it sometimes happens. Pulling others down is more important than being raised up.
ETA that I feel bad about the broad brushstroke and obviously not a whole group. But still reflected in who and what they vote for.
Agreed. Both that it’s true and that it’s a tragedy that it’s true.
As the wise political sage LBJ once memorably put it:
In the intervening ~60 years since LBJ spoke, Progress is something that has happened for many of us. But not for those resolutely facing backwards with their feet planted stubbornly exactly where their granddad had first set his.
What’s different now is that LBJ was “picking pockets” to arguably good ends, whereas TFG and his enablers have recognized how to pick the same pockets, this time for unequivocally bad ends.
Note that Krugman is using the same article that survinga offered and I examined, and comes to a similar conclusion.
Overall I found the paper @survinga cited to be like a lot of social sciences papers. Paraphrasing mightily & parodying just a bit 
:
Abstract: We have messy, conflicting, incompatible, and grossly incomplete data to work from. Which offers no hope of firmly based actionable conclusions. Though we might find a coffee cherry in amongst all the civet shit. So we poked around with that goal in mind and found a few correlations that fit with at least some folks’ ideas of “common sense”. Presented forthwith in Figures 1 through n. Details are shown in Tables 1 through m available from our website.
Body: [Insert a few pages of jargon here]
Our bottom line: This data opens even more questions that further research might answer. IOW: But we did have a lot of fun playing around with R, we really enjoyed the couple of
junketsfield research trips our grant paid for, and we urgently urge the grant-givers to let us try harder next year to greater effect with our new and better questions on possibly new and better data. But probably not.
I exaggerate here for effect, but you can see my point poking out from spots in their seriously-intended efforts and the wooly not-quite-results that effort yielded.
I agree that the paper is a mess, though I tried to take it as seriously as possible.
I spent a year in the lower stacks of a med school library reading every single paper ever published on the subject of lactose intolerance for my book. I learned a lot, including the displaying fact that more than half of medical journal papers are worthless C.V. padding. The social sciences may be worse. I’m a member of MAPACA (the Mid-Atlantic Popular & American Culture Association) and have given papers at their conferences. Which means I had to listen to or read their papers. Proclaiming a mere half as worthless would be understatement.
Both those experiences deeply bothered me. But I am also bothered by something more recent. I clicked on survinga’s cite and read the paper. You did as well. Only one more person here did in the last 16 hours. How seriously can we take posts on the subject if they don’t bother reading the cites?
I don’t really mean to accuse the paper’s authors of bad faith or academic sophistry.
They (probably) were trying diligently to find something significant, and ideally, actionable. Sadly the data just didn’t support that. Whether that’s because even given god-like total awareness nothing can be concluded or done or whether the problem is simply not enough good enough data to detect the weak signal in the loud noise is strictly unanswerable.
The rest of your points are, as always, well-taken.
Meh.
I clicked but did not read in depth. Honestly though something offered up as “Another link that discusses …”?
Usually I’m not going to bother. Personally I prefer if someone summarizes the findings, or informs why that article is worth the read. I also don’t read every article cited in papers. I do look up some.
What a strange interpretation of my argument. If east Texas is culturally like Louisiana, and other parts are not, it means that a state-level comparison is not valid, while a geo-cultural interpretation is. That would be a more likely root cause than the state-level policy differences that Exapno_Mapcase supports as an explanation.
Ok, let me nuance my statement a bit.
US life expectancy is -6 years lower than that in most of its peers (rich industrialized countries)
Others have shown that there is -2 years lost to guns.
I will take a conservative number and state that your excessively dangerous traffic takes -1 years away. (1y more than in peer countries)
[I would go out further and say that both factors are contributing heavily to an unhealthy car dependent lifestyle, but that is very hard to quantify.]
So at least 3 of the 6 years is guns and traffic.
Most data I’ve seen does not take into account the recent spike in both gun and traffic deaths in the US: I feel their contribution is much in recent years but cannot find data to support this directly.
Those 2 are much easier to remedie than inequality or sub-par healthcare. Almost the definition of low hanging fruit. The 2 leading causes of death in people below 40.
Thanks for clearing that up.
Lowering gun deaths is definitely not easy to remedy in the US. I would argue that it would be easier to roll out universal healthcare (say, by expanding Medicare for everyone) than it would be to impose the kind of gun controls and buybacks needed to put a dent into our gun deaths.
Oh the op article. Yeah reading that seems required for participating in the discussion.
As always, xkcd is on-point and just a couple days clairvoyant vs. your insightful comments:
Roughly 86% of the population of Texas lives in that ~1/3 of the state (on or east of the I-35 corridor linking DFW and San Antonio).
So, sure, in a very strict sense, you are correct that the other 15% should be included, but using that 85% as a first order generalization for the entire state has a great deal of validity.
I think the geographic disparities in mortality comes from many reasons. Politics is certainly part of it. The Republican anti-CovidVax campaign killed a lot of people. Lack of Medicaid expansion in some states might have some impact.
It’s one of many.
There’s race, income, diet, prevalence of obesity, etc.
It’s very depressing. As someone who loves America, I know we can do better.
If you explore the county map, you can see some interesting things going on. The very easternmost parts of Texas look like Louisiana, in that they have life expectancies in the 70-75 year range. The high-population counties are only ok–Harris county (with Houston) and Dallas county are at 78 years. But just outside those high-population counties are some modestly smaller ones without the same health problems–Fort Bend, for instance, has a life expectancy of 81.8, which isn’t bad at all. It’s also Texas’ wealthiest county.
To emphasize again, what I was responding to was the claim that state-level policy decisions are the major factor here. I don’t think the county-level view supports that thesis. Obviously we can use states as a granular way of looking at the data, because any geographical variation is going to show up in the state data. But you can’t use that to conclude that there’s something wrong with the state itself, just that the state happens to overlay some other boundary.
And of course I agree with LSLGuy’s point that there is a political feedback loop. But that works at all political levels, not just the state, and is likely more powerful at the more local levels, especially if there is significant variation within a state.
I do get that (and I happen to live in Fort Bend County - it’s a very mixed bag with a large, recent influx of wealthy suburbanites skewing the figures over the existing poorer rural areas) but using the existence of outlier wealthy counties to not only diminish but largely dismiss the concept of policy impact at the state level is premature.
A heatmap of a lot of undesirable things - life expectancy, teenage birth rate, high school graduation rate, poverty, food deserts - are not 100% correlated but are all distinctly worse for the states of the old Confederacy than the national average.
So, sure, maybe those all just happen to be things that local/county policies have almost universally done poorly, but that still ties to the state. If your counties are doing poorly across the board across several different indicators and have done so for decades, the state government bears responsibility at least by neglect if not by active commission.
@Dr.Strangelove two above. Agreed in general. With a caveat.
ETA: Which on review I see @Great_Antibob has largely prefigured just above while I was bloviating.
What I was suggesting is that just as different states react differently to offered federal policies and federal cash (e.g. Medicaid expansion, COVID lockdowns, or suggested mask mandates), there’s also a lot of room within states for state-level policies to have more or less uptake based on local considerations. Which given the incentives on offer, often mean state level programs are increasing, not decreasing, in-state health inequality as they do their work.
Bigger-picture I agree that state-level actions are not big drivers here. Frankly, damn near nothing governmental, except widespread inaction / neglect, is having much impact anywhere at any level. These are problems of what government is not doing at all, not what it is doing whether well or poorly.
By and large, this is cultural and economic, not governmental. And frankly, about half of US citizens want it to stay that way.
These cultural / economic factors are correlated with the states. But mostly the states are simply serving as geographical shorthands, not as identifiable “laboratories of democracy” or any such rot. Most especially not when discussing the geographically large states with lots of intra-state variability. e.g. Rhode Island, New Jersey, and Ohio are fairly homogenous. Texas, FL, and CA not so much.