Health outcomes in the United States are increasingly dependent on decisions being made at the state level, according to a viewpoint piece published this month in the Journal of the American Medical Association.
The paper cites disparities in health across the 50 states are growing, a trend that began in the 1990s. He uses the recent example of COVID-19 to illustrate differences in outcomes in Florida and New York.
Excess deaths from COVID-19 provide a sharp example of this trend that particularly showed up in Florida, according to the author, Dr. Steven Woolf, population health chair and director of health equity with the Center on Society and Health at Virginia Commonwealth University.
“During the fall 2021 delta surge, the state of Florida had three times as many excess deaths as the state of New York," says Woolf, a family physician. "Some of that can be blamed on viral epidemiology and so forth. But it’s likely that a big factor explaining that difference is the different policy approach that Florida took compared to a state like New York.”
The states have roughly the same population, Woolf adds.
In other countries, a national response generated a better outcome.
“If you look at how the United States did with COVID, compared to other countries, you find that we not only experienced more deaths than other countries, but even after adjusting for population size, our rate of deaths was among the highest in the world," Woolf says. "And when you look at other countries that did much better than the United States, you find that they mounted a national response to the pandemic.”
Policies that would reduce viral transmission, such as masking, social distancing, and avoiding big crowds, became politicized, he cites.
“There was early in the pandemic an unfortunate framing that came out of a conflict between what doctors want and what’s good for the economy," Woolf says. "And what the data show us — and certainly that was the experience of many communities across the country — is that the two were tied hand in hand. So places that were not as aggressive in dealing with the virus ended up with longer surges and more disruption to their economy than states that acted more forcefully at the beginning and were able to get community spread under control.”
The trend is not limited to COVID, Woolf adds, as legislatures across the country pass laws that have a direct effect on health and longevity.
“In state capitals across the country, a lot of laws are being passed at quite a pace that will affect many aspects of our lives, like voting rights and abortion and so forth, also will have increasing health implications. So this is not just a curious observation about COVID," says Woolf. "It’s about the future of our health. That decisions being made by governors and state legislatures are going to affect how long people can live. That’s always been true, but it’s getting increasingly true as time goes on.”
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