States of Life –

Where you live can add or subtract years from your life.

For example, average life expectancy in Virginia is at 79.1 years, 19th best in the nation, according to a National Vital Statistics Service report released in February. Hawaii residents have the highest average life expectancy of Americans, at 81.5 years, while residents of Mississippi are at the short end of the spectrum, at 74.6 years.

That was as of 2019, or before COVID-19.

Of course, it’s not just where you live, but how you live, and a host of factors including your health behaviors and genetics. The latter components are known as downstream factors, according to Steven H. Woolf, a professor with the Department of Family Medicine & Population Health at the VCU School of Medicine.

“The downstream factors matter a lot to our health,” he says.

So, too, do upstream factors, such as where you live, ethnicity and other social factors.

Upstream factors can “determine whether we have access to health care and whether we can adopt healthier behaviors,” he says. “That has a lot to do with the environment in which we live, the services and infrastructure that exists in our community, and our own socioeconomic status, whether we can afford to do some of those things, and what kind of neighborhood we can afford to live in, whether we have a job that offers health insurance benefits and so forth.”

Federal, state and local government decisions and policies also affect health.

These impacts have been evident in the COVID-19 pandemic. It provided real-time statistics that reflect how governmental actions affected public health, looking at comparison groups of states that adapted a public health approach to the pandemic and a second group of other states “that were more lax about it,” Woolf says.

“It was a very vivid illustration of this problem that people’s health is deeply affected by these decisions that are made,” he says.

Woolf addressed these issues and the impact of public policy on longevity in a viewpoint piece titled “The Growing Influence of State Governments on Population Health in the United States,” published in March on the Journal of the American Medical Association website.

Woolf writes that some states that enacted stricter measures in efforts to contain the novel coronavirus sustained fewer COVID-19-related fatalities than states that embraced less restrictive policies. These outlooks often reflected longstanding policy attitudes, he adds — “states that had spent decades opposing public health provisions were among the most resistant to COVID-19 guidelines and took active measures to resist restrictions.”

Data on excess deaths, fatalities incurred above what would be expected in an average year, were generally higher in those states. Woolf cites that states that had been more proactive in dealing with the pandemic had far lower excess death rates than their counterparts who were more resistant to such measures. More restrictive states include Massachusetts, which had an excess death rate of 50 per 100,000 residents, and New York, which had a rate of 112 excess deaths per 100,000 in 2021. Woolf cites higher rates in less restrictive states including Florida and Georgia, which each had more than 200 excess deaths per 100,000.

He also notes that from August to December last year, Florida sustained 29,252 excess deaths, compared with New York, a state with a similar-sized population, which reported 8,786 excess deaths.

According to the Virginia Department of Health, the commonwealth sustained 12,068 deaths over the expected mortality rate of 70,704 deaths from March 2020 to February 2021. That is 17.1% higher than expected. the COVID-19 death rate for Virginia as of March was 230 people per 100,000, according to data platform Statista. That was the 16th lowest on a list topped by Hawaii, which had a rate of 99 deaths per 100,000. Mississippi had the most deaths attributed to the novel coronavirus, at 416 deaths per 100,000 residents.

Personal behavior, such as maintaining social distance, can mitigate exposure, but that behavior can be reinforced by a business that chooses to place footprint stickers on the floor that are 6 feet apart. Businesses may also require masks for patrons, a more forceful environmental factor, which in turn can be affected further upstream by a government body that mandates, or doesn’t mandate, masks in public spaces.

“You are exerting a considerable influence on those downstream factors,” Woolf says.

The commonwealth is interesting in terms of its contrasts between Northern Virginia and the red parts of the state, Woolf says. “Attitudes about COVID and mask polices and so forth are pretty heterogeneous.”

Woolf notes that across the state at the height of pandemic surges, you’d find extensive variations in adherence to mask requirements and other containment practices, as well as differences in the extent of anger and resentment over restrictive practices and policies.

The viewpoint piece also explores how long-term policies are reflected in health outcomes. Woolf cites life expectancy rates in Oklahoma and New York as examples. Drawing from statistics from the 1990s to the present, he notes that Oklahomans had a longer life expectancy in the 1990s (75) than their New York counterparts (74.6), but now, New York residents on average (80.7) have the third-highest life expectancy in the nation. Oklahoma residents are now 46th in the nation, with an average life expectancy of 75.7.

Oklahoma basically maintained the status quo, while New York “went on quite a journey from that ranking all the way up to No. 3,” Woolf says.

Factors in play here are economic and demographic changes such as an influx of new Hispanic immigrants that influenced the increase in life expectancy in New York, but Woolf contends a large role may be attributed to public policy decisions that improved access to health care or invested in human capital. “Programs emphasizing education, jobs, economic development, addressing housing insecurity and other factors like that, the social determinants of health, are probably mainly responsible for New York’s life expectancy shooting up that dramatically,” he says.

New York is no statistical outlier, according to Woolf, who contends that states that promoted robust public policy plans in the 1990s and beyond are also generally the states with larger gains in life expectancy, while other states are languished.

“These policy decisions have consequences,” he says.

Woolf’s piece notes that the polarization of red and blue states affects overall health and safety and widens the policy divide. He cites laws and court decisions affecting abortion laws and relaxing gun regulations, contending that such measures “suggest that states will be wielding greater control over the health and safety of their populations. Increasingly, an individual’s life expectancy in the US will depend on the state in which they live.”

Woolf also notes that state governments are empowered to set policies but says, “the public should decide whether life expectancy should be part of the experiment.”


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