Trends in U.S. Population Health: The Central Role of Policies, Politics, and Profits

Abstract

Recent trends in U.S. health have been mixed, with improvements among some groups and geographic areas alongside declines among others. Medical sociologists have contributed to the understanding of those disparate trends, although important questions remain. In this article, we review trends since the 1980s in key indicators of U.S. health and weigh evidence from the last decade on their causes. To better understand contemporary trends in health, we propose that commonly used conceptual frameworks, such as social determinants of health, should be strengthened by prominently incorporating commercial, political-economic, and legal determinants. We illustrate how these structural determinants can provide new insights into health trends, using disparate health trajectories across U.S. states as an example. We conclude with suggestions for future research: focusing on structural causes of health trends and inequalities, expanding interdisciplinary perspectives, and integrating methods better equipped to handle the complexity of causal processes driving health trends and inequalities.

Dynamic Changes in the Association Between Education and Health in the United States

“…Increasingly, researchers are turning their attention to the National Research Council report 87 to develop hypotheses and expand conceptual frameworks to better understand major trends and disparities in the association between education and health. A recent example is the work by Montez and colleagues, which highlights the importance of macro contextual influences in the form of policies, politics, and profits 69 . Although a thorough review of these conceptual advances is beyond the scope of this paper, they represent important steps in developing a more sophisticated understanding of the association between education and health.…”

“…Instead, politics are increasingly playing an outsized role in policies affecting population health, often for the worst. 69,84,85,88 Policy recommendations must take into account political context and power structures in order to make progress on reducing health inequality in the United States. Policy cannot be devoid of the context in which it operates.…”

“…65 Other studies have focused on contexts referenced by neighborhoods, 66 racialized environmental conditions such segregation, 67 and policy and institutional contexts defined by geopolitical boundaries. 7,8,68,69 Zajacova and Lawrence provide an excellent overview of the scientific terrain in these areas. 38 Very few studies, however, have examined how contextual factors may be influencing changes in the association between education and health.…”

Socioeconomic Positions and Midlife Health Trajectories in a Changing Social Context: Evidence from China, 1991–2006

“…However, it is not known whether changes in social contexts that take place in a given society also leave an imprint on people’s health trajectories over the life course. Finding answers to this question is key to better understanding trends in population health, and the answers would also provide a response to recent calls for an updated framework that would incorporate micro- and meso-level social determinants within structural forces (Montez, Hayward, and Zajacova 2021). In addition, in previous cross-national comparative studies, the countries being compared often vary in many respects.…”

Political Economy of the COVID-19 Pandemic: How State Policies Shape County-Level Disparities in COVID-19 Deaths

“…For example, U.S. states with more liberal policies have longer life expectancies than those with more conservative policies ( Montez and Farina 2021 ; Montez et al 2020 ). Moreover, because federal devolution and state preemption laws have given states more authority to make and change their own policies and laws ( Montez 2017 , 2020 ; Montez, Hayward, and Zajacova 2021 ), where people live has become more important in determining how well and how long they will live.…”