Since the 1980s, rural and urban Americans have diverged on a variety of important health indicators. Today, rural Americans live four years shorter than their urban counterparts. These differences are larger than in any other wealthy democracy.
That’s the puzzle animating political scientist Michael Shepherd’s book manuscript, tentatively titled Unhealthy Democracy: How Partisan Politics is Killing Rural America. In this talk at BESI, recorded on March 16, 2025, Shepherd shows how partisan politics at elite and mass levels explain the growing rural-urban health divide in the US.
Shepherd argues Republican policies at the federal and state level uniquely undermine rural health. At the same time, he says, Republican appeals to race and rural culture have allowed them to bring even the sick and poor in rural communities into the Republican fold, blunting accountability for their policies. These patterns have created the rural health spiral, where the worse outcomes get in rural America, the more voters turn away from government and to Republicans, which in turn further worsens rural health.
