Elsevier

Health & Place

Volume 16, Issue 3, May 2010, Pages 558-566
Health & Place

State political cultures and the mortality of African Americans and American Indians

https://doi.org/10.1016/j.healthplace.2010.02.002Get rights and content

Abstract

Purpose

To test the hypothesis that mortality of African Americans is responsive to political cultures of particular states in which they reside whereas mortality of American Indians is unrelated to the political culture of the state but associated instead with cultural differences and with differences in the history of contact with Europeans.

Results

African American mortality rates are significantly correlated with the scale measure of political culture but there is no such association with American Indian mortality.

Conclusions

The differing relationship of these two minority populations with the federal and state governments has shaped their mortality rates in significantly different ways.

Introduction

Mortality differences between racial and regional groups in the United States are as great as between rich and poor countries (Murray et al., 2006). Possible explanations include differences in social capital, income and income inequality, and political cultures. In this paper we consider political cultures in the 48 contiguous states, for they have been implicated in the ways in which public services, tax policies, investment in human capital, and productive activities have been shaped (e.g. Gray, 1996). Among many regional typologies, perhaps the most thoroughly investigated is Elazar’s (1972). He proposed a typology of three dominant political cultures that spread across the country from east to west: the moralistic, the individualistic, and the traditionalistic political cultures. In the moralistic political culture, society is understood to be a commonwealth, and the purpose of government is to achieve a “good community” through positive action (Elazar, 1972, p. 100). In contrast, in the individualistic political culture the political arena is considered to be a market place in which government interventions tend to be limited to those that are seen as a way to reward constituents who have put the majority party in power. Finally, in the traditionalistic political culture, the role of government is the preservation of the existing order.

These cultures derived from different immigrant groups that spread westward in roughly three streams (for a map, see Elazar, 1972, p. 117). The Moralistic political culture spread “across the northern part of the United States thrusting westward [from] an area settled initially by the Puritans of New England and their Yankee descendants.” As their descendants moved west, they were joined by settlers from Scandinavia who shared many of the same values, particularly their religious orientation including a strong emphasis on literacy, and who reinforced the basic Yankee political culture (Elazar, 1972, p. 109).

The origin of the individualistic political culture is to be found in the different non-Puritan groups, including Quakers, Scots Irish, and several German populations, that settled in the middle Atlantic colonies from New York to Maryland and spread west along the middle tier of states. This was the origin of American pluralism and the belief in individual opportunity.

The settlers who came to the southern colonies created a plantation-based economy dependent upon slave labor, made possible by agricultural conditions that did not exist elsewhere in the country. This became what Elazar called the traditionalistic culture that spread across the southern tier of states as far west as Arizona.

Elazar’s typology has struck a responsive chord among many observers of American politics (Gray, 1996, pp. 24–28), for it taps a dimension of our political life and institutions that is often ignored. It has, however, been subjected to criticism. Arguably, it reflects a situation characteristic of the United States at the end of the 1960s, and might therefore be considered dated. In addition, the concept of political ‘culture’ might be viewed as vague and inappropriate given the importance of specific policies in influencing mortality differences, and in any event the states may be irrelevant given the overwhelmingly important role of the federal government in creating and enforcing social policy.

We return to these issues in the discussion, but it is important to address them briefly at the outset. First while cultures do indeed change, change is largely shaped and constrained by pre-existing conditions. Furthermore, as we will show, various types of state government policies and activities have been consistently associated with political culture in expected ways for well over a century, and studies using census data on religious persuasion across the country confirm the consistency of the typology from the early 1900s to the 1980s (Johnson, 1976; Morgan and Watson, 1991). Moreover, a variety of studies demonstrate that (1) political participation is least in traditionalistic states and greatest in moralistic ones (Fitzpatrick and Hero, 1988; Erikson et al., 1993, pp. 172–173), and (2) moralistic political cultures have the most interventionist governments with the largest bureaucracies and the greatest likelihood of initiating new programs, followed by states with individualistic political cultures, and then by states with traditionalistic political cultures (Sharkansky, 1969). Because they are ranked along these dimensions, the three political cultures have often been treated as an interval or ordinal variable, not simply as categorical.

Second, while specific policies are indeed important, our interest is in describing the political context in which a large number of policies and programs with an impact on health may or may not flourish. The concept of political culture is one useful way to begin to describe and understand that context.

Third, state governments continue to be important even in the presence of a powerful central government. The American brand of federalism explicitly reserves to the states all matters not explicitly ceded to the federal government, and states jealously guard many of their prerogatives. Medicare and Medicaid are illustrations. Medicare, like social security, is a national program whose benefits are not influenced by state policies. Medicaid, on the other hand, involves both federal and state monies in various combinations and states thus have a good deal of influence on the level of benefits.

In this paper, we ask whether the mortality of white Americans, African Americans, and American Indians follow a gradient from lowest in moralistic states to highest in traditionalistic states. We focus on African Americans and American Indians because the history of each group has been inextricably entwined with the nation’s, and because their relationships with local and federal governments have been so different. It is our hypothesis that mortality of whites and African American is lower the more moralistic the political culture of a state, whereas we expect no association between American Indian mortality and the political culture of the state in which they reside.

The rationale is as follows. Mortality rates among white Americans have been lower in the North than in the South for more than two centuries (Haines, 2000). Because the three political cultures are distributed from traditionalistic in the South to moralistic in the North, a difference within the white population is expected. Expectations with regard to the two minority groups differ, however, for African Americans were enslaved to provide labor, and they were incorporated into the economy first as slaves and then as the most deprived members of the working class. Tribal differences that had existed in Africa were eroded by the solvent of slavery. For instance, different African languages have not persisted in the United States, nor is there evidence of tribal endogamy. As members of an agricultural and industrial working class, African Americans are subject to the policies of local and state governments in the places where they reside, as well to the federal government, as are white Americans.

For American Indians the situation was different. In contrast to African Americans, it was land and natural resources that were required. Thus if they were not annihilated, they were relegated to reservations that were of no value to whites. As a result of treaties, they have a unique relationship with the federal government entitling them to a variety of benefits, including free health care, however inadequate those may be, and to territory (reservations) where tribal governments exercise a certain degree of autonomy and where traditional cultures and languages have not altogether disappeared. This has been especially the case west of the Mississippi, where Indian populations were less thoroughly decimated than in the East.

American Indians and African Americans are concentrated in different states. In general, American Indians are found mainly in the Southwest and on the Northern Plains. They comprise 5–10% of the population in Arizona, New Mexico, Oklahoma, North and South Dakota, and Montana. In contrast, the African American population accounts for less than 5% of the population in all the states mentioned immediately above except Oklahoma, where about 8% of the population is African American.

Several states have very few members of either minority group: Maine, New Hampshire, Vermont, Minnesota, Idaho, and Utah, all places that do not have large industrial cities to which African Americans migrated in the 20th century. Outside of the South, African Americans are most likely to be in the large cities of the Northeast, Midwest, and California.

Another consequence of the different relationships of these two minority groups with the larger society is in the way they benefit from health care policies. Thus, for American Indians, the provision of health services tended to be haphazard and generally inadequate until about the middle of the 20th century when the federal government took a more active role than it had previously (Kunitz, 1996). As a result, (1) on many Indian reservations, especially in the West, health services were expanded and improved substantially and were provided by the federal government, and (2) over the following half century mortality declined dramatically and the dominant causes shifted from infectious to chronic diseases (Kunitz, 1983, Kunitz, 2008).

In contrast, African Americans have been subjected to mainstream, often discriminatory, policies, including health care policies, of the states and localities where they happened to reside. Since the start of the 20th century, mortality has declined in parallel with that of white Americans, but never has it reached equality (Kunitz and Pesis-Katz, 2005).

Because African Americans are more thoroughly incorporated into the larger population than American Indians and are not recognized as a dependent sovereign nation with treaty rights to land and services from the federal government, their health status would be expected to be more responsive to the political and economic environment of the states in which they reside than are most American Indians on reservations. In cities, where about 50% of American Indians now live, the experience of Indians may be more similar to that of African Americans, but adequate data are not available with which to explore that comparison. Attention is therefore focused on American Indians on or near reservations and African Americans across the country. This is not fatal to our argument, for we are concerned with the relative insulation from state policies afforded by living on or near reservations. The services available to reservation and nearby residents – such as free health care provided by the Indian Health Service – are not portable, and when Indians leave reservations, they enter quite a different world, though the option to return to their homes for health care is often exercised (Rhoades et al., 2005).

Section snippets

Data

Elazar’s typology defines political cultures according to the level of political participation, size of government bureaucracy, and government intervention in the community and the initiation of new programs (Sharkansky 1969, p. 69). Applying this classification, he defined over 200 sub-areas within the 48 states (averaging about 4 per state). Sharkansky (1969) assigned each sub-area a score from 1 (most moralistic) to 9 (most traditionalistic) and then created an average score for each state.

Correlates of political culture

As noted above, the more moralistic a political culture, the more interventionist and larger is the state government, and the more likely is it to initiate new programs. Table 1 displays several rank order correlations between the scale of political culture and variables that reflect public policies, socio-economic measures and the quality and accessibility of health services, all factors that are assumed to have an impact on a population’s health.

The more moralistic a state, the higher is the

Discussion

Our analyses set out to test the hypothesis that mortality of whites and African American is lower the more moralistic the political culture of a state, whereas American Indian mortality is not associated with the political culture of the state in which they reside. We find that mortality, both overall and amenable to health care, among whites and African Americans is indeed associated with the political culture of the state in which they live. It is highest in states where the dominant culture

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    Tel.: +44 20 7927 2229; fax: +44 20 7580 8183.

    2

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