Analysis of trends in premature mortality by Labour voting in the 1997 general election

Relationship of public health with continued shifting of party voting in the United States

BACKGROUND

In the U.S. presidential election of 2016, communities with poorer public health shifted votes to the Republican party. Whether this trend has persisted beyond 2016 is unclear.

METHODS

We created a county-level measure of public health (the "unhealthy" component) by performing principal component analysis on 9 health statistics. We then estimated shifting of votes by defining "net vote shift" as the percentage of Republican votes in the 2018 U.S. House of Representatives election minus the percentage of Republican votes in the same election in 2016. Finally, we performed linear regression to assess the independent, county-level association of the unhealthy component with net vote shift after adjusting for county-level demographic factors.

RESULTS

The mean county-level net vote shift was -6.4 percentage points (SD 12.6 percentage points), consistent with a mean net vote shift toward the Democratic party. After adjustment for demographic covariates, the unhealthy score was associated with higher net vote shift (17.7 percentage points shift toward Republican per unit unhealthy, p = .0323).

CONCLUSIONS

In the 2018 congressional elections, despite an overall shift toward the Democratic Party there is evidence of ongoing shifting of community voting in unhealthy communities toward the Republican party.

Life expectancy and inequalities therein by income from 2016 to 2018 across the 253 electoral constituencies of the National Assembly of the Republic of Korea

OBJECTIVE

We calculated life expectancy and inequalities therein by income for the period of 2016-2018 across the 253 electoral constituencies of the 20th National Assembly election in Korea.

METHODS

We obtained population and death data between 2016 and 2018 from the National Health Information Database and constructed abridged life tables using standard life table procedures according to sex and income quintiles for the electoral constituencies of the 20th National Assembly election held in 2016.

RESULTS

Life expectancy across the 253 constituencies ranged from 80.51 to 87.05 years, corresponding to a gap of 6.54 years. The life expectancy difference by income across the 253 constituencies ranged from 2.94 years to 10.67 years. In each province, the difference in life expectancy by income across electoral constituencies was generally greater than the inter-constituency differences. Constituencies in capital and metropolitan areas showed a higher life expectancy and a lower life expectancy difference by income than constituencies in rural areas.

CONCLUSIONS

Pro-rich inequalities in life expectancy by income existed in every electoral constituency in Korea. Both intra-constituency and inter-constituency socioeconomic inequalities in health should be highlighted in future policy-making in the National Assembly.

Political parties and mortality: The role of social status and personal responsibility

Previous research findings across a variety of nations show that affiliation with the conservative party is associated with greater longevity; however, it is thus far unclear what characteristics contribute to this relationship. We examine the political party/mortality relationship in the United States context. The goal of this paper is two-fold: first, we seek to replicate the mortality difference between Republicans and Democrats in two samples, controlling for demographic confounders. Second, we attempt to isolate and test two potential contributors to the relationship between political party affiliation and mortality: (1) socioeconomic status and (2) dispositional traits reflecting a personal responsibility ethos, as described by the Republican party. Graduate and sibling cohorts from the Wisconsin Longitudinal Study were used to estimate mortality risk from 2004 to 2014. In separate Cox proportional hazards models controlling for age and sex, we adjusted first for markers of socioeconomic status (such as wealth and education), then for dispositional traits (such as conscientiousness and active coping), and finally for both socioeconomic status and dispositional traits together. Clogg's method was used to test the statistical significance of attenuation in hazard ratios for each model. In both cohorts, Republicans exhibited lower mortality risk compared to Democrats (Hazard Ratios = 0.79 and 0.73 in graduate and sibling cohorts, respectively [p < 0.05]). This relationship was explained, in part, by socioeconomic status and traits reflecting personal responsibility. Together, socioeconomic factors and dispositional traits account for about 52% (graduates) and 44% (siblings) of Republicans' survival advantage. This study suggests that mortality differences between political parties in the US may be linked to structural and individual determinants of health. These findings highlight the need for better understanding of political party divides in mortality rates.

Are political views related to smoking and support for tobacco control policies? A survey across 28 European countries

BACKGROUND

General political views are rarely considered when discussing public support for tobacco control policies and tobacco use. The aim of this study was to explore potential associations between political views, smoking and support for tobacco control policies.

METHODS

We analysed responses from 22,313 individuals aged ≥15 years from 28 European Union (EU) member states, who self-reported their political views (far-left [1-2 on a scale 1-10]; centre-left (3-4); centre (5-6); centre-right (7-8); and far-right (9-10) in wave 82.4 of the Eurobarometer survey in 2014. We ran multi-level logistic regression models to explore associations between political views and smoking, as well as support for tobacco control policies, adjusting for socio-demographic factors.

RESULTS

Compared to those placing themselves at the political centre, people with far-left political views were more likely to be current smokers (Odds Ratio [OR] = 1.13; 95% Confidence Interval [CI]: 1.01-1.26), while those in the centre-right were the least likely to smoke (OR = 0.84; 95% CI: 0.76-0.93). Similar associations were found for having ever been a smoker. Respondents on the left side of the political spectrum were more likely to support tobacco control policies and those on the centre-right were less likely to support them, as compared to those at the political centre, after controlling for smoking status.

CONCLUSIONS

General political views may be associated not only with support for tobacco control policies, but even with smoking behaviours, which should be taken into account when discussing these issues at a population level. Further research is needed to explore the implications of these findings.

County community health associations of net voting shift in the 2016 U.S. presidential election

Importance

In the U.S. presidential election of 2016, substantial shift in voting patterns occurred relative to previous elections. Although this shift has been associated with both education and race, the extent to which this shift was related to public health status is unclear.

Objective

To determine the extent to which county community health was associated with changes in voting between the presidential elections of 2016 and 2012.

Design

Ecological study with principal component analysis (PCA) using principal axis method to extract the components, then generalized linear regression.

Setting

General community.

Participants

All counties in the United States.

Exposures

Physically unhealthy days, mentally unhealthy days, percent food insecure, teen birth rate, primary care physician visit rate, age-adjusted mortality rate, violent crime rate, average health care costs, percent diabetic, and percent overweight or obese.

Main outcome

The percentage of Donald Trump votes in 2016 minus percentage of Mitt Romney votes in 2012 (“net voting shift”).

Results

Complete public health data was available for 3,009 counties which were included in the analysis. The mean net voting shift was 5.4% (+/- 5.8%). Of these 3,009 counties, 2,641 (87.8%) had positive net voting shift (shifted towards Trump) and 368 counties (12.2%) had negative net voting shift (shifted away from Trump). The first principal component (“unhealthy score”) accounted for 68% of the total variance in the data. The unhealthy score included all health variables except primary care physician rate, violent crime rate, and health care costs. The mean unhealthy score for counties was 0.39 (SD 0.16). Higher normalized unhealthy score was associated with positive net voting shift (22.1% shift per unit unhealthy, p < 0.0001). This association was stronger in states that switched Electoral College votes from 2012 to 2016 than in other states (5.9% per unit unhealthy, p <0.0001).

Conclusions and relevance

Substantial association exists between a shift toward voting for Donald Trump in 2016 relative to Mitt Romney in 2012 and measures of poor public health. Although these results do not demonstrate causality, these results suggest a possible role for health status in political choices.

State political ideology, policies and health behaviors: The case of tobacco

Anti-smoking campaigns are widely viewed as a success case in public health policy. However, smoking rates continue to vary widely across U.S. states and the success of anti-smoking campaigns is contingent upon states' adoption of anti-smoking policies. Though state anti-smoking policy is a product of a political process, studies of the effect of policies on smoking prevalence have largely ignored how politics shapes policy adoption, which, in turn, impact state health outcomes. Policies may also have different effects in different political contexts. This study tests how state politics affects smoking prevalence both through the policies that states adopt (with policies playing a mediating role on health outcomes) or as an effect modifier of behavior (tobacco control policies may work differently in states in which the public is more or less receptive to them). The study uses publicly available data to construct a time-series cross-section dataset of state smoking prevalence, state political context, cigarette excise taxes, indoor smoking policies, and demographic characteristics from 1995 to 2013. Political ideology is measured using a validated indicator of the ideology of state legislatures and of the citizens of a state. We assess the relationship between state political context and state smoking prevalence rates adjusting for demographic characteristics and accounting for the mediating/moderating role of state policies with time and state fixed effects. We find that more liberal state ideology predicts lower adult smoking rates, but that the relationship between state ideology and adult smoking prevalence is only partly explained by state anti-smoking policies.

Regional Differences in Trends in Life Expectancy and the Influence of the Political and Socioeconomic Contexts in Germany

The aim of the study is to investigate to what extent trends in life expectancy are influenced by political variables and socioeconomic characteristics that play a role at the regional level of the federal states in Germany. Data on life expectancy in males and females at birth are analyzed from 1986 to 1998 for 12 federal states in Eastern and Western Germany. These states are classified into five types of political government since 1980: (1) long-term Christian democratic, (2) long-term social democratic, (3) change from Christian to social democratic, (4) change from communist to social democratic, and (5) change from communist to Christian democratic. The study showed three main results. First, life expectancy has been directly influenced by the major political forces that determined policies in East and West Germany. Second, life expectancy was higher in federal states with predominantly Christian democratic governments than in those with predominantly social democratic governments. Third, life expectancy was strongly related to the economic power of the federal states. Because federal states characterized by a more prosperous economic situation were those with a predominantly Christian democratic government, while federal states with a less prosperous situation were mostly governed by social democrats, it is difficult to disentangle the effects of economic and political factors on life expectancy. Nevertheless, this study underlines the importance of politics and policies on such robust and more general health indicators as mean life expectancy at birth.

Political party affiliation, political ideology and mortality

BACKGROUND

Ecological and cross-sectional studies have indicated that conservative political ideology is associated with better health. Longitudinal analyses of mortality are needed because subjective assessments of ideology may confound subjective assessments of health, particularly in cross-sectional analyses.

METHODS

Data were derived from the 2008 General Social Survey-National Death Index data set. Cox proportional analysis models were used to determine whether political party affiliation or political ideology was associated with time to death. Also, we attempted to identify whether self-reported happiness and self-rated health acted as mediators between political beliefs and time to death.

RESULTS

In this analysis of 32,830 participants and a total follow-up time of 498,845 person-years, we find that political party affiliation and political ideology are associated with mortality. However, with the exception of independents (adjusted HR (AHR)=0.93, 95% CI 0.90 to 0.97), political party differences are explained by the participants' underlying sociodemographic characteristics. With respect to ideology, conservatives (AHR=1.06, 95% CI 1.01 to 1.12) and moderates (AHR=1.06, 95% CI 1.01 to 1.11) are at greater risk for mortality during follow-up than liberals.

CONCLUSIONS

Political party affiliation and political ideology appear to be different predictors of mortality.

In sickness and in health

In search of a better understanding of inequalities in citizen political engagement, scholars have begun addressing the relationship between personal health and patterns of political behavior. This study focuses on the impact of personal health on various forms of political participation. The analysis contributes to existing knowledge by examining a number of different participation forms beyond just voting. Using European Social Survey data from 2012/2013 for Denmark, Finland, Iceland, Norway and Sweden (N = 8,060), self-reported turnout and six alternative modes of political engagement were modeled as dependent variables. Contrary to expectations, poor health did not depress participation across all forms. As assumed by the increased activism hypothesis, all else equal, people with poor health were more active than their healthy counterparts in direct contacts with power holders and demonstrations. The results reveal a "reversed health gap" by showing that people with health problems are in fact more politically active than what previous research, which has focused on voting, has suggested. Although the magnitude of the gap should not be overdramatized, our results stress the importance of distinguishing between different forms of participation when analyzing the impact of health on political engagement. Nevertheless, the findings show that poor health can stimulate people into political engagement rather than depressing activity. This finding holds when the effects of several sociodemographic and motivational factors are controlled for.

Association between political ideology and health in Europe

Studies have largely examined the association between political ideology and health at the aggregate/ecological level. Using individual-level data from 29 European countries, we investigated whether self-reports of political ideology and health are associated. In adjusted models, we found an inverse association between political ideology and self-rated poor health; for a unit increase in the political ideology scale (towards right) the odds ratio (OR) for reporting poor health decreased (OR 0.95, 95% confidence interval 0.94-0.96). Although political ideology per se is unlikely to have a causal link to health, it could be a marker for health-promoting latent attitudes, values and beliefs.

The contribution of migration to changes in the distribution of health over time: five-year follow-up study in Northern Ireland

A number of recent studies have highlighted the potential contribution of migration to increasing inequalities in health between areas with different levels of deprivation. Some of these studies have reported that increasing inequalities between areas can, at least partly, be explained by selective migration. Both mortality and morbidity have been used as indicators of health status, but many of the studies focusing on morbidity have suffered from specific methodological problems, including the use of self-reported health measured after migration had occurred, thereby ignoring the possible effect that migration itself may have on health and the reporting of health. This study used general practice records assessed prior to movement, an arguably more objective measure of health status, from 40 general practices, to determine whether selective migration influenced the distribution of health in Northern Ireland between the years 2000 and 2005. Evidence of selective migration was found in the study, with migrants often having significantly different levels of health to non-migrants. However, overall migration within this cohort did not substantially alter the distribution of health through time, partly because the migrants out of the deprived and affluent areas were replaced by in-migrants with similar levels of health. The absence of an effect of migration in this instance should not be used, however, to conclude that migration effects are unimportant in assessing changes in inequalities through time. Rather, migration should be viewed in the context of the underlying population dynamics, which at the time of this study were characterised by a process of urban regeneration. Varying population movements, operating at different times and locations, require that the effects of migration be considered in all studies which examine changes in the spatial distribution of health.

Increasing inequalities in health: Is it an artefact caused by the selective movement of people?

Changes in health socio-economic inequalities are currently measured by comparing the mortality gradient across aggregates of small administrative areas at two points in time. However, this methodology may be flawed as it ignores population movement, which previous research has shown to be selective, with a net loss of the more affluent (and possibly healthier) residents from deprived to more affluent areas. This paper investigates whether selective migration contributed sufficiently to the observed socio-economic gradients in mortality in England and Wales throughout the 1990s so as to invalidate the current method of monitoring health inequalities. The ONS Longitudinal Study for England and Wales was used to calculate directly standardised mortality rates (DSR) by decile of deprivation in 1991 and 2001. The DSRs for 2001 were calculated twice, once according to decile of residence in 2001, and also according to the original decile in 1991. Selective migration was found to make an important contribution in explaining increases in inequalities between areas, accounting for about 50% of the increase for those aged less than 75. At the older age groups, however, selective migration was responsible for a narrowing of mortality differentials over time. These results indicate that caution should be exercised when using repeated ecological studies in assessing the extent of changes in inequalities over time.

Neighbourhood environment and its association with self rated health: evidence from Scotland and England

OBJECTIVES

To investigate associations between measures of neighbourhood social and material environment and self rated health.

DESIGN

New contextual measures added to cross sectional study of a sample of people from the Health Survey for England and the Scottish Health Survey to provide multilevel data.

PARTICIPANTS

13,899 men and women aged 16 or over for whom data on self rated health were available from the Health Survey for England (years 1994-99) and the Scottish Health Survey (years 1995 and 1998).

RESULTS

Fair to very bad self rated health was significantly associated with six neighbourhood attributes: poor physical quality residential environment, left wing political climate, low political engagement, high unemployment, lower access to private transport, and lower transport wealth. Associations were independent of sex, age, social class, and economic activity. Odds ratios were larger for non-employed residents than for employed residents. Self rated health was not significantly associated with five other neighbourhood measures: public recreation facilities, crime, health service provision, access to food shops, or access to banks and buildings societies.

CONCLUSIONS

Some, but not all, features of the neighbourhood environment are associated with self rated health and may be indicators of important causal pathways that could provide a focus for public health intervention strategies. Associations were more pronounced for non-employed residents, perhaps because of greater exposure to the local environment compared with employed people. Operationalizing specific measures of the characteristics of local areas hypothesised to be important for living a healthy life provides a more focused approach than general measures of deprivation in the search for area effects.

Do social policies and political context matter for health in the United Kingdom?

This U.K. case study combines lessons from historical assessments with new empirical analyses of trends over the last decade to inform an appraisal of the impact of social actions on health. The empirical analyses examine life expectancy in the 354 local government councils in England by first identifying those that have better or worse health than expected fromtheir socioeconomic profile, and then selecting paired sets of "overachievers" and "underachievers" for more in-depth analysis. The findings taken as a whole provide evidence that social policies and political context do indeed matter for health. The historical material from the first industrial revolution, in particular, provides some of the most compelling evidence for this proposition. The empirical analyses over the last decade found a very powerful inverse association: the more deprived the local council, the lower the life expectancy of the population within that locality. However, even for the same level of deprivation and socioeconomic characteristics, some councils were doing much better than others in terms of health: for example, more than three years difference in life expectancy for carefully matched "urban fringe" councils. The article then examines the councils' political makeup and hence their likely policy perspective.

Selective migration from deprived areas in Northern Ireland and the spatial distribution of inequalities: implications for monitoring health and inequalities in health

Much of the evidence suggesting that inequalities in health have been increasing over the last two decades has come from studies that compared the changes in relative health status of areas over time. Such studies ignore the movement of people between areas. This paper examines the population movement between small areas in Northern Ireland in the year prior to the 1991 census as well as the geographical distribution of migrants to Northern Ireland over the same period. It shows that deprived areas tended to become depopulated and that those who left these areas were the more affluent residents. While immigrants differed a little from the indigenous population, the overall effect of their distribution would be to maintain the geographical socio-economic status quo. The selective movement of people between areas would result in the distribution of health and ill-health becoming more polarized, i.e. produce a picture of widening inequalities between areas even though the distribution between individuals is unchanged. These processes suggest potential significant problems with the area-based approaches to monitoring health and inequalities in health.