The American Nations and Life Expectancy

Here‘s an interesting article that notes and tries to explain some striking differences in life expectancy among otherwise very similar groups of Americans:

On paper, Lexington County, S.C., and Placer County, Calif., have a lot in common. They’re both big, wealthy, suburban counties with white supermajorities that border on their respective state’s capital cities. They both were at the vanguard of their states’ 20th century Republican advances — Lexington in the 1960s when it pivoted from the racist Dixiecrats; Placer with the Reagan Revolution in 1980 — and twice voted for Donald Trump by wide margins. But when it comes to how long their residents can count on living, the parallels fall apart. Placer has a Scandinavia-like life expectancy of 82.3 years. In Lexington, the figure is 77.7, a little worse than China’s.

Or take Maine’s far-flung Washington County, the poorest in New England where the per capita income is $27,437. The county is a hardscrabble swath of blueberry fields, forestland and fishing ports that was ravaged by the opioid epidemic and is almost completely white. It has one of the worst life expectancies in the entire Northeast: 75.5 years. But that’s more than six years better than the equally remote, forested, impoverished, white and drug-battered Perry County of eastern Kentucky.

The truth of life expectancy in America is that places with comparable profiles — similar advantages and similar problems — have widely different average life outcomes depending on what part of the country they belong to.

The underlying theory here is that there are now about nine to eleven or so distinct American nations, regionally speaking, that don’t track either state borders or census definitions of larger regions, and that the long-term cultural and political patterns in these different micro-nations explain much of the striking differences in public health to be found among them, even when one controls for such powerful variables as wealth and race/ethnicity.

We repeated the experiment using counties that fell in the worst quartile for clinical care and saw the gap grow even wider, with Greater Appalachian (74.6) and Deep Southern (74.7) life expectancy in those communities lagging Yankeedom by about 3 years and New Netherland by about five and a half. That there are fewer counties where most people can afford and access top-notch clinical care in these southern regions than the northern and Pacific coast ones isn’t really a surprise: laissez-faire political leaders tend to create systems that have looser health insurance regulations, leaner Medicaid programs and fewer public and non-profit hospitals. That those that do manage to have decent services nonetheless underperform suggests reversing these gaps won’t be easy.

Turns out even the “haves” are not doing better in the “laissez-faire” regions. One of the most arresting facts that emerged from our analysis was that the most impoverished quartile of U.S. counties in Yankeedom (ones where around 30 to 60 percent of children live in poverty) have a higher life expectancy than the least impoverished quartile of U.S. counties (where child poverty ranges from 3 to 15 percent) in the Deep South by 0.3 years. Those are both big regions (circa 50 million people each) with a wide mix of counties: rural, urban, rich, poor, blue-collar and white-collar, agricultural and industrial. If you compare the poorest category of counties in (completely urbanized) New Netherland to the richest ones in Deep South, the former has a 0.4-year advantage in life expectancy. And people in the Left Coast’s poorest quartile of counties live 2.4 years longer than those in the richest quartile counties in the Deep South.

The argument here is related to from that found in the book Dying of Whiteness. But it suggests that whites in reactionary anti-government red states are not dying of any kind of generic “white” cultural identity, but of a particular type of white identity — that found in Red America, which again doesn’t track either state or classic regional boundaries.

The larger point here is that the current fracturing of America follows very complicated geographical lines, that don’t lend themselves very readily to any sort of amicable divorce, as increasingly tempting as such a response is becoming to contemporary political and cultural polarization.