The Political Realignment of Health: How Partisan Power Shaped Infant Health in the United States, 1915–2017

Abstract

The U.S. two-party system was transformed in the 1960s, when the Democratic Party abandoned its Jim Crow protectionism to incorporate the policy agenda fostered by the Civil Rights Movement and the Republican Party redirected its platform toward socioeconomic and racial conservatism. We argue that the policy agendas that the parties promote through presidents and state legislatures codify a racially patterned access to resources and power detrimental to the health of all. To test the hypothesis that fluctuations in overall and race-specific infant mortality rates (IMR) shift between the parties in power before and after the Political Realignment, we apply panel data analysis methods to state-level data from the National Center for Health Statistics, 1915–2017. Net of trend, overall, and race-specific infant mortality rates were not statistically different between presidential parties before the Political Realignment. This pattern, however, changed after the Political Realignment, with Republican administrations consistently underperforming Democratic ones. Net of trend, non-Southern state legislatures controlled by Republicans underperform Democratic ones in overall and racial IMRs in both periods.

Political Ideology Direction of Policy Agendas and Maternal Mortality Outcomes in the U.S., 1915–2007

“…Salient examples are the establishment of Social Security under Franklin D. Roosevelt and the series of policy and legislative reforms of the Great Society and the War on Poverty under Lindon B. Johnson—all of which continue to affect the health of all, today. The largest and most influential public health-specific programs—e.g., Medicaid, Medicare, CHIP—and reforms to them—e.g., the Affordable Care Act—have been introduced by presidents as well (Forgotson, 1967 ; Rodríguez et al, 2022 ), and have shown to deliver differential effects by race and other minority statuses (Ye & Rodriguez, 2021 ). There is also evidence that presidents and political processes explicit to the presidency—e.g., macroeconomic fluctuations during general elections—affect critical social determinants of health like unemployment, inflation, and income inequality (Bartels, 2016 ).…”

“…Progressive ideological movements across the globe tend to be associated with the enhancement of welfare regimes that in turn produce better health outcomes (Eikemo et al, 2008 ). In the U.S. context, evidence shows that, net of history, Republican presidential administrations—characterized by implementing more conservative policies especially after the 1960s—underperform Democratic ones in decreasing infant mortality rates, overall and by race (Rodríguez et al, 2022 ; Rodriguez et al, 2014a , 2014b ). This pattern is also detected at the subnational level, with less conservative U.S. states manifesting better life expectancies and lower infant mortality rates than more conservative ones (Montez, 2020 ; Rodriguez et al, 2022 ).…”

“…By abandoning its support for the Jim Crow system and by incorporating the Civil Rights Movement’s agenda, the Democratic Party contrasted the Republican Party which turned toward socioeconomic and racial conservatism. This dramatic transformation in the 1960s was crucial for population health, including infant mortality rates (IMR), which are related to maternal mortality (Forgotson, 1967 ; Rodríguez et al, 2022 ). In analyzing data after the PR, Rodriguez and colleagues show that, net of trend, IMR fluctuations follow the back-and-forth of presidential party regimes since 1965 (Rodriguez, 2019 ; Rodriguez et al, 2014a , 2014b ; Rodriguez et al, 2022 ).…”

Racism and Health: Three Core Principles

“…There is an important and growing corpus of research focused on the politics of health and health policy 18,101,104,107–114 . Still, a comparatively small subset of work directly attends to power 107,109,115,116 .…”

“…There is an important and growing corpus of research focused on the politics of health and health policy. 18,101,104,[107][108][109][110][111][112][113][114] Still, a comparatively small subset of work directly attends to power. 107,109,115,116 Research on racism and health equity stands to benefit from more consistently and thoroughly incorporating analyses of power.…”