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Montez article on US state policies, politics and life expectancy published in Milbank Quarterly

Aug 4, 2021

US State Policies, Politics, and Life Expectancy

Jennifer Karas Montez, Jason Beckfield, Julene Kemp Cooney, Jacob M. Grumbach, Mark D. Hayward, Huseyin Zeyd Koytak, Steven H. Woolf, Anna Zajacova

Milbank Quarterly, August 2020

Jennifer Karas Montez

Jennifer Karas Montez


Life expectancy in the United States has increased little in previous decades, declined in recent years, and become more unequal across U.S. states. Those trends were accompanied by substantial changes in the U.S. policy environment, particularly at the state level. State policies affect nearly every aspect of people's lives, including economic well-being, social relationships, education, housing, lifestyles, and access to medical care. This study examines the extent to which the state policy environment may have contributed to the troubling trends in U.S. life expectancy.


The authors merged annual data on life expectancy for U.S. states from 1970 to 2014 with annual data on 18 state-level policy domains such as tobacco, environment, tax, and labor. Using the 45 years of data and controlling for differences in the characteristics of states and their populations, the authors modeled the association between state policies and life expectancy, and assessed how changes in those policies may have contributed to trends in U.S. life expectancy from 1970 through 2014.


Results show that changes in life expectancy during 1970-2014 were associated with changes in state policies on a conservative-liberal continuum, where more liberal policies expand economic regulations and protect marginalized groups. States that implemented more conservative policies were more likely to experience a reduction in life expectancy. The authors estimated that the shallow upward trend in U.S. life expectancy from 2010 to 2014 would have been 25 percent steeper for women and 13 percent steeper for men had state policies not changed as they did. The authors also estimated that U.S. life expectancy would be 2.8 years longer among women and 2.1 years longer among men if all states enjoyed the health advantages of states with more liberal policies.


Understanding and reversing the troubling trends and growing inequalities in U.S. life expectancy requires attention to U.S. state policy contexts, their dynamic changes in recent decades, and the forces behind those changes. Changes in U.S. political and policy contexts since the 1970s may undergird the deterioration of Americans’ health and longevity.