Disenfranchisement by differential death rates

A reader sent us a pdf the other day of a paper with an interesting interpretation of black/white differential mortality, hoping we'd write about it.  The paper is called "Black lives matter: Differential mortality and the racial composition of the U.S. electorate, 1970–2004," Rodriguez et al.  The authors analyzed the effects of excess mortality in marginalized populations on the composition of the electorate in the US between 1970 and 2004, and conclude that mortality differentials mean fewer African American voters, and that this can turn elections, as they demonstrate for the election of 2004.

The authors used cause of death files for 73 million US deaths spanning 34 years to calculate:

(1) Total excess deaths among blacks between 1970 and 2004, (2) total hypothetical survivors to 2004, (3) the probability that survivors would have turned out to vote in 2004, (4) total black votes lost in 2004, and (5) total black votes lost by each presidential candidate.

This is straightforward demography: what was the death rate for whites in a given age group in a given year, and how does the black death rate compare?  This allows Rodriguez et al. to estimate excess deaths (relative to whites) at every age, and then, knowing the proportion of every age group that votes historically, and the proportion of those votes that go to each major party, they can estimate how many votes were lost, and how they might have changed election outcomes.  Clever, and important.

We estimate 2.7 million excess black deaths between 1970 and 2004. Of those, 1.9 million would have survived until 2004, of which over 1.7 million would have been of voting-age. We estimate that 1 million black votes were lost in 2004; of these, 900,000 votes were lost by the defeated Democratic presidential nominee. We find that many close state-level elections over the study period would likely have had different outcomes if voting age blacks had the mortality profiles of whites.  US black voting rights are also eroded through felony disenfranchisement laws and other measures that dampen the voice of the US black electorate. Systematic disenfranchisement by population group yields an electorate that is unrepresentative of the full interests of the citizenry and affects the chance that elected officials have mandates to eliminate health inequality.

Throughout the 20th century, they write, black mortality was 60% higher than white mortality, on average.  Why?  "Predominantly black neighborhoods are characterized by higher exposure to pollution, fewer recreational facilities, less pedestrian-friendly streets/sidewalks, higher costs for healthy food, and a higher marketing effort per capita by the tobacco and alcohol industries."  And, black neighborhoods have less access to medical facilities, the proportion of the black population that's uninsured is higher than whites, and exposure to daily racism takes a toll on health, among other causes.

Age distributions of the deceased by race, Rodriguez et al, 2015

The resulting differential mortality, the authors suggest, influenced many local as well as national elections in 2004.  And, with the deep, insidious effects Rodriguez et al. report, it may well be that excess mortality begets excess mortality, as blacks overwhelmingly vote Democratic, and the Republicans who win when black voter turnout isn't what it would be without the effects of differential mortality are the politicians who are less likely to support, among other things, a role for government in health care.  (To wit, all those serial Republican votes against the Affordable Care Act, and the budget passed just last week by Republicans in the Senate that would do away with the ACA entirely.)  And, it has long been known that the uninsured disproportionately die younger, and of diseases for which the insured get medical care.

"Lyndon Johnson and Martin Luther King, Jr. - Voting Rights Act" by Yoichi Okamoto - Lyndon Baines Johnson Library and Museum. Image Serial Number: A1030-17a. Wikipedia

This isn't the only form of disenfranchisement that the African American population is subject to, of course.  Felony disenfranchisement is a major cause, and, recent election cycles have seen successful attempts by multiple Republican-led state governments to "control electoral fraud" (the existence of which has been hard to impossible to prove) by limiting the voting rights of blacks, Hispanics, the young and the elderly, people who are more likely to vote Democratic.

In the May 21 New York Review of Books, Elizabeth Drew wrote a scathing review of these ongoing attacks.  It's a must-read if you're interested in the systematic, planned, fraudulent co-option of voting rights in the US.  This, coupled with the 2013 Supreme Court decision on the Voting Rights Act, along with the role of big money in politics, is having an impact on democracy in the US.  As Drew wrote,

In 2013 the Supreme Court, by a 5–4 vote, gutted the Voting Rights Act. In the case of Shelby v. Holder, the Court found unconstitutional the sections requiring that states and regions with a history of voting discrimination must submit new voting rights laws to the Justice Department for clearance before the laws could go into effect. Congressman John Lewis called such preclearance “the heart and soul” of the Voting Rights Act. No sooner did the Shelby decision come down than a number of jurisdictions rushed to adopt new restrictive voting laws in time for the 2014 elections—with Texas in the lead.

Republicans can be rightly accused of a lot of planned disenfranchisement of minority, young and elderly voters, given the extensive gerrymandering of the last 10 years or so, and the recent spate of restrictive voter ID laws.  Can they be accused of planning disenfranchisement by differential mortality?  Probably not, though it's pretty likely this report won't spur them into action to address the causes of mortality inequality.  Though, Rodriguez et al. write:

The current study findings suggest that excess black mortality has contributed to imbalances in political power and representation between blacks and whites. Politics helps determine policy, which subsequently affects the distribution of public goods and
services, including those that shape the social determinants of health, which influence disenfranchisement via excess mortality. In the United States, especially after the political realignment of the 1960s, policy prescriptions emanating from government structures and representing ideologically divergent constituencies have influenced the social determinants of health, including those that affect racial disparities. And given the critical role of elected politicians in the policy-making apparatus, the available voter pool is an essential mechanism for the distribution of interests that will ultimately be represented in the policies and programs that affect us all.

It's hard to imagine that the Democrats in power today would champion the kind of Great Society programs Johnson pushed through in the 1960's, but Obama did give us the Affordable Care Act, and whatever you think of it, it's possible that this could have an impact, even if slight, on differential black/white mortality.

As we edge further away from universal enfranchisement in this democracy, for obvious and, as Rodriguez et al. report, less obvious reasons, Ken always points out that we should step back and ask how different the kind of minority rule we've got now (in effect, 1% rule, with wealthy legislators passing laws that favor the wealthy) is from the minority rule that has been the order of the day throughout history.  It's a dispiriting thought, given that we saw a flurry of action in favor of equal rights through the latter half of the 1900's.  But equality is not a major theme in political discourse these days.

One way or another, hierarchies of power and privilege are always established.  The minority at the societal top always find ways to keep the majority down, and retain inequitable privilege for themselves.  Differential mortality of the kind reported here is just one current way that the privilege hierarchy is maintained.  Even the communists, not to mention Christians, whose formal faiths have been against inequity, are perpetrators.  Maybe there's room for optimism somewhere, but where isn't obvious. One argument is that, at least, the living conditions of those at the socioeconomic bottom (in developed countries) are better than their societal ancestors.  Of course equity is itself a human concept and not one about which there is universal agreement in favor.  But this new study is food for thought about ideal societies, and how difficult they are to achieve.