The 1965 Voting Rights Act removed voting burdens from Black Americans. In 1975, Congress expanded protections for other groups, including Hispanic Americans and Native Americans. Among other measures, the newer law mandated bilingual ballots in certain states or districts.
In a recent working paper for the National Bureau of Economic Research, Institution for Social and Policy Studies faculty fellow Rourke O’Brien and his colleagues showed that expanding voting rights in 1975 improved material conditions for everyone and immediately reduced mortality for non-white groups.
But their analysis also found that the new law increased mortality for white people, especially lower-educated whites.
We spoke with O’Brien, associate professor of sociology, about how perceived loss of racial status likely contributed to this secondary finding.
The lead author on the study was Atheendar Venkataramani, associate professor of medical ethics and health policy and the University of Pennsylvania’s Perelman School of Medicine. Other authors included Elizabeth Bair, senior statistical analyst at the University of Pennsylvania’s Department of Medical Ethics and Health Policy; and Christopher Lowenstein, a postdoctoral scholar at the University of Missouri’s Department of Economics.
ISPS: What sparked your interest in studying the health impacts of extending voting rights?
Rourke O’Brien: This originates from a larger research agenda in which we have been exploring how shocks to opportunity structures might have downstream health effects on the population. We are exploring another way to conceptualize opportunity, through participation in political life.
ISPS: What do you mean by opportunity structures?
O’Brien: These are social, economic, and institutional pathways that can change what’s viable for you and your family. Including policies that promote upward economic mobility or shift political power. We study them because we know, for example, that when you empower underprivileged minority populations, that leads to discernable improvements for those groups that we can measure.
ISPS: Why study the Voting Rights Act’s 1975 extension rather than the original 1965 Act?
O’Brien: Other studies have examined the 1965 law, but it’s difficult to do as there were simply too many confounding policy changes in the mid 60s. That’s when you get Medicaid, Medicare, food stamps. All of these major changes make it difficult to isolate the effect of any one policy or program.
ISPS: What makes 1975 a better test case?
O’Brien: The 1975 extension had unique properties to it. For one, it came as something of a surprise. No one was necessarily thinking it was going to happen. There was also a clear goal of extending coverage in Spanish-speaking and Native American communities. And there was already a decade of evidence on what the VRA could do. 1975 provided us with what we call a quasi-experimental setup. A natural policy experiment.
ISPS: What did you find?
O’Brien: We saw a decrease in relative mortality for most non-white cohorts in counties newly covered by the law. That’s what we expected.
ISPS: And you had an unexpected result.
O’Brien: We saw an increase in mortality for white adults and for older non-white men.
ISPS: Was that the only surprise?
O’Brien: The speed of this effect was also surprising. We saw an almost instant improvement for non-whites and an almost instant deterioration for whites.
ISPS: What does that indicate?
O’Brien: It was too fast for changes in policy, funding, or services. Which supports an explanation that relies on psychosocial mechanisms instead.
ISPS: What do you mean by that?
O’Brien: We mean that these initial effects are probably not operating through material outcomes. But instead stemming from a change to social and political reality that altered folks’ sense of relative status, which in turn impacted individual thoughts and behaviors.
ISPS: What does that mean in the context of this voting rights expansion?
O’Brien: Humans are very conscious of status. We are like status-sorting machines. Changes in voting rights can feel like a direct loss of standing to one group at the same time it is a gain to others.
ISPS: Why is that?
O’Brien: Politics, to some extent, can be perceived as a zero-sum game. One in which empowering one group will dilute another group’s relative power.
ISPS: And you propose that this felt sense of lost standing translated to stress-related health deterioration?
O’Brien: Yes. The white adult mortality increases were concentrated in cardiovascular deaths, which would be consistent with stress responses.
ISPS: You also consulted survey data from the time.
O’Brien: Surveys showed that white adults in the counties newly covered by the VRA thought Black people’s position was improving and started identifying more often as Republican. This supports the idea that people noticed the change and perhaps reacted emotionally. Remember this is the 1970s. Inflation is high, wages are stagnating. Against the backdrop of a weakening economy, status threat hits harder.
ISPS: How did you rule out alternative explanations?
O’Brien: There aren’t many plausible alternative explanations for such an immediate effect. In the medium-run, material conditions improved for everyone, which should reduce mortality, not increase it. We found improvements in incomes, education, and health care spending. Yet we still have this divided demographic pattern that no alternative explanation fits.
ISPS: You also tested and ruled out what’s known as the Tuskegee effect, right?
