In this section of the blog I will present thoughts on recent events, or otherwise interesting data, publications and such. I will attempt at least to do so every week . . .
First, it should be recognized that opinions expressed here are my own, and do not necessarily reflect a majority view in the Department or the school.
Second, I am likely to use a fair amount of jargon or technical language - apologies in advance. When possible I will suggest other sources where the topic under discussion can be explored in further depth.
Third, I would like to have any feed-back that any reader has to offer. Well, perhaps that is a bit too expansive . . . we will suppress the scandalous and scatological. Comments should be . . .
For many of us – certainly in medicine and public health – the recent presidential election ended in disaster. Obviously it is to soon to judge the impact of the Trump presidency, but the vibes are note good. Much has been written about the potential motivation and background of the 60 million Americans who cast their vote for the “outsider”, with explanations ranging from racism to nativism to disgust with “politics as usual”. Perhaps most relevant to us in Public Health, it has been widely noted the economic hard times experienced by many middle-aged Americans, particularly those in the mid-west where good paying industrial jobs have disappeared, have been accompanied by a sharp deterioration in health. Lumped together as “diseases of despair”, the most important causes of death that have turned upward include suicide, drug overdose (often opiates) motor vehicle accidents (often associated with heavy drinking).
Together with colleagues at Johns Hopkins I explored how close the severe worsening of health indicators and the rejection of the Democratic candidate were linked. We obtained data for all the counties in the US, together with voting patterns in the last 3 presidential elections, and – sure enough – in those crucial regions of the country where swing voters determined the outcome of the election mortality in the middle-age population rose sharply.
Our manuscript describing these results is currently under review at a journal so the full text is subject to a press “embargo”, however the abstract and the main graph are presented below.
Background: Understanding the effects of widespread disruption of the social fabric on public health outcomes can provide insight into the forces that drive major political realignment. Our objective was to estimate the association between increases in mortality in middle-aged non-Hispanic white adults from 1999-2005 to 2008-2014 and the surge in support for the Republican Party in pivotal US counties.
Methods: We conducted a longitudinal ecological study in 3321 US counties from 1999 to 2016. Increases in mortality were measured using age-specific (45-54 years of age) all-cause mortality from 1999-2005 to 2008-2014 at the county level. Support for the Republican Party was measured as the party’s vote share in the presidential election in 2016 adjusted for results in 2008 and 2012.
Results: We found a significant up-turn (p<0.001) in mortality from 1999- 2005 to 2008-2014 in counties where the Democratic Party won twice (2008 and 2012) but where the Republican Party won in 2016 (+11.5/100,000), as compared to those in which the Democratic Party won in 2016 (-10.6/100,000). An increase in mortality of 14.6/100,000 was associated with a significant (p<0.001) 1% vote swing from the 2008-2012 average to 2016.
Yes, the graph is a little hard to read at first, but what it shows is that counties with a rise in mortality – falling on the right side of the zero marker on the bottom – also switched into the category of increased Republican support. These counties were all almost exclusively in the South and the Mid-west (blue and green dots . . . yes, I know the label at the bottom is hard to read, but the pattern of blue and green is readily apparent.)
What does this mean? Well certainly those regions feeling the most pain from de-industrialization were desperate for a change . . . perhaps this is the archetypal drowning man reaching for straws. The point we explore further in the paper is that public surveillance – ie, detection of this epidemic in hard-hit regions earlier – could help us formulate interventions to help people in these counties meet the overwhelming challenges they face. This is not a new idea. In the 19th century, Rudolf Virchow, one of the early public health scientists in Europe, argued that “health is but politics on a social scale” and described epidemics as “great warning signs which
the statesman is able to read.” Certainly the Democratic party missed that message altogether, by proclaiming that unemployment was down, more people had health insurance, and that the country was, on the whole, doing well. Well, lots of folks were not doing so well . . . And we will all pay for turning a blind eye to those who have been less fortunate.