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  • D.C.’s Crime Problem Is a Democracy Problem

    D.C.’s Crime Problem Is a Democracy Problem

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    Matthew Graves is not shy about promoting his success in prosecuting those who stormed the U.S. Capitol on January 6, 2021. By his count, Graves, the U.S. attorney for the District of Columbia, has charged more than 1,358 individuals, spread across nearly all 50 states and Washington, D.C., for assaulting police, destroying federal property, and other crimes. He issues a press release for most cases, and he held a rare news conference this past January to tout his achievements.

    But Graves’s record of bringing violent criminals to justice on the streets of D.C. has put him on the defensive. Alone among U.S. attorneys nationwide, Graves, appointed by the president and accountable to the U.S. attorney general, is responsible for overseeing both federal and local crime in his city. In 2022, prosecutors under Graves pressed charges on a record-low 33 percent of arrests in the District. Although the rate increased to 44 percent last fiscal year and continues to increase, other cities have achieved much higher rates: Philadelphia had a 96 percent prosecution rate in 2022, while Cook County, Illinois, which includes Chicago, and New York City were both at 86 percent. D.C.’s own rate hovered in the 60s and 70s for years, until it began a sharp slide in 2016.

    These figures help account for the fact that, as most major U.S. cities recorded decreases in murders last year, killings in the nation’s capital headed in the other direction: 274 homicides in 2023, the highest number in a quarter century, amounting to a nearly 50 percent increase since 2015. Violent crime, from carjackings to armed robberies, also rose last year. Some types of crime in the District are trending down so far in 2024, but the capital has already transformed from one of the safest urban centers in America not long ago to one in which random violence can take a car or a life even in neighborhoods once considered crime free.

    Journalists and experts have offered up various explanations for D.C.’s defiance of national crime trends. The Metropolitan Police Department is down 467 officers from the 3,800 employed in 2020; Police Chief Pamela Smith has said it could take “more than a decade” to reach that number again. But the number of police officers has decreased nationwide. The coronavirus pandemic stalled criminal-court procedures in D.C., but that was also the case across the country. The 13-member D.C. city council, dominated by progressives, tightened regulations on police use of force after the murder of George Floyd in 2020, but many local councils across the country passed similar laws. Reacting to public pressure, the D.C. council this month passed, and Mayor Muriel Bowser signed, a public-safety bill that rolls back some policing restrictions and includes tougher penalties for crimes such as illegal gun possession and retail theft.

    Jeff Asher: The murder rate is suddenly falling

    As a journalist who has covered crime in the District for four decades, I believe that one aspect of the D.C. justice system sets it apart, exacerbating crime and demanding remedy: Voters here cannot elect their own district attorney to prosecute local adult crimes.

    The District’s 679,000 residents and the millions of tourists who visit the capital every year could be safer if D.C. chose its own D.A., responsive to the community’s needs and accountable to voters. D.C. residents have no say in who sits atop their criminal-justice system with the awesome discretion to bring charges or not. Giving voters the right to elect their own D.A. would not only move the criminal-justice system closer to the community. It would also reform one of the more undemocratic, unjust sections of the Home Rule Act. The 1973 law, known for granting the District limited self-government, also maintained federal control of D.C.’s criminal-justice system; the president appoints not just the chief prosecutor but also judges to superior and district courts.

    “Putting prosecution into the hands of a federal appointee is a complete violation of the founding principles this country was built on,” Karl Racine, who served as D.C.’s first elected attorney general, from 2015 to 2023, told me. (The District’s A.G. has jurisdiction over juvenile crime.) “Power is best exercised locally.”

    Allowing the District to elect its own D.A. would not solve D.C.’s crime problem easily or quickly. Bringing criminals to justice is enormously complicated, from arrest to prosecution to adjudication and potential incarceration; this doesn’t fall solely on Graves or any previous U.S. attorney. The change would require Congress to revise the Home Rule charter, and given the politics of the moment and Republican control of the House, it’s a political long shot. In a 2002 referendum, 82 percent of District voters approved of a locally elected D.A. Four years later, Eleanor Holmes Norton, the District’s longtime Democratic delegate to Congress, began introducing legislation to give D.C. its own prosecutor. But her efforts have gone nowhere, regardless of which party controlled Congress or the White House.

    Many Republicans in Congress—as well as former President Donald Trump—like to hold up the District as a crime-ridden example of liberal policies gone wrong, and they have repeatedly called for increased federal control to make the city safer. Ironically, what distinguishes the District from every other U.S. city is that its criminal-justice system is already under federal control. If Republicans really want to make D.C. safer, they should consider empowering a local D.A. who could focus exclusively on city crime.

    In two interviews, Graves defended his record of prosecuting local crime and pointed to other factors contributing to D.C.’s homicide rate. “The city is lucky to have the career prosecutors it has,” he told me. He questioned whether a locally elected D.A. would be any more aggressive on crime. But he also said he is fundamentally in favor of the District’s right to democratically control its criminal-justice system.

    “I personally support statehood,” he said. “Obviously, if D.C. were a state, then part of that deal would be having to assume responsibility for its prosecutions.”

    The District’s porous criminal-justice system has long afflicted its Black community in particular; in more than 90 percent of homicides here, both the victims and the suspects are Black. Since the 1980s, I have heard a constant refrain from Washingtonians east of the Anacostia River that “someone arrested Friday night with a gun in their belt is back on the street Saturday morning.”

    In the District’s bloodiest days, during the crack epidemic, murders in the city mercilessly rose, peaking in 1991 at 509. From 1986 to 1990, prosecutions for homicide, assault, and robbery increased by 96 percent. Over the next two decades, homicides and violent crime gradually decreased; murders reached a low of 88 in 2012. That year, the U.S. Attorney’s Office prosecution rate in D.C. Superior Court was 70 percent. But the District’s crime rate seemed to correspond more to nationwide trends than to any dramatic changes in the prosecution rate.

    David A. Graham: America’s peace wave

    The rate of federal prosecution of local crime in the District stood at 65 percent as recently as 2017 but fell precipitously during a period of turbulence in the U.S. Attorney’s Office under President Trump, when multiple people cycled through the lead-prosecutor spot. (“That is your best argument about the danger of being under federal control,” Graves told me.) After a mob attacked the U.S. Capitol in 2021 and Graves took office later that year, he temporarily redeployed 15 of the office’s 370 permanent prosecutors to press cases against the violent intruders in D.C. federal court. The prosecution rate for local crime stood at 46 percent in 2021 but plummeted to the nadir of 33 percent in 2022.

    “It was a massive resource challenge,” Graves said of the January 6 prosecutions. “It’s definitely a focus of mine, a priority of mine.” But he added: “We all viewed the 33 percent as a problem.”

    Graves, 48, an intense, hard-driving lawyer from eastern Pennsylvania, told me that his job, “first and foremost, is keeping the community safe.” He has a track record in the District: He joined the D.C. federal prosecutor’s operation in 2007 and worked on local violent crime before moving up to become the acting chief of the department’s fraud and public-corruption section. He went into private practice in 2016 and returned when President Joe Biden nominated him to run the U.S. Attorney’s Office, in July 2021. He has lived in the District for more than 20 years. “It’s my adopted home,” he said.

    Graves attributes D.C.’s rising murder rate in large part to the fact that the number of illegal guns in D.C. “rocketed up” in 2022 and 2023: Police recovered more than 3,100 illegal firearms in each of those years, compared with 2,300 in 2021. “D.C. doesn’t appropriately hold people accountable for illegally possessing firearms,” he told me. According to Graves, D.C. judges detain only about 10 percent of defendants charged with illegal possession of a firearm.

    He attributed his office’s low prosecution rates to two main causes: first, pandemic restrictions that dramatically cut back on in-person jury trials, including grand juries, where prosecutors must present evidence to bring indictments. Without grand juries, Graves said, prosecutors could not indict suspects who were “sitting out in the community.” Second, the District’s crime lab lost its accreditation in April 2021 and was out of commission until its partial reinstatement at the end of 2023. Without forensic evidence, prosecutors struggled to trace DNA, drugs, firearm cartridges, and other evidence, Graves explained: “It was a massive mess that had nothing to do with our office.” Police and prosecutors were unable to bring charges for drug crimes until the Drug Enforcement Agency agreed in March 2022 to handle narcotics testing.

    Even with these impediments, Graves said his office last year charged 90 percent of “serious violent crime” cases in D.C., including 137 homicides, in part by increasing the number of prosecutors handling violent crime cases in 2022 and 2023.

    But accepting Graves’s explanations doesn’t account for at least 18 murder suspects in 2023 who had previously been arrested but were not detained—either because prosecutors had dropped charges or pleaded down sentences (in some cases before Graves’s tenure), or because judges released the defendants. (The 18 murder suspects were tracked by the author of the anonymous DC Crime Facts Substack and confirmed in public records.) “Where the office does not go forward with a firearms case at the time of arrest, it is either because of concerns about whether the stop that led to the arrest was constitutional or because there is insufficient evidence connecting the person arrested to the firearm,” Graves told me in an email.

    Andrew Exum: We need to learn to live with guns

    Last month, the National Institute for Criminal Justice Reform, a research and advocacy nonprofit, released a report showing that in 2021 and 2022, homicide victims and suspects both had, on average, more than six prior criminal cases, and that most of those cases had been dismissed. Police and nonprofit groups working to tamp down violence described “a feeling of impunity among many people on the streets that may be encouraging criminal behavior.” Police “also complained of some cases not being charged or when they are, the defendant being allowed to go home to await court proceedings,” according to the report, which cited interviews with more than 70 Metropolitan Police Department employees.

    “Swift and reliable punishment is the most effective deterrent,” Vanessa Batters-Thompson, the executive director of the DC Appleseed Center for Law and Justice, a nonprofit that advocates for increased local governance, told me.

    In January, the Justice Department announced that it would “surge” more federal prosecutors and investigators to “target the individuals and organizations that are driving violent crime in the nation’s capital,” in the words of U.S. Attorney General Merrick Garland. Graves welcomed the move, which he said has added about 10 prosecutors so far and will create a special unit to analyze crime data that could provide investigators with leads. Similar “surges” have been deployed in Memphis and Houston.

    “But [D.C. has] no control over what that surge is,” Batters-Thompson said—how large or long-lasting it is. Even if federal crime fighters make a dent in the District’s violence and homicide rates, the effort would amount to a temporary fix.

    Electing a D.A. for D.C. would not only take Congress reforming the Home Rule Act. There’s also the considerable expense of creating a district attorney’s office and absorbing the cost now borne by the federal government. (It’s an imperfect comparison, but the D.C. Office of the Attorney General’s operating budget for fiscal year 2024 is approximately $154 million.) Republicans in control of the House are more intent on repealing the Home Rule Act than granting District residents more autonomy.

    Hannah Giorgis: D.C. statehood is more urgent than ever

    But if Republicans want D.C. to tackle its crime problem, why shouldn’t its residents—like those of Baltimore, Philadelphia, Denver, Boston, Seattle, and elsewhere—be able to elect a district attorney dedicated to that effort? Crime is often intimate and neighborhood-based, especially in a relatively small city such as the District. Effective prosecution requires connection and trust with the community, both to send a message about the consequences of bad behavior and to provide victims and their families with some solace and closure. Those relationships are much more difficult to forge with a federally appointed prosecutor whose jurisdiction is split between federal and local matters, and who is not accountable to the people he or she serves.

    Racine, the former D.C. attorney general, was regularly required to testify in oversight hearings before the city council. Graves doesn’t have to show up for hearings before the District’s elected council, though he couldn’t help but note to me that progressive council members have in the past accused D.C.’s criminal-justice system of being too punitive.

    Graves told me that his office has a special community-engagement unit, that he attends community meetings multiple times a month, and that his office is “latched up at every level” with the police, especially with the chief, with whom Graves said he emails or talks weekly.

    “Given our unique role,” he said, “we have to make ourselves accountable to the community.”

    Sounds like the perfect platform to run on for D.C.’s first elected district attorney.

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    Harry Jaffe

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  • BMI Won’t Die

    BMI Won’t Die

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    If anything defines America’s current obesity-drug boom, it’s this: Many more people want these injections than can actually get them. The roadblocks include exorbitant costs that can stretch beyond $1,000 a month, limited insurance coverage, and constant supply shortages. But before all of those issues come into play, anyone attempting to get a prescription will inevitably confront the same obstacle: their body mass index, or BMI.

    So much depends on the simple calculation of dividing one’s weight by the square of their height. According to the FDA, people qualify for prescriptions of Wegovy and Zepbound—the obesity-drug versions of the diabetes medications Ozempic and Mounjaro—only if their BMI is 3o or higher, or 27 or higher with a weight-related health issue such as hypertension. Many who do get on the medication use BMI to track their progress. That BMI is the single biggest factor determining who gets prescribed these drugs, and who doesn’t, is the result of how deeply entrenched this metric has become in how both doctors and regular people approach health: Low BMI is good and high BMI is bad, or so most of us have come to think.

    This roughly 200-year-old metric has never been more relevant—or maligned—than it is in the obesity-drug era. BMI has become like the decrepit car you keep driving because it still sort of works and is too much of a hassle to replace. Its numerous shortcomings have been called out for many years now: For starters, it accounts for only height and weight, not other, more pertinent measures such as body-fat percentage. In June, the American Medical Association formally recognized that BMI should not be used alone as a health measure. Last year, some doctors called for BMI to be retired altogether, echoing previous assertions.

    The thing is, BMI can be an insightful health metric, but only when used judiciously with other factors. The problem is that it often hasn’t been. Just as obesity drugs are taking off, however, professional views are changing. People are so accustomed to seeing BMI as the “be-all, end-all” of health indicators, Kate Bauer, a nutritional-sciences professor at the University of Michigan, told me. “But that’s increasingly not the way it’s being used in clinical practice.” A shift in the medical field is a good start, but the bigger challenge will be getting everyone else to catch up.

    BMI got its start in the 1830s, when a Belgian astronomer named Adolphe Quetelet attempted to determine the properties of the “average” man. Using data on primarily white people, he observed that weight tended to vary as the square of height—a calculation that came to be known as Quetelet’s index.

    Over the next 150 years, what began as a descriptive tool transformed into a prescriptive one. Quetelet’s index (and other metrics like it) informed height-weight tables used by life-insurance companies to estimate risk. These sorts of tables formed “recommendations for the general population going from ‘average’ to ‘ideal’ weights,” the epidemiologist Katherine Flegal wrote in her history of BMI; eventually, nonideal weights were classified as “overweight” and “obese.” In 1972, the American physiologist Ancel Keys proposed using Quetelet’s index—which he renamed BMI—to roughly measure obesity. We’ve been stuck with BMI ever since. The metric became embedded not only in research and doctor’s visits but also in the very definitions of obesity. According to the World Health Organization, a BMI starting at 25 and less than 30 is considered overweight; anything above that range is obese.

    But using BMI to categorize a person’s health was controversial from the start. Even Keys called it “scientifically indefensible” to use BMI to judge someone as overweight. BMI doesn’t account for where fat is distributed on the body; fat that builds up around organs and tissues, called visceral fat, is linked to serious medical issues, while fat under the skin—the kind you can pinch—is usually less of a problem. Muscularity is also overlooked: LeBron James, for example, would be considered overweight. Both fat distribution and muscularity can vary widely across sex, age, and ethnicity. People with high BMIs can be perfectly healthy, and “there are people with normal BMIs that are actually sick because they have too much body fat,” Angela Fitch, an assistant professor at Harvard Medical School and the president of the Obesity Medicine Association, told me.

    For all its flaws, BMI is actually useful at the population level, Fitch said, and doctors can measure it quickly and cheaply. But BMI becomes troubling when it is all that doctors see. In some cases, the moment when a patient’s BMI is calculated by their doctor may shape the rest of the appointment and relationship going forward. “The default is to hyper-focus on the weight number, and I just don’t think that that’s helpful,” Tracy Richmond, a pediatrics professor at Harvard Medical School, told me. Anti-obesity bias is well documented among physicians—even some obesity specialists—and can lead them to dismiss the legitimate medical needs of people with a high BMI. In one tragic example, a patient died from cancer that went undiagnosed because her doctors attributed her health issues to her high BMI.

    But after many decades, the medical community has begun to use BMI in a different way. “More and more clinicians are realizing that there are people who can be quite healthy with a high BMI,” Kate Bauer said. The shift has been gradual, though it was given a boost by the AMA policy update earlier this year: “Hopefully that will help clinicians make a change to supplement BMI with other measures,” Aayush Visaria, an internal-medicine resident at Rutgers Robert Wood Johnson Medical School who researches BMI’s shortcomings, told me.

    Physicians I spoke with acknowledged BMI’s flaws but didn’t seem too concerned about its continued use in medicine—even as obesity drugs make this metric even more consequential. BMI isn’t a problem, they said, as long as physicians consider other factors when diagnosing obesity or prescribing drugs to treat it. If you go to a doctor with the intention of getting on an obesity drug, you should be subject to a comprehensive evaluation including metrics such as blood sugar, cholesterol levels, and body composition that go “way beyond BMI,” Katherine Saunders, a clinical-medicine professor at Weill Cornell Medicine, said. Because Wegovy and other drugs come with side effects, she told me, doctors must be absolutely sure that a patient actually needs them, she added.

    But BMI isn’t like most other health metrics. Because of its simplicity, it has seeped out of doctor’s offices and into the mainstream, where this more nuanced view still isn’t common. Whether we realize it or not, BMI is central to our basic idea of health, affecting nearly every aspect of daily life. Insurance companies are notorious for charging higher rates to people with high BMI and lowering premiums for people who commit to long-term weight loss. Fertility treatments and orthopedic and gender-affirming surgery can be withheld from patients until they hit BMI targets. Workplace wellness programs based on BMI are designed to help employees manage their weight. BMI has even been used to prevent prospective parents from adopting a child.

    The rise of obesity drugs may make these kinds of usages of BMI even harder to shake. Determining drug eligibility by high BMI supports the notion that a number is synonymous with illness. Certainly many people using obesity drugs take a holistic view of their health, as doctors are learning to do. But focusing on BMI is still common. Some members of the r/Ozempic Subreddit, for example, share their BMI to show their progress on the drug. Again, high BMI can be used to predict who has obesity, but it isn’t itself an obesity diagnosis. The problem with BMI’s continued dominance is that it makes it even harder to move away from simply associating a number on a scale with overall health, with all the downstream consequences that come along with a weight-obsessed culture. As obesity drugs are becoming mainstream, “there needs to be public education explaining that BMI by itself may not be a good indicator of health,” Visaria said.

    In another 200 years, surely BMI will finally be supplanted by something else. If not much sooner: A large effort to establish hard biological criteria for obesity is under way; the goal is to eliminate BMI-based definitions once and for all. Caroline Apovian, a professor at Harvard Medical School, gives it “at least 10 years” before a comparably cheap or convenient replacement arises—though any changes would take longer to filter into public consciousness.” Until that happens, we’re stuck with BMI, and the mess it has wrought.

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    Yasmin Tayag

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  • How Many Republicans Died Because the GOP Turned Against Vaccines?

    How Many Republicans Died Because the GOP Turned Against Vaccines?

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    No country has a perfect COVID vaccination rate, even this far into the pandemic, but America’s record is particularly dismal. About a third of Americans—more than a hundred million people—have yet to get their initial shots. You can find anti-vaxxers in every corner of the country. But by far the single group of adults most likely to be unvaccinated is Republicans: 37 percent of Republicans are still unvaccinated or only partially vaccinated, compared with 9 percent of Democrats. Fourteen of the 15 states with the lowest vaccination rates voted for Donald Trump in 2020. (The other is Georgia.)

    We know that unvaccinated Americans are more likely to be Republican, that Republicans in positions of power led the movement against COVID vaccination, and that hundreds of thousands of unvaccinated Americans have died preventable deaths from the disease. The Republican Party is unquestionably complicit in the premature deaths of many of its own supporters, a phenomenon that may be without precedent in the history of both American democracy and virology.

    Obviously, nothing about being a Republican makes someone inherently anti-vaccine. Many Republicans—in fact, most of them—have gotten their first two shots. But the wildly disproportionate presence of Republicans among the unvaccinated reveals an ugly and counterintuitive aspect of the GOP campaign against vaccination: At every turn, top figures in the party have directly endangered their own constituents. Trump disparaged vaccines while president, even after orchestrating Operation Warp Speed. Other politicians, such as Texas Governor Greg Abbott, made all COVID-vaccine mandates illegal in their state. More recently, Florida Governor Ron DeSantis called for a grand jury to investigate the safety of COVID vaccines. The right-wing media have leaned even harder into vaccine skepticism. On his prime-time Fox News show, Tucker Carlson has regularly questioned the safety of vaccines, inviting guests who have called for the shots to be “withdrawn from the market.”

    Breaking down the cost of vaccine hesitancy would be simple if we could draw a causal relationship between Republican leaders’ anti-vaccine messaging and the adoption of those ideas by Americans, and then from those ideas to deaths due to non-vaccination. Unfortunately, we don’t have the data to do so. Individual vaccine skepticism cannot be traced back to a single source, and even if it could, we don’t know exactly who is unvaccinated and what their political affiliations are.

    What we do have is a patchwork of estimations and correlations that, taken together, paint a blurry but nevertheless grim picture of how Republican leaders spread the vaccine hesitancy that has killed so many people. We know that as of April 2022, about 318,000 people had died from COVID because they were unvaccinated, according to research from Brown University. And the close association between Republican vaccine hesitancy and higher death rates has been documented. One study estimated that by the fall of 2021, vaccine uptake accounted for 10 percent of the total difference between Republican and Democratic deaths. But that estimate has changed—and even likely grown—over time.

    Partisanship affected outcomes in the pandemic even before we had vaccines. A recent study found that from October 2020 to February 2021, the death rate in Republican-leaning counties was up to three times higher than that of Democratic-leaning counties, likely because of differences in masking and social distancing. Even when vaccines came around, these differences continued, Mauricio Santillana, an epidemiology expert at Northeastern University and a co-author of the study, told me. Follow-up research published in Lancet Regional Health Americas in October looked at deaths from April 2021 to March 2022 and found a 26 percent higher death rate in areas where voters leaned Republican. “There are subsequent and very serious [partisan] patterns with the Delta and Omicron waves, some of which can be explained by vaccination,” Bill Hanage, a co-author of the paper and an epidemiologist at Harvard, told me in an email.

    But to understand why Republicans have died at higher rates, you can’t look at vaccine status alone. Congressional districts controlled by a trifecta of Republican leaders—state governor, Senate, and House—had an 11 percent higher death rate, according to the Lancet study. A likely explanation, the authors write, could be that in the post-vaccine era, those leaders chose policies and conveyed public-health messages that made their constituents more likely to die. Although we still can’t say these decisions led to higher death rates, the association alone is jarring.

    One of the most compelling studies comes from researchers at Yale, who published their findings as a working paper in November. They link political party and excess-death rate—the percent increase in deaths above pre-COVID levels—among those registered as either Democrats or Republicans, providing a more granular view. They chose to analyze data from Florida and Ohio from before and after vaccines were available. Looking at the period before the vaccine,  researchers found a 1.6 percentage-point difference in excess death rate among Republicans and Democrats, with a higher rate among Republicans. But after vaccines became available, that gap widened dramatically to 10.4 percentage points, again with a higher Republican excess death rate. “When we compare individuals who are of the same age, who live in the same county in the same month of the pandemic, there are differences correlated with your political-party affiliation that emerge after vaccines are available,” Jacob Wallace, an assistant professor of public health at Yale who co-authored the paper, told me. “That’s a statement we can confidently make based on the study and we couldn’t before.”

    Even with this new research, it is difficult to determine just how many people died as a result of their political views. In the “excess death” study, researchers dealt only with rates of excess death, not actual death-toll numbers. Overall, excess deaths represent a small share of deaths. “On the scale of national registration for both parties,” Wallace said, “we’re talking about relatively small numbers and differences in deaths” when you look at excess death rates alone.

    The absolute number of Republican deaths is less important than the fact that they happened needlessly. Vaccines could have saved lives. And yet, the party that describes itself as pro-life campaigned against them. Democrats are not without fault, though. The Biden administration’s COVID blunders are no doubt to blame for some of the nation’s deaths. But on the whole, Democratic leaders have mostly not promoted ideas or enforced policies around COVID that actively chip away at life expectancy. It is a tragedy that the Republican push against basic lifesaving science has cut lives short and continues to do so. The partisan divide in COVID deaths, Hanage said, is just “another example of how the partisan politics of the U.S. has poisoned the well of public health.”

    What’s most concerning about all of this is that partisan disparities in death rates were also apparent before COVID. People living in Republican jurisdictions have been at a health disadvantage for more than 20 years. From 2001 to 2019, the death rate in Democratic counties decreased by 22 percent, according to a recent study; in Republican counties, it declined by only 11 percent. In the same time period, the political gap in death rates increased sixfold.

    Health outcomes have been diverging at the state level since the ’90s, Steven Woolf, an epidemiologist at Virginia Commonwealth University, told me. Woolf’s work suggests that over the decades, state policy decisions on health issues such as Medicaid, gun legislation, tobacco taxes, and, indeed, vaccines have likely had a stronger impact on state health trajectories than other factors. COVID’s high Republican death rates are not an isolated phenomenon but a continuation of this trend. As Republican-led states pushed back on lockdowns, the impact on population death rates was observed within weeks, Woolf said.

    If the issue is indeed systemic, that doesn’t bode well for the future. Other factors could explain the higher death rate in Republican-leaning places—more poverty, less education, worse socioeconomic conditions—, though Woolf said isn’t convinced that those factors aren’t related to bad state health policy too. In any case, the long-term decline of health in red states indicates that there is an ongoing problem at a high level in Republican-led places, and that something has gone awry. “If you happen to live in certain states, your chances for living a long life are going to be much higher than if you’re an American living in a different state,” Woolf said.

    Unfortunately, this trend shows no signs of breaking. The anti-science messaging that fuels such a divide is popular with Republican leaders because it plays so well with their constituents. Far-right crowds cheer for missed vaccine targets and jokes about executing scientific leaders. In an environment where partisanship trumps all—including trying to save people’s lives—such messaging is both politically effective and morally abhorrent. The data, however imperfect, demand a reckoning with the consequences of such a strategy not only during the pandemic but over the past few decades, and in the years to come. But to acknowledge how many Republicans didn’t have to die would mean giving credence to scientific and medical expertise. So long as America remains locked in a poisonous partisan battle in which science is wrongly dismissed as being associated with the left, the death toll will only rise.

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    Yasmin Tayag

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