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

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

In an ideal world, public health would be independent of politics. Yet recent events in the U.S., such as the Supreme Court’s impending repeal of Roe v. Wade, the spike in gun violence across the country, and the stark partisan divide on the response to the Covid-19 pandemic, are putting public health on a collision course with politics. Although this may seem like a new phenomenon, American politics has been creating a deep fissure in the health of Americans over the past two decades.

I say that based on a comprehensive analysis my colleagues and I performed and published Tuesday in The BMJ. In this study, in which we linked U.S. mortality and election data from 2001 to 2019, people in counties that voted for Republican presidential candidates were more like to die prematurely than those in counties that voted for Democratic candidates, and the gap has grown sixfold over the last two decades. We found similar results when we looked only at counties that voted for one party’s candidate throughout that period, as well as when we used state election data for governors.

As death rates in Democratic counties declined 22% between 2001 to 2019, Republican counties saw on an 11% decline, with almost no improvement since 2008.

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The seed for this paper was planted a few years ago when I found myself moonlighting as a cardiologist in a rural hospital in North Carolina that had declared bankruptcy. It was the only hospital in a county of more than 150,000 people. Suddenly, the rural health crisis wasn’t just an abstract, far-away process for me but one I was in the midst of. To better understand what was going on in rural America, several colleagues and I conducted a series of analyses, published in the Journal of the American Medical Association, showing that the gap in death rates between urban and rural areas was wide — and widening. To further explore what might be causing this, I became interested in looking at political affiliation as a possible driver of this gap, given that rural counties tended to lean toward voting for Republican candidates.

Yet as the results of our latest analysis began to materialize, they surprised our entire team of seasoned health policy researchers who had seen it all.

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Regardless of whether we looked at urban or rural areas, people living in areas with Republican political preferences were more likely to die prematurely than those in areas with Democratic political preferences. There was no single cause of death driving this lethal wedge: The death rate due to all 10 of the most common causes of death has widened between Republican and Democratic areas.

Why is this gap widening? Health policy is one possibility our study points to. Based on statistical testing, the gap in mortality appeared to particularly widen after 2008, which corresponds to the passage of the Affordable Care Act in 2010, a major part of which was Medicaid expansion. Our prior work showed that Medicaid expansion led to significant gains in health insurance among at-risk individuals and was associated with widespread improvements in health outcomes, including saving lives. The effect has been particularly notable in rural areas, where Medicaid expansion has helped mitigate rural hospital closures. In our BMJ analysis, rural Republican counties have the highest death rates and have experienced the least improvement over time. Yet many Republican states have resisted Medicaid expansion, and decisions like this and a general underinvestment in public health by Republican governors might be the reason behind the growing Democratic-Republican mortality gap.

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Health behaviors are becoming increasingly enmeshed in political identity, as the pandemic has highlighted, and those could also be at play. What is perhaps most telling in our study is that while both Black and Hispanic Americans experienced largely similar gains in health regardless of what political environment they lived in, with Black residents of Democratic areas experiencing the greatest reduction in deaths rates of any major racial-ethnic group, the sharpest divide is seen among white Americans. In fact, the fourfold growth in the gap in death rates between white residents of Democratic and Republican areas seems to be driving most of the overall expanding chasm between Democratic and Republican areas.

For clinicians and researchers, the message is clear: We can no longer pretend that politics doesn’t permeate American health care and policy. While the separation of medicine and politics is aspirational, particularly in the U.S., that ship has sailed and, as our paper reveals, has been sailing for at least the last two decades. While medical journals now frequently focus on social drivers of health, our analysis highlights the need to also account for the political drivers that affect Americans’ health.

As a researcher, I often ask myself “What’s next?” after publishing a study. But I must confess to feeling a little nihilistic this time around: Will this study change minds, or will it become just another projectile in the broader partisan slugfest this country is trapped in? Odds are that most politicians and their most passionate supporters are so locked into their tribes that no amount of data will make them reconsider their positions, even if those very positions are proving to be self-destructive.

As a researcher who is primarily a clinician, however, my main motivating force is compassion and empathy for my patients, and wanting the best for them. I remain hopeful that we can still come together on a common goal of achieving healthy lives for all Americans.

Efforts to improve public health will hit a wall if they are not followed by advocacy. But advocacy shouldn’t mean finger-pointing or victim-blaming. The solution is not to further enmesh health care in politics, but to disentangle it from partisan ideologies. Efforts to reach across the aisle on areas with bipartisan support, such as improved care of chronic disease and supporting rural health care, should be accelerated while programs such as Medicaid expansion should be somehow detoxified. All of this seems almost impossible in our current political environment, but I have to believe some of these are achievable goals.

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Perhaps our findings might nudge some politicians to reconsider their policy positions. With the pandemic only likely to widen this gap, it may not be too late to reverse course and close the chasm. The most encouraging aspect of our work is that it shows that the link between health and politics is not inevitable. In fact, in 2001, there was almost no difference in death rates between Democratic and Republican areas. Rural Democratic counties, for example had higher death rates in 2001 than Republican counties, though now Republican rural counties experience much higher rates of death. The gap in death rates between Republican and Democratic counties is therefore an entirely modern phenomenon.

Whether American politicians will listen remains to be seen. Yet I am hopeful that there are people who will see in these sobering data a reason to act as the well-being of their communities crumbles.

Haider J. Warraich is a physician at the VA Boston Healthcare System and Brigham and Women’s Hospital, an assistant professor at Harvard Medical School, and the author of “The Song of Our Scars: The Untold Story of Pain” (Basic Books, April 2022). The views expressed here are his and not necessarily those of his employers.

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Here’s Google’s letter saying employees can relocate to states with abortion rights

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Here’s Google’s letter saying employees can relocate to states with abortion rights

In the wake of the Supreme Court’s decision on Friday to overturn Roe v. Wade, Google’s chief people officer Fiona Cicconi sent a staff-wide email to employees on Friday informing them of Google’s response to the ruling. Among other things, the email states that Googlers that they can “apply for relocation without justification,” and that people in charge of the relocation process “will be aware of the situation” in assessing their requests.

The Supreme Court’s ruling does not make abortion illegal throughout the US — instead, it leaves the decision up to individual states. A number of states have immediately restricted abortion rights, including Louisiana, Missouri and Kentucky. Other states, including California, where Google is headquartered, have vowed to protect abortion rights within their borders.

Here’s the letter in full:

Hi everyone,

This morning the US Supreme Court issued a ruling in Dobbs v. Jackson Women’s Health Organization that rolls back Roe v. Wade.

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This is a profound change for the country that deeply affects so many of us, especially women. Everyone will respond in their own way, whether that’s wanting space and time to process, speaking up, volunteering outside of work, not wanting to discuss it at all, or something else entirely. Please be mindful of what your co-workers may be feeling and, as always, treat each other with respect.

Equity is extraordinarily important to us as a company, and we share concerns about the impact this ruling will have on people’s health, lives, and careers. We will keep working to make information on reproductive healthcare accessible across our products and continue our work to protect user privacy.

To support Googlers and their dependents, our US benefits plan and health insurance covers out-of-state medical procedures that are not available where an employee lives and works. Googlers can also apply for relocation without justification, and those overseeing this process will be aware of the situation. If you need additional support, please connect 1:1 with a People Consultant via [link to internal tool redacted].

We will be arranging support sessions for Googlers in the US in the coming days. These will be posted to Googler News.

Please don’t hesitate to lean on your Google community in the days ahead and continue to take good care of yourselves and each other.

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The Verge has reached out to Google to clarify whether the relocation policy is new, or if it’s be changed due to the Supreme Court’s decision. We will update this story if we hear back.

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Sony studios, major game publishers offer public support for abortion rights

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Sony studios, major game publishers offer public support for abortion rights

enos lives —

Ubisoft, Activision Blizzard, and more respond to Supreme Court decision.

Kyle Orland

Just some of the game franchises represented by studios coming out in support of reproductive rights today.

Enlarge / Just some of the game franchises represented by studios coming out in support of reproductive rights today.

Last month, Insomniac Games (Spider-Man) CEO Ted Price reportedly told his employees that parent company Sony “will not approve ANY statements from any studio on the topic of reproductive rights.” That is apparently no longer true, as Insomniac and other Sony studios have tweeted statements in support of “reproductive freedom” in the wake of this morning’s Supreme Court decision overturning the longstanding Roe v. Wade precedent on the issue.

“We are human beings who make games,” Insomniac tweeted this morning. “Reproductive freedom and bodily autonomy are human rights.”

By the afternoon, many of Sony’s other North American game studios had started tweeting similar messages, including Sucker Punch (Ghost of Tsushima), Naughty Dog (The Last of Us), Santa Monica Studio (God of War), San Diego Studio (MLB: The Show), and Bend Studio (Days Gone). Some of Sony’s European studios, including Media Molecule (LittleBigPlanet), Guerilla Games (Horizon), and PlayStation London Studio, have also joined in with tweeted statements of support.

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“Naughty Dog believes reproductive freedom and bodily autonomy are basic human rights and essential to the health and wellbeing of everyone,” the studio wrote in its tweet. “We will continue to uphold these values and actively support all our employees in receiving the care they need and want.”

Travel and other support

That bit about “actively support[ing]” employees may be less important for the Santa-Monica-based Naughty Dog since California seems likely to continue protecting abortion access via legislation. For Sony studios in less abortion-friendly states, though (such as Austin, Texas-based Bluepoint Games), the parent company has yet to publicly follow the lead of Microsoft, which committed in early May to fund out-of-state travel for employees that needed it to seek abortion-related care.

Destiny-developer (and soon-to-be-Sony-subsidiary) Bungie led the game industry by offering strong public support for “reproductive choice” last month. Today, Bungie updated its public statement on the issue and outlined its own travel-reimbursement program “for any employee to use when they or a dependent cannot get access to the healthcare they need where they live. We remain undeterred in our commitment to stand up for reproductive choice and liberty.”

In a statement provided to the press, Activision Blizzard reaffirmed its plans, first announced earlier this month, to offer “expanded medical travel benefits” for issues “including reproductive health, gender-affirming treatment, transplant care, and any other medical care… that is not available in a covered person’s state, or within 100 miles of where they live.”

Other major game publishers including Ubisoft, Bethesda, Niantic Labs, and Devolver Digital have tweeted out statements in support of reproductive rights today. And the International Game Developers Association told Ars in a statement that “we believe bodily autonomy and choice over one’s own reproductive and healthcare matters” are crucial to the organization’s mission. “One must be in control of their own health matters in order to successfully manage their career and life.”

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Earlier this month (and amid reported pressure from employees) Electronic Arts tweeted a Pride Month statement that included the phrase “Women’s Rights are Human Rights.”

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Mars probe running Windows 98 receives software update after two decades

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Mars probe running Windows 98 receives software update after two decades

Windows 98



(Image credit: Future)

Patch management for the latest versions of Windows might the concern of most of us located here on Earth, but meanwhile, the European Space Agency’s (ESA) Mars Express spacecraft has received the first update to its Window 98-based system in 19 years.

The mission was first launched to discover of signs of liquid water on Mars, including a suspected 20x30km lake of salty water buried under 1.5 km of ice in the red planet’s southern polar region.

The updates were conducted by engineers from the Istituto Nazionale di Astrofisica (INAF), Italy, and were fully funded by the Italian Space Agency (ASI).

What does this mean?

The agency said the upgrade will enable the spacecraft to view Mars and its moon Phobos with better levels of detail.

The Mars Advanced Radar for Subsurface and Ionospheric Sounding (MARSIS) instrument on Mars Express sends low-frequency radio waves down towards the planet using its 40-metre long antenna.

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Most of these waves are reflected from the planet’s surface, but significant amounts travel through the crust and are reflected at boundaries between layers of different materials below the surface, including ice, soil, rock, and water.

By examining the reflected signals, scientists can map the structure below the surface of Mars to a depth of a few kilometres and study properties such as the thickness and composition of its polar ice caps and the properties of volcanic and sedimentary rock layers.

The space agency didn’t go into a great deal of detail regarding the specs of the hardware receiving the update, however Tom’s Hardware speculated it could have a Pentium 90 processor, meaning it could potentially run classic games such as Doom as well as explore the secrets of Mars.

“Previously, to study the most important features on Mars, and to study its moon Phobos at all, we relied on a complex technique that stored a lot of high-resolution data and filled up the instrument’s on-board memory very quickly,” said Andrea Cicchetti, the MARSIS deputy principal investigator and operation manager at INAF.

He added: “By discarding data that we don’t need, the new software allows us to switch MARSIS on for five times as long and explore a much larger area with each pass.”

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Will McCurdy has been writing about technology for over five years. He has a wide range of specialities including cybersecurity, fintech, cryptocurrency, blockchain, artificial intelligence, cloud computing, payments, retail technology, and venture capital investment. He has previously written for FStech, Retail Systems, and National Technology News and is an experienced podcast and webinar host, as well as an avid long form feature writer.

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