The primary drivers of death rates are lack of income and health care access, underlying disease risk, and behavioral factors.[32] The complex relationships among health care, public policy and outcomes are difficult to study. Much public health research focuses on the life expectancy gaps that exist based on race, ethnicity and sex. Rather than identifying individual policy interventions, this research tends to note the need for integrated changes in public behavior, the medical community and government.[33]
Researchers studying the role of government interventions report the importance of social services in addition to direct health care expenditures. They find that “states with a higher ratio of social to health spending had significantly better subsequent health outcomes for the following seven measures: adult obesity; asthma; mentally unhealthy days; days with activity limitations; and mortality rates for lung cancer, acute myocardial infarction, and type 2 diabetes.”[*] Increasing public health funding crowds out funding for other state services that can support better health; the authors mention social programs such as housing, nutrition assistance, early childhood education, and income support. The authors report that even controlling for the total level of public health and social support, places with more spent on social services relative to health care tend to have better health outcomes.
Aside from Covid-19, a major public health concern is the national health crisis driven by drug abuse. Michigan’s drug overdose death rate is near the national median, at 31.5 per 100,000 people.[34] Most overdose deaths are counted as an accidental cause of death; nationally, drug overdoses make up one third of accidental deaths.[35]
In 2017, accidents were the fourth leading cause of death in Michigan.[36] Reducing drug overdose deaths would reduce Michigan’s death rate, but unfortunately, there is no obvious easy solution to the problem.[37] Supply chains for opioids like fentanyl are particularly challenging for law enforcement to track and halt. Stricter sentences for offenders will not necessarily help, because increasing sentence length has little deterrence effect when the likelihood of being caught is low.[38]
Some localities adopt “harm-reduction” policies in an attempt to address the health side of the issue, providing safe injection sites and anti-overdose drugs in a setting with a promise of no arrests. These have the potential to reduce deaths from overdoses or complications from unclean needles. Some researchers caution, however, that these measures just increase overall drug usage by making addiction safer, and thus that they do not reduce drug-related deaths on net.[39] Other researchers disagree and do not think there is a mortality downside to these harm-reduction policies.[40]
Another source of accident-related deaths is traffic fatalities. There is some evidence that state policy can also affect deaths from auto accidents. Michigan’s current blood-alcohol limit is 0.08, and researchers find that 6% of all traffic fatalities are alcohol-related but involve drivers with levels below the 0.08 threshold.[†] States with stricter blood-alcohol limits have fewer traffic fatalities.[41] Speed limits matter, too. One paper reports, “A 5 mph increase in the maximum state speed limit was associated with an 8% increase in fatality rates on interstates and freeways and a 4% increase on other roads.”[42]
[*] This ratio is the sum of social service and public health spending divided by the sum of Medicare and Medicaid spending. Elizabeth H. Bradley, Maureen Canavan, Erika Rogan, Kristina Talbert-Slagle, Chima Ndumele, Lauren Taylor and Leslie A. Curry, "Variation in health outcomes: the role of spending on social services, public health, and health care, 2000–09" (Health Affairs 35, no. 5, 2016): 760-768.
[†] The 0.08 is a measure of grams of alcohol per 100 milliliters of blood. MCL § 257.625(1)(b).