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Lerner Center for Public Health Promotion and Population Health

Population Health Research Brief Series

Conservative State Policies Contribute to Higher Mortality Rates among Working-age Americans

Jennifer Karas Montez, Nader Mehri, Shannon Monnat

October 2022


The risk of dying during working ages (25 to 64) is high, rising, and unequal in the United States. Working-age mortality rates are much higher in some states than others. Part of the explanation may relate to differing policies across states that affect health. While some states enact policies that invest in people’s economic, social, and behavioral wellbeing, others enact policies that are potentially harmful to health. Using mortality data from the U.S. Centers for Disease Control and Prevention, this study examined how state policies on criminal justice, taxes, environment, firearms, marijuana, health care, labor, and tobacco were associated with the risk of dying among working-age adults from 2000 to 2019. The authors also estimated how changing these policies across a liberal-to-conservative continuum might affect the risks of dying from any cause and from cardiovascular disease (CVD), suicide, alcohol, and drug poisoning. The authors found that more conservative marijuana policies and more liberal policies on firearms, labor, environment, taxes, and tobacco were related to lower risk of death among working-age adults. Simulations show that changing all eight state policy domains to a fully liberal orientation might have saved 171,030 lives in 2019, while changing them to a fully conservative orientation might have cost 217,635 lives. Fixing the high and rising mortality among working-age adults requires state policymakers to enact policies that provide a foundation for all Americans to achieve economic, social, and behavioral wellbeing.  

Lerner Center for Public Health Promotion and Population Health