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U.S. death rates show how politics are affecting public health

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Re: U.S. death rates show how politics are affecting public health

#101
post #60

A key takeaway from the study is that Americans are getting healthier. Figure 5 shows a big drop in heart disease which must be due to more exercise and better eating habits. Also: "In this national analysis, we found that Americans living in counties that voted Democratic during presidential elections from 2000 to 2016 experienced lower age adjusted mortality rates (AAMRs) than residents of counties that voted for a…

"A key takeaway from the study is that Americans are getting healthier."

Or perhaps just have better treatments?

Re: U.S. death rates show how politics are affecting public health

#102

Obesity. I grew up in a "deep red" area of the Midwest. It wasn't always like this, but it seems obesity is the norm now. And obesity has many health consequences. It's probably more cultural than political, though.

I live in the Midwest. If you drive past the suburbs, the only restaurants available are fast food burger, fried chicken and pizza chains, with a subway thrown in (I don't consider subway healthy). Obviously it's not profitable to own a healthy restaurant out there, but why? Is it a lack of healthy eating education? Is it a "harder" life and junk food is a reward? Or is it cost? If it's cost, healthy home cooked food…

Perhaps the restaurant selection reflects that most people in the region don't eat out? I too live in the general area of the "Midwest" (not really but close enough), and everybody I know cooks at home far more than they eat out, and more/better restaurants wouldn't change that behavior much since we are all poor. The problem then becomes what is cooked at home, and how much is eaten, and those aren't great. It's not for lack of available ingredients (although prices of "better" ingredients tend to play some role, like I'm not going to buy an "organic" bag of dirty carrots for 3x more than the regular dirty carrots from the same brand in the same package). In my unstudied and ignorant opinion, it comes down to a cultural thing, specifically a line of recipes and behaviors stemming from the Depression era. "Eat everything on your plate" is a common refrain, even when the plate is too big and too full. The same sort of calorie dense foods are made, but as scarcity decreased, gluttony increased, and that part simply hasn't gone back down yet.

Re: U.S. death rates show how politics are affecting public health

#103
post #89
post #27

Earlier quoted context omitted.

One party is hurting their own constituents by limiting access to healthcare at the state level. Verifying this actually has negative outcomes isn’t inherently political. Imagine if the research showed zero correlation, that would have been far more interesting. Understanding the outcomes of political choices isn’t inherently political. It’s completely reasonable for someone to say yes this saves lives but it’s still…

Really? Only thing I can think of that is (sort of) a political decision to “limit health care” is refusing to expand Medicaid. I know that didn’t happen across the board for Republican counties/states, though, so what in the world are you claiming?

That wasn’t the specific example I was thinking of, but it is illustrative of such policy decisions.

Credit where credit is due, Iowa and Hawaii actually rank very highly in terms of healthcare affordability and outcomes.

Re: U.S. death rates show how politics are affecting public health

#104
post #79

Earlier quoted context omitted.

In broad swaths of the midwest, the outside isn't especially attractive, if it's not outright ugly. Minimal elevation change anywhere in sight, little visible rock outside road cuts, very few—and all unimpressive—waterfalls, slow, muddy, gross streams and rivers. And the landscape may well be like that for hundreds of miles in any direction. Then, on top of it, the weather's miserable 9 months out of the year. Oppres…

My Finnish perspective on cold. Our seasons are not as extreme as in the Midwest, but our culture has adapted to cold winters by necessity. The winter clothes you wear when traveling from one indoor place to another are not appropriate for extended outdoor use, and the other way around. Many people need years or even decades to accept that they have to dress differently for the outdoors. Until that, they often think…

> Finnish residential areas almost always have forests with walking trails nearby. I haven't been to the Midwest, but my impression is that American urban planning doesn't like leaving large undeveloped areas everyone is free to roam near developed areas. That often leaves the residents with nowhere to go by foot.

That's the case where I am. 15 minute bike ride to reach the nearest park of any kind. There are no publicly-accessible forests within reasonable walking or biking distance (20+ minutes by car, largely on highways) and the ones that exist are few, tiny, and crowded because there's very little else around to do outside, as far as being-in-nature sorts of activities.

Most of our forests were destroyed decades ago by agriculture, and when we build housing developments we take all the plants off the land first, destroying any surviving trees and even stripping much of the topsoil (yes, seriously).

The nearest large region of sort-of-OK outdoor space we have is about 5 hours away by car. It's comparable to the worst parts of the Appalachian Mountains. You're looking at 12+ hours of driving to reach anything better than that.

Winter's definitely nicer than Summer, here. Uglier, but nicer. You can always wear more clothes. There's no beating the humidity, except to go indoors or get in water. Plus the mosquitos and ticks aren't out in Winter.

It's a little better if you own some rural land. At least you can go plink cans with a rifle or mess around on four-wheelers. Our forests have a way of developing nasty, thick, poison-and-thorn-filled underbrush that make them pretty miserable to be in if they're truly undeveloped, but if you manage to get some land with some trees on it and don't mind using some light-weight farm equipment to create and maintain some walking paths, that can be an alright time in Spring and Fall.

Re: U.S. death rates show how politics are affecting public health

#105
post #34
post #19

Earlier quoted context omitted.

Before looking for cause, you always look for plausible co-variates. Here, there are a ton: red counties tend to be rural. Rural places have huge problems with health care access, obesity, addiction, poverty, and many other issues that predict poor health outcome.

The study takes ruralness into account, shown in this graph: https://www.bmj.com/content/bmj/377/bmj-2021-069308/F4.mediu...

That doesn't "take it into account"...it just plots them, based on which presidential candidate the county voted for. And by looking at the plot, it's clear that age-adjusted mortality rates are almost perfectly aligned for rural democratic and republican areas until 2009, when they drop suddenly for the democratic areas. Then they both continue tracking in parallel. Why is that? Can't tell. Sure is suspicious. Could it be that a bunch of counties flipped in 2008?

I skimmed this paper to see if the authors did any of the facepalm-obvious things you'd do to control for covariates if you were serious about doing an observational analysis (e.g. multi-factor regression), but saw nothing. They're literally just looking at differences in slopes in the lines:

> Trends in mortality were examined to identify changes in slope using Joinpoint Regression Program version 4.8.0.1, which models consecutive linear segments on a log scale, connected by joinpoints, and can measure when slopes of annual percentage change (APC) undergo a statistically significant change

This is a...well, let's just call it non-conventional...analysis method.

Re: U.S. death rates show how politics are affecting public health

#106
post #94

Earlier quoted context omitted.

American "salads" are BS. * BS Leaf (some worthless lettuce) * Mostly filler of BS Leaf * Poor in vegetables * Poor in seeds / nuts * Frequently small or cheap protein * A 'shelf stable' dressing for flavor Yes, I've _considered_ making a salad at home, but by the time I buy ingredients I either have to eat the same for half a week in a row to try to use them up before they go bad, or just outright overpay. No, I can…

Not really true in my experience, unless you're talking about side salads at typical restaurants. At a "main salad" kind of place, you can do a lot better in terms of greens, nuts, dressing options. Look at the menus for chains like Sweetgreen or Simply Green

I haven't seen any of those near me, are they regional?

Re: U.S. death rates show how politics are affecting public health

#107
post #88

Earlier quoted context omitted.

That sounds depressing! But it's not my experience at all in the Midwest. I love the seasons. Summer can get a little hot, but there is still a lot to do around here. Winter is very fun to from cross country skiing, to fat tire biking, bonfires, and snowmobiling. I go out regularly in anything as low as -30F to -40F as long as I am dressed properly. Then we get Fall/Spring which are very special. Honestly I've been t…

> Many in our area are farmers and they are a lot tougher than your post suggests. Heh, I come very directly from extremely country stock, so I'd never disparage their hardiness. ... However, even the farmers are rocking fancy trucks and climate-controlled combines & tractors with GPS guidance, these days :-) AFAIK you still have to step out of your air conditioning to shoo loose cattle back in their pens, or mend a…

Not every agricultural operation is diversified like that. I don't have a great source, but this one is kind of ok if you flip back and forth between the maps. They have a better map that only works on desktop, and they have the raw data too.

https://www.nass.usda.gov/Publications/AgCensus/2017/Online_...

Re: U.S. death rates show how politics are affecting public health

#108

Isn't this basic demagoguery 101 -- attach huge social outcomes to the victory or loss of one political party?

I've become disturbed by this tendency the last couple of years to justify political decisions by appeal to public health. My own political leanings are complex, so I say this not from a partisan perspective.

It's very easy to specify hypothetical laws, that if enacted and enforced, would have dramatic public health benefits. A tyrrany of health, if you will. But that doesn't mean it would be ethically acceptable. Conversely, a great many military and other actions, ethically justified, are not healthy at all for its participants.

The problem with these political appeals based on public health is that physical health per se, or even health in general, is just one of many values to be weighted in decision making. I think there's been a general creep in what "health" encompasses, while being selective in other ways. I do think this is part of the reason for pushback from certain quarters, a reaction against trying to dress up politics in the disguise of science without being honest about it.

Science is always political to some extent, I think. So trying to argue that some phenomenon is a "scientific" issue, and therefore best addressed by qualified scientists seems disingenuous to me. It's not so much that expertise isn't real, it's that it has to have limits or it's meaningless.

Re: U.S. death rates show how politics are affecting public health

#109
post #5

Doesn't this just reflect the class of the average voter of the two parties, ie. measuring the different socio-economic realities? Seems a bit over the top to hitch it all on ‘political environment’. I'm no expert but it feels like these MDs should have gotten a social scientist or two to co-author.

Not really: https://www.usatoday.com/story/news/politics/onpolitics/2016... >In fact, Silver parsed the data to discover the average Trump voter makes $72,000 per year — a middle-class income solidly above the typical American. >As compared with most Americans, Trump’s voters are better off. The median household income of a Trump voter so far in the primaries is about $72,000, based on estimates derived from exit pol…

Off topic, but good grief:

>> But it’s well above the national median household income of about $56,000

That's household.

And the Fed wants LOWER wages. What is wrong with people!? Pay more!

Re: U.S. death rates show how politics are affecting public health

#110
post #94

Earlier quoted context omitted.

American palettes are screwed up. Most people wouldn't eat a meal of a simple salad, some lean protein and a multigrain carb.

American "salads" are BS. * BS Leaf (some worthless lettuce) * Mostly filler of BS Leaf * Poor in vegetables * Poor in seeds / nuts * Frequently small or cheap protein * A 'shelf stable' dressing for flavor Yes, I've _considered_ making a salad at home, but by the time I buy ingredients I either have to eat the same for half a week in a row to try to use them up before they go bad, or just outright overpay. No, I can…

At home, I keep a spinach/kale mix, dried fruit and several different nuts.

Vegetables and cheeses tend to rotate every week.

I often times do my protein on the side but that's preference.

I currently have a love affair with Kewpie's onion and garlic dressing but normally go for some olive oil and vinegar, a pinch of salt and black pepper.

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