A recent study published in Nature Human Behaviour suggests that conservative Americans have experienced worse health outcomes and higher mortality rates than their liberal counterparts over the past decade. The research provides evidence that this widening health gap stems from demographic shifts within political coalitions and a growing distrust in medical professionals among right-leaning individuals. These changing attitudes toward seeking and following medical advice tend to leave conservative individuals more vulnerable to preventable health risks.
Scientists Elizabeth Elder and Neil A. O’Brian conducted the study to better understand how political beliefs might act as a social determinant of health. Past studies on this topic often relied on county-level geographic data or self-reported health surveys. These older methods often produced mixed findings because self-reported health can be subjective and county-level averages do not always reflect individual behaviors.
To resolve these contradictory findings, Elder and O’Brian sought to link individual political orientations directly to verified medical data and death records. The researchers also wanted to understand how the relationship between political ideology and physical health has changed since the early 2010s. Medical issues have become highly politicized in recent years, prompting the scientists to investigate whether this polarization affects real-world health outcomes.
“During COVID, I watched how people’s political identity became a powerful predictor of how they engaged with the public health officials and its impact on health outcomes related to COVID,” said O’Brian, an assistant professor of political science at the University of North Carolina at Chapel Hill. “I started wondering, though, if polarization around trust in public health officials (like Anthony Fauci) or distrust in vaccines, spread beyond COVID-related matters to trust one’s personal doctor and whether they thought medicines to treat chronic disease were safe and effective.”
To answer these questions, the scientists analyzed data from the National Longitudinal Study of Adolescent to Adult Health. This long-term research project tracked a nationally representative group of individuals who were adolescents in the 1990s. The researchers focused on data collected during three specific time periods: 2001, 2008 to 2009, and 2016 to 2018.
This unique dataset includes both the participants’ self-reported political ideology and in-home medical measurements taken by trained professionals. The medical data included body mass index, blood pressure, cholesterol, inflammation, and blood glucose levels. The authors combined these five measurements to create a comorbidity index, which is a single score that indicates how many different medical conditions or health risks a person has at the same time.
The sample sizes for these survey periods were very large, with over 11,000 to 13,000 respondents providing political ideology data in each of the three examined waves. The researchers also checked the participants’ vital status against the National Death Index, a database administered by the Centers for Disease Control and Prevention. This database allowed them to see not only who had passed away by the year 2022 but also the underlying cause of death.
During the 2008 to 2009 period, the scientists found no significant differences in the physical health of liberal and conservative participants. By the 2016 to 2018 survey, the medical data showed a noticeable shift. The respondents who identified as the most conservative recorded the highest comorbidity scores, indicating they were the least healthy group.
The researchers tracked individuals who changed their political beliefs over time to see what might be driving this shift. They found that people who were less healthy in 2008 tended to adopt more conservative political views by 2016. At the same time, the liberal coalition gained an advantage in socioeconomic factors like income and education, which tend to be associated with better overall health.
The mortality data provided evidence of a similar timeline. In the early 2000s, liberals died at rates similar to or slightly higher than conservatives. By the period between 2020 and 2022, this pattern had reversed entirely. The most conservative respondents were significantly more likely to die than the most liberal respondents.
This elevated death rate was primarily driven by internal causes, such as heart disease and cancer, rather than external causes like car accidents. The authors noted that this difference in mortality was not entirely due to coronavirus infections. Even when the scientists removed deaths directly caused by the virus from their calculations, conservative participants still experienced higher mortality rates.
This mortality difference is quite large when compared to other known health risks. “The mortality rate for internally caused deaths between very liberal and very conservative in the pandemic era (in our paper defined as 2020-22) is about two-thirds the gap between people making over $100,000 and those making less than $30,000 a year,” O’Brian explained. He noted that income is often thought of as a powerful social determinant of health. “That’s a pretty substantive gap,” he said.
Since demographic changes and the recent pandemic could not fully explain the widening health gap, Elder and O’Brian conducted a second study. They wanted to test whether right-leaning individuals were simply engaging less with the healthcare system today. In the spring of 2024, the scientists surveyed 21,751 adults living in the United States using an online panel platform.
This large survey asked participants about their recent visits to primary care providers and emergency room doctors. The questionnaire asked how much they trusted these medical professionals and whether they followed their clinical advice. The scientists measured political beliefs using self-reported ideology, political party identification, and the participant’s choice between Donald Trump and Joe Biden in recent elections.
The survey results indicated that conservative Americans, particularly those who identify as Republicans or Trump voters, express significantly less trust in their primary care doctors. These right-leaning respondents reported that they were less likely to follow the medical advice given by their primary care providers. They also reported lower levels of trust in emergency room doctors compared to left-leaning respondents.
The researchers also presented participants with a hypothetical scenario involving sudden chest pain. The right-leaning respondents indicated they would be less likely to schedule a doctor’s appointment if they experienced this alarming symptom. This suggests a broader hesitation to seek medical care for issues completely unrelated to the recent pandemic.
Additionally, the scientists looked at a subgroup of respondents who reported having chronic illnesses like high blood pressure, heart disease, or diabetes. This subgroup made up about 38 percent of the total survey sample. The researchers asked these individuals if they believed their prescribed daily medications were safe and effective using a specialized questionnaire.
The questionnaire asked participants to agree or disagree with statements like whether their lives would be impossible without their medications or if they worried about long-term side effects. Right-leaning respondents with chronic illnesses were more skeptical of their prescription medications than left-leaning individuals with similar health conditions. This political divide in the consumption of medical care may sustain or deepen the health divide that has emerged in recent decades.
“People’s political affiliation has become a strong predictor of whether people visit, trust and adhere to their doctor’s advice,” O’Brian said. “This persists even after accounting for factors that correlate with political identity and health, like rurality, income or education.”
O’Brian pointed out that this polarization in trust and engagement with the medical system came at an unfortunate time, as a health gap was already emerging between the left and right on the eve of the pandemic. “This means that those on the right, who entered the pandemic era with some of the worst health outcomes, are now reporting they are less likely to see their primary care provider, trust them, or believe medicines to treat chronic disease are safe and effective,” he added. “This has the potential to make those health outcomes worse.”
While these findings are detailed, the authors note several limitations and potential misinterpretations. The data describes observed associations rather than direct cause and effect. It is not entirely certain that a person’s political beliefs directly cause them to distrust doctors or experience worse physical health. Other unmeasured social or cultural factors could be influencing both a person’s political ideology and their healthcare behaviors at the exact same time.
The long-term medical data also focused on a specific cohort of Americans born between 1976 and 1982. “The health data are from one cohort in one period, so it’s still an open question of whether this generalizes to other cohorts or whether it will persist,” O’Brian said. “That said, ecological studies over the 2010s have found similar gaps emerging between ‘red’ and ‘blue’ areas of the country.”
Future research should aim to determine whether this partisan gap in medical trust is indeed a causal factor in declining physical health. Scientists might also look into exactly when this political divide in medical trust began to emerge. Understanding these mechanisms will be highly important for public health officials who are trying to reach populations that have grown skeptical of modern medical institutions.
“Looking at trust in doctors and health outcomes along political lines is just one way to think about engagement with healthcare, and an increasingly important one,” O’Brian noted. “But health and creating access and trust in the health system is a multi-dimensional problem and other work can and does look at other social cleavages in health and engagement.”
The study, “The political polarization of health outcomes in the USA,” was authored by Elizabeth Elder and Neil A. O’Brian.
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