Inter-state disparities in mortality linked to decades-old public health investments

New England researchers published a new paper in the Journal of Economic Perspectives, examining the growing inter-state disparity in mid-life mortality. The authors consider that the substantial variation might be linked with educational or income differences, “deaths of despair” (e.g., drug overdoses, suicide), or combinations of place-based policies and conditions. The authors find that the change in mortality over time doesn’t vary much by states’ educational attainment, but that states with the highest income levels, rather than the most income growth, have experienced the greatest mortality declines over time. This is notable since mortality was similar in high- and low-income places just a few decades ago. The authors investigate the possibility that in the 1990s, highincome states invested in health-promoting policy and infrastructure, like higher cigarette taxes and Medicaid expansion. They find also that related, but distinct shifts in health behaviors occurred at the same time in many of the same places, and these elements converge to produce a faster reduction in mortality in high income states. Although place and health have been linked before, the authors argue their work documents the “cumulative effect of regional policies over the life-cycle” in ways that existing research linking health and neighborhoods has not.

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