U.S. State Policy Contexts and Physical Health among Midlife Adults

Abstract

The authors examine how state policy contexts may have contributed to unfavorable adult health in recent decades, using merged individual-level data from the 1993–2016 Behavioral Risk Factor Surveillance System ( n = 2,166,835) and 15 state-level policy domains measured annually on a conservative-to-liberal continuum. The authors examine associations between policy domains and health among adults 45 to 64 years old and assess how much of the associations are accounted for by adults’ socioeconomic, behavioral and lifestyle, and family factors. A more liberal version of the civil rights domain was associated with better health. It was disproportionately important for less educated adults and women, and its association with adult health was partly accounted for by educational attainment, employment, and income. Environment, gun safety, and marijuana policy domains were, to a lesser degree, predictors of health in some model specifications. In sum, health improvements require a greater focus on macro-level factors that shape the conditions in which people live.

Anticipatory stress, state policy contexts, and mental health during the COVID-19 pandemic

“…In fact, prior studies using the Household Pulse Survey data have found that respondents had greater levels of educational attainment and were less racially diverse than the U.S. population ( Donnelly & Farina, 2021 ). This selection effect may lead to more conservative estimates in the present study, as disadvantaged adults are more likely to experience economic hardship and to benefit from social policies ( Kemp et al, 2022 ; Montez, 2017 , 2020 ). Lastly, other factors may also be co-occurring during this unique historical period that should be considered.…”

Income Inequality and Population Health: Examining the Role of Social Policy

“…These measures, shown in Table 1, contained 135 policies spanning 16 domains: abortion, campaign finance, civil rights and liberties, criminal justice, education, environment, gun control, health and welfare, housing and transportation, immigration, private sector labor, public sector labor, LGBT rights, marijuana, taxes, and voting. Evidence on how these policy domains are plausibly linked to life expectancy are described elsewhere (Kemp, Grumbach, and Montez 2022). For each state, the data contained a score for each domain annually from 2000 through 2014.…”

The Future of Social Determinants of Health: Looking Upstream to Structural Drivers

“…66 Future research should address these gaps by examining how policy contexts across multiple domains combine to shape health, as well as the specific pathways through which policy contexts become embodied, and how these processes may be shaped by one's social location. 62,65 We also need a better understanding of how cultural and ideological aspects of structural oppression affect population health. Several studies have shown that living in areas with elevated levels of racist actions, sentiments, and ideologies is associated with worse health among minoritized populations.…”

“…Although this emerging field has provided valuable insights, important gaps in our knowledge remain 66 . Future research should address these gaps by examining how policy contexts across multiple domains combine to shape health, as well as the specific pathways through which policy contexts become embodied, and how these processes may be shaped by one's social location 62,65 …”