Population Health Research Brief Series

Death rates among U.S. working-age adults have risen in many counties over the past three decades even as they fell in others. What explains why some places have become less healthy while others have not?

This brief describes how state policy contexts and local economic conditions jointly shape working-age mortality across roughly 3,000 U.S. counties from 1990 to 2019.

The authors find that death rates were lowest in economically secure counties located in states with more liberal policy contexts (i.e., states that take a more active role in shaping the economy and supporting residents' material and physical wellbeing). Counties in states with more conservative policy contexts (i.e., those where the state opposes intervention in markets and favors traditional social values) generally had higher mortality than counties in more liberal states—regardless of local economic conditions.