New scientific studies from Nationhood Lab and partners reveal regional differences in lifestyle health indicators, COVID-19 infections and deaths, life expectancy

July 9 2024

NEWPORT, R.I. – A series of newly published studies reveal significant differences between U.S. regions in various measures of health and healthy lifestyles, life expectancy, and COVID-19 infection, vaccination and death rates, with southern regions showing the worst problems.

The research is the result of an ongoing collaboration between Salve Regina University’s Nationhood Lab and public health researchers at the University of Illinois-Chicago, the Minneapolis-based HealthPartners Institute, and the University of Minnesota that has produced fifteen academic papers in the past year. The four studies appeared in three peer-reviewed academic journals, Progress in Cardiovascular Disease, the Journal of Cardiopulmonary Rehabilitation and Prevention, and Current Problems in Cardiology.

In the first of the studies, published in the Journal of Cardiopulmonary Rehabilitation and Prevention, health researchers Ross Arena of the University of Illinois – Chicago, Nicolaas Pronk and Thomas Kottke of the Minneapolis-based HealthPartners Institute, and Nationhood Lab director Colin Woodard introduced the Lifestyle Health Index (or LHI), a multi-factor tool that combines lifestyle behaviors, chronic conditions, and self-reported health status, generating a scores that allow comparisons between populations. The researchers used this approach to score all U.S. counties for which data was available and then, using Woodard’s American Nations model of U.S. regions, compared scores across regions.

The researchers found significant differences in lifestyle health across the American Nations regions, with Greater Appalachia, Deep South, New France and First Nation performing worst, Left Coast and New Netherland best. They also detected an anomalous “hot spot” spanning almost the entirety of El Norte’s Texas section.  “The patterns illustrated by the newly developed index are consistent with previous observations demonstrating regional patterns with unique cultural phenotypes in the context of certain unhealthy lifestyle behaviors and chronic conditions,” wrote lead author Arena, who heads the Physical Therapy department at UI-Chicago.

In a follow-up study published this week in Current Problems in Cardiology, the researchers revealed significant county- and American Nations-level correlations between Lifestyle Health Index scores and COVID-19 vaccination, infection, and mortality rates. It also revealed wide per capita differences in COVID-19 death rates between American Nations regions, with the Deep South, Greater Appalachia and the Midlands racking up more than twice the death rate of Left Coast.

“For reasons yet to be clearly defined, U.S. regions with poorer health, as indicated by the LHI were less likely to comply with mitigation and vaccination strategies,” lead author Arena wrote. “Based on our previous work using the American Nations model, unique geographic cultural influences are important drivers to the varying health characteristics and outcomes in the U.S. As a nation, we need to better understand drivers of health-related decisions on a community level and tailor locally optimized messaging. Had such strategies been deployed,” he added, “countless lives could have been saved.”

A third paper, recently published in the Journal of Cardiopulmonary Rehabilitation and Prevention, used compared LHI with county-level population changes between July 1, 2021, and June 30, 2022. They found population declines to be closely linked to low LHI scores, with increased mortality (due to the pandemic) driving much of the change. Poor LHI was also associated with high birth rates, “increasing the likelihood that an unhealthy lifestyle-chronic disease cycle will persist in future generations.”

In a fourth paper, published in Progress in Cardiovascular Diseases, Arena, Pronk and Woodard used the American Nations model to probe correlations between various health indices and behaviors and life expectancy (itself the subject of a detailed analysis here at Nationhood Lab and Politico.) The study produced evidence-based threshold targets for public health efforts to mitigate smoking, obesity, physical inactivity, and food deserts and showed some regions have poor health indices and life expectancy. “The Deep South and Greater Appalachia house unhealthy living hot spots that are undoubtedly driving lower life expectancy in those regions,” lead author Arena concluded. “While it is important that we do not lose sight of the broader national perspective in promoting healthy lifestyles for all, particular focus should be directed toward areas where the problems are most acute. Understanding and addressing the forces driving poor outcomes in these hot spot areas will derive valuable, nationally applicable lessons that can help improve U.S. public health.”

Previous studies by Arena, Pronk, Woodard and other researchers have established regional differences in a wide range of health indices, including physical inactivity, diabetes, obesity, disabilities, gun violence, sleep disturbances, and other health problems. Papers in this initiative have also been published in the American Journal of Medicine, The Lancet Regional Health Americas, and the Journal of Activity, Sedentary and Sleep Behaviors.

Nationhood Lab, based at the Pell Center for International Relations and Public Policy at Salve Regina University, is an interdisciplinary research, writing, testing and dissemination project focused on counteracting the authoritarian threat to American democracy and the centrifugal forces threatening the federation’s stability. The project delivers more effective tools with which to describe and defend the American liberal democratic tradition and better understand the forces undermining it.