The politics hypothesis and racial disparities in infants’ health in the United States

Abstract

We propose the politics hypothesis—i.e., the hypothesis that political forces comprise either a powerful predecessor of the social determinants of health or are essential social determinants of health themselves. We examine the hypothesis that political actors like presidents, their ideology, and institutions like the political parties they represent shape overall and race-specific health outcomes. Using census and Vital Statistics data among many other sources, we apply both theory- and data-driven statistical methods to assess the role of the president's party and the president's political ideology as predictors of overall and race-specific infant mortality in the United States, 1965–2010. We find that, net of trend, Republican presidencies and socially-conservative ideology of U.S. presidents are strongly associated with slower declines of infant mortality rates, overall and for white and black infants, compared to Democratic and socially-liberal presidents in the U.S. Approximately half (46%) of the white-black infant mortality gap, about 20,000 additional infant deaths, and most if not all the infant mortality rate gap between the U.S. and the rest of the developed world, can be attributed to the 28 years of Republican administrations during the study period. These findings are consistent with the politicization of public health and the conceptualization of politics as a powerful predecessor, in the causal chain, of the social determinants of health. Understanding the political ideological and institutional contexts in which health policies and healthcare and welfare programs are implemented, as well as how governments construct culture and social psychology, provide a more comprehensive framework for understanding and improving population patterns of disease, mortality, and entrenched racial disparities in health in the U.S.

The Political Context and Infant Health in the United States

“…The indicators of infant health we examine provide the first observable measure of individual health and well-being (Behrman and Butler 2007;Conley, Strully, and Bennett 2003;Moster, Lie, and Markestad 2008;Prinz et al 2018). Our analysis extends pioneering research on the impact of the president's party on infant mortality (Rodriguez 2019;Rodriguez, Bound, and Geronimus 2014) by examining widely prevalent adverse birth outcomes that predict health and wellbeing over the entire life course. We consider the effect of political party at the national and state levels (presidents and governors) as well as other features of the political context, extensively examining heterogeneity across race and ethnicity, and attending to the timing of effects of Democratic administrations.…”

African Americans’ Diminished Returns of Parental Education on Adolescents’ Depression and Suicide in the Adolescent Brain Cognitive Development (ABCD) Study

“…Historically, African Americans have had less political power. Thus, they have not been able to influence laws and policies [67][68][69]. In the absence of a strong political presence from minority groups, U.S. policies have enhanced the benefits of the dominant group, Whites.…”

Unequal Associations between Educational Attainment and Occupational Stress across Racial and Ethnic Groups

“…The results pointed to different types of policies that may help to reduce educational differences in work stress, in particular policies supporting those who are disadvantaged in the labor market. Overall political climate [33,34,35,36] and welfare state [37,38,39] also impact occupational stress across racial and ethnic groups.…”