US State Policies, Politics, and Life Expectancy
US State Policies, Politics, and Life Expectancy
复制标题
DOI：
10.1111/1468-0009.12469
复制
发表时间：
2020-08-04
影响因子：
6.6
通讯作者：
Zajacova, Anna
中科院分区：
文献类型：
--
作者：
Montez, Jennifer Karas;Beckfield, Jason;Zajacova, Anna
政策要点自20世纪70年代以来，特别是2010年之后，美国国家政策的变化对美国预期寿命的停滞和近期下降发挥了重要作用。美国的一些州政策似乎是提高预期寿命的关键杠杆，例如烟草、劳工、移民、民权和环境政策。如果美国所有州都享有政策更为自由的州的健康优势，那么美国女性的预期寿命预计将延长 2.8 年，男性的预期寿命将延长 2.1 年，这将使美国的预期寿命与其他高收入国家持平。背景 在过去的几十年里，美国的预期寿命几乎没有增加，近年来却有所下降，而且美国各州的预期寿命变得更加不平等。这些趋势伴随着美国政策环境的重大变化，特别是在州一级。国家政策几乎影响人们生活的方方面面，包括经济福祉、社会关系、教育、住房、生活方式和医疗保健。这项研究探讨了国家政策环境在多大程度上可能导致美国预期寿命出现令人不安的趋势。方法 我们将 1970 年至 2014 年美国各州预期寿命的年度数据与烟草、环境、税收和劳动力等 18 个州级政策领域的年度数据合并。利用 45 年的数据并控制各州及其人口特征的差异，我们对国家政策与预期寿命之间的关联进行了建模，并评估了这些政策的变化如何影响 1970 年至 2014 年美国预期寿命的趋势。研究结果表明，1970 年至 2014 年预期寿命的变化与保守-自由连续体上的国家政策变化相关，在该连续体中，更自由的政策扩大了经济监管并保护边缘化群体。实施更为保守政策的国家更有可能出现预期寿命缩短的情况。我们估计，如果国家政策没有像现在这样改变，2010 年至 2014 年美国预期寿命的小幅上升趋势中，女性预期寿命将增加 25%，男性将增加 13%。我们还估计，如果所有州都享有政策更为自由的州的健康优势，那么美国女性的预期寿命将延长 2.8 年，男性的预期寿命将延长 2.1 年。结论 要理解和扭转美国预期寿命的令人不安的趋势和日益严重的不平等，需要关注美国的国家政策背景、近几十年来的动态变化以及这些变化背后的力量。自 20 世纪 70 年代以来美国政治和政策环境的变化可能会加剧美国人健康和寿命的恶化。
Policy PointsChanges in US state policies since the 1970s, particularly after 2010, have played an important role in the stagnation and recent decline in US life expectancy. Some US state policies appear to be key levers for improving life expectancy, such as policies on tobacco, labor, immigration, civil rights, and the environment. US life expectancy is estimated to be 2.8 years longer among women and 2.1 years longer among men if all US states enjoyed the health advantages of states with more liberal policies, which would put US life expectancy on par with other high-income countries. Context Life expectancy in the United States has increased little in previous decades, declined in recent years, and become more unequal across US states. Those trends were accompanied by substantial changes in the US 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 US life expectancy. Methods We merged annual data on life expectancy for US 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, we modeled the association between state policies and life expectancy, and assessed how changes in those policies may have contributed to trends in US life expectancy from 1970 through 2014. Findings 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. We estimated that the shallow upward trend in US life expectancy from 2010 to 2014 would have been 25% steeper for women and 13% steeper for men had state policies not changed as they did. We also estimated that US 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. Conclusions Understanding and reversing the troubling trends and growing inequalities in US life expectancy requires attention to US state policy contexts, their dynamic changes in recent decades, and the forces behind those changes. Changes in US political and policy contexts since the 1970s may undergird the deterioration of Americans' health and longevity.