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State policies and their impact on public health were thrust into the spotlight at the onset of the COVID-19 pandemic in 2020. But a new study sheds light on how they have been intertwined for much longer. Researchers found that more conservative state policies were generally associated with higher mortality of working-age adults – a rate that has been growing for decades in the United States.

“The rise has been particularly alarming over the last decade. And it’s a major reason why overall life expectancy in the US stopped increasing around 2010 and started to decline around 2014,” said co-author Jennifer Karas Montez, director of the Center for Aging and Policy Studies at ���ϲ�����. “While some states have invested in their populations’ wellbeing – for example, raising the minimum wage, implementing an EITC, expanding Medicaid, enacting clean indoor air laws – other states have either not invested or even divested. It’s this latter group of states where the lives of working-age adults are being cut particularly short.”

The decisions being made in state houses increasingly having life and death consequences for working-age Americans.

Jennifer Karas Montez

The researchers, including Jennifer Karas Montez, Nader Mehri, and Shannon Monnat of ���ϲ�����, analyzed data from 1999-2019. They combined mortality information from the National Vital Statistics System and state-level data on policy domains including gun safety, the environment, labor, and tobacco. Their study found that more liberal policies in most domains were associated with lower mortality, including some connections that were particularly notable.

“For example, more firearm safety policies are strongly connected to men’s suicide risk, with more liberal policies predicting smaller suicide risk,” Montez said. “Also interesting, we found that labor policies are strongly connected to alcohol-induced causes of death and suicide deaths for men.”

Researchers did find one domain where more conservative policies were associated with lower mortality. Conservative marijuana policies were associated with lower working-age mortality from suicide and alcohol-induced causes. But researchers caution that while the link between policies and mortality rates is straightforward in some cases, like tobacco use, others like labor are more complex.

“Labor policies like raising the minimum wage and mandating paid leave can help prevent economic hardship, allow workers to take time off when they are sick or need to care for loved ones without fear of losing their jobs or income, reduce stress, and prevent stress-related coping behaviors such as smoking and heavy alcohol consumption,” Montez said.

Researchers say their simulations estimate that changing to more liberal policies in the eight domains across all states might have saved more than 170,000 lives in 2019. The study concludes that fixing the high and rising mortality among working-age adults requires lawmakers to pay close attention to the policies they enact.

“The decisions being made in state houses increasingly having life and death consequences for working-age Americans,” Montez said. “Much of the narrative about the rising death rates of working-age Americans has pointed to opioid manufacturers and businesses leaving certain parts of the country. Our analyses points to another major player, and that’s state policymakers.”

The full study is published online by .

is a sociology professor at ���ϲ����� and director of the Center for Aging and Policy Studies.

is a postdoctoral fellow at ���ϲ�����’s Aging Studies Institute.

is a sociology professor at ���ϲ����� and the Lerner Chair for Public Health Promotion and Population Health.