When it comes to international comparisons, every social, economic, and health indicator out there has a similar, familiar shape. First, economic prosperity tends to help a great deal in ensuring countries become healthier, fairer, and happier all around. When you plot any figure on a chart (life expectancy, social mobility, sheer joie de vivre), the relationship is pretty linear. Money is not everything, but it helps a ton.
Second, in every single chart, there is a country that is out there in a corner, floating by itself, breaking the trend. A country that is incredibly wealthy, often to a comical level, and yet it has worse health outcomes, worse social mobility, and folks consumed by endless angst and despair. A country that should be incredibly great by income, and yet it just does terribly in pretty much anything we care about.
That country is, sadly, the United States.
Take life expectancy, for instance. Americans live on average, 4.1 years less than other wealthy countries, despite being much wealthier. Child poverty is much higher, as well as child mortality. School achievement is often worse; social mobility, lower; homicide rates, higher. We are much more likely than Europeans to face all kinds of tragedies and illnesses, from substance abuse to dying in a car crash. We are consistently unhappier. Our cars, houses, and TVs are bigger, and we have a ton more money, but it doesn’t seem to add up to much.
This persistent disconnect between our outrageous wealth and poor outcomes is often blamed on income inequality. Wealthy Americans are much wealthier than wealthy Europeans, while working Americans are often poorer than their European counterparts. This is indeed the case, but it tends to hide something important: our massive, persistent regional disparities.
Let’s go back to life expectancy. If we take the U.S. as a whole, our numbers are indeed terrible. If we look at those statistics in more detail, however, it quickly becomes evident that there are quite a few states that look “normal” by international comparisons—that is, they have close to the high life expectancy figures you would expect in a wealthy nation. Places like California, New York, New Jersey, Minnesota, Washington, or pretty much the whole of New England are fine. Not exactly Spain, Japan, or France (the big outliers with great health outcomes), but something that wouldn’t look out of place in Central Europe.
This pattern persists across the board. Homicide rates in the U.S. are much higher than in the rest of developed nations, on aggregate. The homicide rate in America is more than eight times the rate of my native Spain. Broken down by state, however, the difference is much narrower; New England is about twice as dangerous as France, and “only” three times higher than the (unusually safe) Spain. School achievement in New England, Minnesota, or Washington is as good or better than in any European country. Even if we look at wages at the bottom of the income scale, these states treat workers as well as, or better than, Germany or France.
This might look like cherry-picking, except that the states that look “normal” tend to have one big thing in common: they are coastal and northern, overwhelmingly blue, and all have taken similar policy decisions in things relating to healthcare, labor rights, social services, and taxation. They have higher minimum wages, large Medicaid programs, stronger labor protections, spend a lot more on education, and, coincidentally, have the kind of non-embarrassing outcomes that I described above. They are not quite “normal” because there are quite a few federal policies they cannot quite shake themselves off (gun rights, for instance), but they are all fine places to live.
At the same time, the U.S. has huge swaths of the country with absolutely dreadful indicators—so awful as to crater national averages. Mississippi’s homicide rate is thirty-eight times higher than Spain’s. Its life expectancy is below Mexico, Brazil, or Albania. The places that fall consistently at the bottom here are, unsurprisingly, mostly in the South and middle of the country, and they are, also unsurprisingly, mostly run by Republicans, taking the opposite policy positions from their blue counterparts. They are the places that look incredibly out of place in any international comparison and that drag U.S. averages down.
Interestingly, these huge disparities between blue and red states are fairly new. From World War II to around 1980, the South was poorer than Northern and coastal states, but those disparities were closing rapidly. Starting around the Reagan presidency, as Republicans took control of the old South and became dominant in rural areas, the regional convergence not only stopped but reversed itself. The Southern states are not poorer and less healthy than the Northern ones by accident, but as a consequence of decades of policy choices.
Do not be mistaken. Blue states have plenty of problems, starting with our persistent inability to build enough housing and deal with a very real affordability crisis. Our social services could be better, and we could have stronger labor rights. Overall, however, they are much better places to live in many, many ways, and much more “normal” than what conservatives call “Real America.”