Recent research published in nature human behavior Over the past decade, conservative Americans have shown poorer health and higher mortality rates than liberal Americans. This study provides evidence that this widening health disparity is due to demographic shifts within political coalitions and growing distrust of medical professionals among those on the right. This change in attitude toward seeking and following medical advice tends to make conservative people more vulnerable to preventable health risks.
Scientists Elizabeth Elder and Neil A. O’Brien conducted this study to better understand how political beliefs act as social determinants of health. Previous research on this topic often relied on county-level geographic data or self-reported health surveys. These older methods often yielded mixed results because self-reported health status can be subjective and county-level averages do not necessarily reflect individual behavior.
To resolve these contradictory findings, Elder and O’Brien sought to directly link individuals’ political orientation to verified medical data and death records. The researchers also wanted to understand how the relationship between political ideology and physical health has changed since the early 2010s. Health care issues have become highly politicized in recent years, and scientists are being asked to investigate whether this polarization affects real-world health outcomes.
“During the COVID-19 pandemic, we observed how people’s political identity was a strong predictor of how they interacted with public health officials and its impact on health outcomes related to COVID-19,” said O’Brien, an assistant professor of political science at the University of North Carolina at Chapel Hill. “But I began to wonder if the polarization around trust in public health officials (like Anthony Fauci) and distrust in vaccines extends beyond issues related to COVID-19 to whether people trust their doctors or whether they believe drugs to treat chronic conditions are safe and effective.”
To answer these questions, scientists analyzed data from the National Longitudinal Study of Adolescent to Adult Health. This longitudinal research project followed a nationally representative group of adolescents during the 1990s. The researchers focused on data collected during three specific time periods: 2001, 2008-2009, and 2016-2018.
This unique dataset includes both participants’ self-reported political ideology and home medical measurements taken by trained professionals. Medical data included BMI, blood pressure, cholesterol, inflammation, and blood sugar levels. The authors combined these five measurements to create a comorbidity index, a single score that indicates how many different medical conditions or health risks a person has at the same time.
The sample sizes for these survey periods were very large, with over 11,000 to 13,000 respondents providing political ideology data in each of the three waves surveyed. The researchers also checked the participants’ vital status against the National Death Index, a database maintained by the U.S. Centers for Disease Control and Prevention. By 2022, this database will allow us to see not only who has died, but also the underlying cause of death.
From 2008 to 2009, scientists found no significant differences in the physical health of liberal and conservative participants. Between the 2016 and 2018 surveys, there were notable changes in medical data. Respondents who identified as the most conservative recorded the highest comorbidity scores, indicating that they were the least healthy group.
Researchers tracked individuals who changed their political beliefs over time to see what caused this change. They found that people who were in less good health in 2008 were more likely to adopt more conservative political views by 2016. At the same time, free association gained advantages in socio-economic factors such as income and education, which tend to be associated with improved overall health.
Mortality data provided evidence of a similar timeline. In the early 2000s, liberals had similar or slightly higher death rates than conservatives. From 2020 to 2022, this pattern was completely reversed. The most conservative respondents were significantly more likely to die than the most liberal respondents.
This increase in mortality is primarily caused by internal causes such as heart disease and cancer, rather than external causes such as car accidents. The authors noted that this difference in mortality rates was not entirely due to coronavirus infection. Even when scientists excluded deaths directly caused by the virus from their calculations, conservative participants still had higher death rates.
This difference in mortality rates is significant when compared to other known health risks. “During the pandemic era (defined in the paper as 2020-22), the internal cause mortality rate between very liberal and very conservative groups was about two-thirds of the difference between people making more than $100,000 a year and people making less than $30,000 a year,” O’Brien explained. He noted that income is often considered a strong social determinant of health. “That’s a pretty substantial gap,” he said.
Elder and O’Brien conducted a second study because demographic changes and the recent pandemic cannot fully explain the widening health disparities. They wanted to test whether people on the right were simply less involved in today’s health care system. In the spring of 2024, scientists surveyed 21,751 adults living in the United States using an online panel platform.
This large survey asked participants about recent visits to their primary care provider or emergency room physician. The survey asked how much they trusted these medical professionals and whether they followed their clinical advice. The scientists measured political beliefs using self-reported ideology, party identification, and participants’ choice of Donald Trump or Joe Biden in the most recent election.
The survey results showed that conservative Americans, particularly those who identify as Republicans or Trump supporters, have significantly lower trust in their primary care physicians. These right-wing respondents reported being less likely to follow medical advice from their primary care provider. They also reported lower levels of trust in emergency room doctors than left-leaning respondents.
The researchers also presented participants with a hypothetical scenario involving sudden chest pain. Right-wing respondents said they would be less likely to schedule a doctor’s appointment if they experienced this alarming symptom. This suggests a widespread reluctance to seek medical care for issues completely unrelated to the recent pandemic.
The scientists also looked at subgroups of respondents who reported having chronic conditions such as high blood pressure, heart disease, and diabetes. This subgroup comprised approximately 38 percent of the total study sample. Researchers used a specialized questionnaire to ask these people whether they believed the drugs they were prescribed daily to be safe and effective.
In the survey, participants were asked whether they agreed or disagreed with statements such as whether they could not live without the drug or whether they were concerned about long-term side effects. Right-wing respondents with chronic conditions were more skeptical about prescription drugs than left-wing respondents with similar health conditions. This political divide in health care consumption has the potential to maintain or deepen the health disparities that have emerged in recent decades.
“People’s political affiliation is a strong predictor of whether they will seek medical attention, trust it, and follow their advice,” O’Brien said. “This trend persists even after accounting for factors related to political identity and health, such as rurality, income, and education.”
O’Brien noted that this polarization in trust and engagement with the health system came at an unfortunate time, as health disparities between left and right were already emerging on the eve of the pandemic. “This means that people on the right who entered the pandemic era with the worst health conditions now report being less likely to see their primary care provider, less likely to trust them, and less likely to believe that medications to treat chronic conditions are safe and effective,” he added. “This can worsen your health condition.”
Although these findings are described in detail, the authors point out several limitations and potential misconceptions. The data describe observed associations rather than direct cause and effect. It is not entirely certain whether a person’s political beliefs directly cause distrust of doctors or poor health. Other unmeasured social or cultural factors may be influencing both an individual’s political ideology and medical practice at exactly the same time.
Long-term health data also focused on a specific cohort of Americans born between 1976 and 1982. “The health data are from one cohort over a period of time, so whether this generalizes to other cohorts or persists is still an open question,” O’Brien said. “However, ecological studies in the 2010s found similar gaps between ‘red’ and ‘blue’ regions of the country.”
Future research should aim to determine whether this partisan gap in medical trust actually contributes to poorer physical health. Scientists may also be able to investigate exactly when this political fissure in medical trust began to emerge. Understanding these mechanisms is critical for public health officials seeking to reach populations skeptical of modern medical institutions.
“Looking at trust in doctors and health outcomes along political lines is just one way of thinking about our interactions with health care, and it’s becoming increasingly important,” O’Brien said. “However, creating access and trust in health and health systems is a multifaceted issue, and other studies can and do look at other social cleavages in health and engagement.”
The study, “Political Polarization of Health Outcomes in the United States,” was authored by Elizabeth Elder and Neil A. O’Brien.
