State political cultures and the mortality of African Americans and American Indians
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
References (52)
- et al.
Gloval variations in health: evaluating Wilkinson’s income inequality hypothesis using the World Values Survey
Social Science and Medicine
(2009) - et al.
Hospital utilization for ambulatory care sensitive contions: health outcome disparities associated with race and ethnicity
Social Science and Medicine
(2003) - et al.
Changes in cardiovascular disease risk factors among American Indians: the strong heart study
Annals of Epidemiology
(2002) Political culture, issues and the electorate: evidence from the progressive era
Western Political Quarterly
(1988)- et al.
Recent findings on preventable hospitalizations
Health Affairs
(1996) - et al.
Politics and Society in the South.
(1987) - Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999–2005....
Aiming Higher: Results from a State Scorecard on Health System Performance
(2007)- et al.
Relationship between premature mortality and socioeconomic factors in black and white populations of US metropolitan areas
Public Health Reports
(2001) The spatial pattern of black–white segregation in US metropolitan areas: An exploratory analysis
Urban Studies
(2006)
American Federalism: A View from the States
Statehouse Democracy: Public Opinion and Policy in the American States
Political culture and political characteristics of the American states: a consideration of some old and new questions
Western Political Quarterly
The socioeconomic and political context of States
The white population of the United States, 1790—1920
Metropolitan governance, residential segregation, and mortality among African Americans
American Journal of Public Health
Accuracy of race coding on American Indian death certificates, Montana 1996–1998
Public Health Reports
Regional Differences in Indian Health
Political culture in American states: Elazar’s formulation examined
American Journal of Political Science
Mortality of White Americans, African Americans, and Canadians: the causes and consequences for health of welfare state institutions and policies
Milbank Quarterly
Disease Change and the Role of Medicine: The Navajo Experience
The history and politics of health care policy for American Indians
American Journal of Public Health
The Health of Populations: General Theories and Particular Realities
Changing patterns of American Indian mortality
American Journal of Public Health
Cited by (11)
Mortality risk among a sample of sexual minority women: A focus on the role of sexual identity disclosure
2021, Social Science and MedicineCitation Excerpt :This highlights the importance of considering sociopolitical risk factors when addressing mortality risk. This concern holds true outside the realm of sexual minority research; for example, African American mortality rates have been shown to be significantly correlated with a state-level measure of political culture (Kunitz et al., 2010). Sociopolitical factors that affect mortality in SMW are likely to be both geographically-varying (e.g., by community, by state) as we see in the examples above, and time-varying.
Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study
2019, The Lancet Global HealthCitation Excerpt :For example, research in Europe shows that the adverse health effects of unemployment differ among different models of the welfare state,43 and the association between wealth and self-rated health differs in ethnic groups in the USA.44 Furthermore, the magnitude of ethnic differences in mortality in some countries, including the USA, varies with independent measures of racism45 and with measures of political culture.46 However, disentangling these relationships is extremely complicated in a multinational study because of the very different national contexts.
Associations between state-level policy liberalism, cannabis use, and cannabis use disorder from 2004 to 2012: Looking beyond medical cannabis law status
2019, International Journal of Drug PolicyCitation Excerpt :Gray (2012) developed a policy liberalism index that ranked states from ‘most liberal’ to ‘most conservative’ in 2005 and 2011 based on state-level policies such as gun control, abortion access, and tax structure. Studies have applied this more uniform comparison of policy context across states to assess the impact of policy climate on outcomes such as educational funding or mortality for racial/ethnic minorities (Kunitz, McKee, & Nolte, 2010; Tandberg, 2010). The impact that the broader policy climate has on CU outcomes, independent of MCL, remains unexplored.
Variations in amenable mortality-Trends in 16 high-income nations
2011, Health PolicyCitation Excerpt :This analysis has been at the country level only and has not disaggregated mortality by region, ethnicity or socioeconomic characteristics, so concealing potentially large variations within populations [3]. Evidence from Australia, New Zealand and the United States consistently points to higher levels of amenable mortality among, respectively, the indigenous population and African Americans compared to non-indigenous populations and white Americans [22–24]. In the US however the gap varies substantially by state [25], suggesting that observed differences cannot solely be attributed to lifestyle or biological factors.
Adoption of sun safe workplace practices by local governments
2014, Journal of Public Health Management and Practice
- 1
Tel.: +44 20 7927 2229; fax: +44 20 7580 8183.
- 2
Present address: RAND Europe, Westbrook Center, Milton Road, Cambridge CB4 1YG, United Kingdom. Tel.: +44 1223 273 853.