Red States and Blue States and the Social Determinants of Health

I've had some fun showing correlations between ill health, and numbers of uninsured people in the various states, and the percentage of the vote that went to the moral values candidate in 2004. His own state of Texas is worst on one measure and close to worst on another.

However, correlation is not evidence of causation. Obviously, those people didn't vote for the Dear Leader because they are uninsured and have low life expectancies. (And actually, to presume that the people who voted that way are themselves uninsured and fated to die young is to commit another fallacy, called the ecological fallacy. But this is not a course in research methods so I won't get into that right now.) Instead, these facts about the states presumably go together because of other, underlying causes that aren't in our model so far.

It is well known that so-called Socio-economic Status (SES), which is some mixture of level of formal education, income, and occupational prestige, is strongly related to health status, and that access to medical care does not explain the relationship. (And in fact, providing universal access as most wealthy countries have done does not reduce it by very much.) It is true that lower SES people are more likely to use tobacco and to be obese than are higher SES people. But after you control for the readily observable behavioral factors disparities still remain. It has also been found that the disparities are related to the overall level of inequality in society, in other words societies with a lower average level of wealth, but low inequality, tend to have healthier people than do wealthier societies with high levels of inequality. Welcome to the USA, where we are less healthy than the Western Europeans and also far more unequal.

Various causal stories can be told about the correlations I have noted here. The red states tend to be poorer on average and to have lower average levels of educational attainment than do the blue states. That makes their people sicker, but it doesn't directly make them vote for a faux Texan whose main political agenda is to further impoverish them. These states also have more conservative political cultures, obviously. Does that make them have more inequality, more poverty, and lower education, or is it the other way around? What do you think?