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Are Southern States Less Free Due to Lack of Public Health Policy?

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Robyn McCullough
October 24, 2021

The unfortunate reality is that those living in the Southern States should expect to live a shorter life than the rest of the United States. It seems unfair that zip code can be a bigger indicator of life expectancy than genetics, but public health reflects the policies in place that provide the quality of life we enjoy. The life expectancy between those living in blue states and red states continues to widen, and for the first time since WW2 the life expectancy for the United States as a whole has decreased. It would be nice to say that public health is a bipartisan issue and is equally valued across party lines, but that has clearly not been the case for a long time, even before COVID-19 further divided party lines. Now, there is no escaping the convergence of public health and politics.

Despite the evidence, politicians and policymakers in the South still do not prioritize the health of their constituents. Instead, emotionally charged terms like “freedom” and “socialism” are used to deter constituents away from desperately needed public health policies, while politicians simultaneously climb the career ladder atop the backs of those they cause suffering. The health disparities in the South compared to the rest of the United States are well documented. Most Southern states that have failed to expand Medicaid coverage also have the highest uninsured rates in the United States. Uninsured adults receive poorer quality of care and experience worse health outcomes than those who are insured.

Despite having the highest rate of adults experiencing mental illness, Southern states also have the least access to mental health treatment. In Florida, 61% of adults with mental illness did not receive treatment and more people die from suicides than homicides in nearly all Florida counties. Oftentimes, people are unable to find proactive mental health treatment until tragedy is inevitable, such as in the case of Mikese Morse, which is only one of many stories. Additionally, nearly all Southern States are dealing with an obesity epidemic, contributing to the nation’s highest rates of heart disease deaths. Even seemingly non-health-related policies have an impact on public health and should be considered as such. For example, many Southern States have failed to raise minimum wage, which is associated with higher rates of suicide, hypertension and worse birth outcomes. These are just a few of the most immediate and obvious concerns.

So, why are those in the South less receptive to public health policy? Some studies suggest that the messaging hits a barrier because it does not appeal to the shared values of this audience. For example, it wasn’t until a childhood obesity campaign related the impacts on military readiness that more conservative-leaning individuals saw the problem worthy of government intervention. Generally speaking, those in the South hold more conservative ideals, where individualism is emphasized, and government regulation is often regarded as an intrusion of personal freedom. But it can also be argued that the lack of public health policy inadvertently decreases personal freedom by limiting social mobility. People who have good health and well-being have more freedom and control over their own life choices. For instance, most anthropologists attribute the rise of civilization to agriculture, which freed people from hunting and gathering, or simply surviving, so they could engage in other activities that allowed for advancement. In the same sense, freeing people from unnecessary health burdens caused by poor public policy will allow more individual and economic prosperity

In Franklin Roosevelt’s Acceptance Speech (1936), he said, “Necessitous men are not free men.” Southerners believe the lack of public health policy makes them freer when in reality, people who are stuck in a cycle of poor health and/or poverty are robbed of the opportunity for true freedom, liberty, and the pursuit of happiness. We can expect the disparities in the United States to continue to widen unless public health policy is able to appeal to the broader audience needed for progress to be made.


Author: Robyn McCullough is a public sector management consultant with a focus on change management and internal communications. She earned her Master of Public Administration from the University of San Francisco and her Bachelor of Business Administration from American Military University while serving active duty in the United States Air Force. You can reach Robyn at [email protected].

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The American Society for Public Administration is the largest and most prominent professional association for public administration. It is dedicated to advancing the art, science, teaching and practice of public and non-profit administration.

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