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A Red State Model for Health

We started in a “red state,” Arizona—though with the goal of expanding ASAP to other red, purple and blue states.

Starting in a red state required a dramatically different start-up strategy than in the very blue Northeast or on the “Left Coast,” and even than in “purple” states (shown as gray in the below 2023 map—indicating divided state control of legislature and/or governor). [Note: some “purple” states like Colorado or Michigan, or “red” states like Arizona or Kansas, may have a different color in this map, since it is just a post-2022 election snapshot, not a long-term average.]

Yet many of our strategies are translatable to other states, with changes defined by local leaders in those states.

Red & blue states graphic

In red states, one cannot simply appeal to political leaders to spend more to improve residents’ health, because:

  • Health is not a core Republican goal for the government
  • Lower-income populations with the greatest health risks are not core Republican constituencies
  • GOP legislators would much rather cut taxes than raise them, especially for government-funded health & social services
  • There is deep GOP skepticism that spending more government money will improve things, anyway.

However, a recent study analyzing two recent decades of national health data, showed that teen prediabetes is now almost as high among white middle-income families, as among lower-income families and families of color.

Prediabetes by ethnicity and income

Source: Liu et al, 2020: Trends in Prediabetes Among Youths in the US From 1999 Through 2018
(summary in CNN). Pre-1980 estimated by HFUS.

Tragically, inactivity and unhealthy nutrition are now so widespread that:

the majority of families at all income levels & of all ethnicities (and therefore of all political parties) are at-risk of chronic disease early in life

In fact, red-states tend to have even higher levels of chronic disease and racial & income disparities—particularly in the South and Midwest.  The below CDC map shows the prevalence of diabetes by state and county, with the darkest colors representing the highest prevalence:

Obesity map
Diabetes stats

Adding to the funding challenges in red-states, the largest philanthropic foundations tend to be concentrated in blue-states—and tend to have a progressive ideological bent that “turns off” red-state political leaders and their “base”.

In addition, non-coastal Western states have many residents, who grew up in other states and then moved to the West—so they tend to have less sense of being part of their new local community, in places like Arizona, than do residents of older states in the Midwest and East. So those more recently arrived residents often give less donations to local charities in their adopted states.

Also, many “Sunbelt” red-state residents are retired and on fixed incomes, and therefore averse to higher taxes—plus a large percentage of them vote.

We make the red-state-friendly “lemonade” by:

  • Connecting the dots to show political leaders the state’s financial self-interest in reducing health costs—and that the only viable way to achieve this is by investing in effective preventive education in schools.
  • Promoting shared public-private investments by those who benefit the most—reducing the cost to the legislature, and gaining the support of the business community, by creating mutual sustainable fundingof which legislatures only pay a minor share.
  • Building high credibility, including buy-in by the health, education & business sectors; utilizing proven, cost-effective, evidence-based programs & policies; with high-ROI sustainable funding strategies and unprecedented accountability. This includes an independent K-12 Prevention Fund to ensure that funds are invested as promised, and that they produce expected results.
  • Much higher than normal accountability for state, private & philanthropic spending, including continual reporting of results & ROI by funder-stakeholder group, and guaranteed “sunsetting”: if it’s not working, the funds stop.

Also, while this is a model that works for red states, it can also work for purple & blue states—which are also under increasing fiscal pressure and demands for real improvements—not just “virtue-signaling”, “woke” talk, corporate PR, & empty promises—which keep failing to move the needle on racial inequities and income inequalities.

Speaking of red-state models: did you see our oped with Heritage Foundation?

Washington Examiner page

Counteracting stereotypes about conservative vs progressive perspectives on health, education & public policy, this nonpartisan opinion piece, A COVID-19 vaccine won’t save us, but improving our health can, was co-authored by Healthy Future US’s Scott Turner and Heritage Foundation’s Lt. Gen. Thomas Spoehr (Ret.). (It was published during the pandemic in the Washington, D.C. “conservative counterpart” to the Washington Post—the Washington Examiner.)

Read More:  Why State and not Federal? 
Read More:  Rising Health Costs Undermine Future Tax Cuts
Read More:  Controlling Government Spending