Expanding the Ballot: New Research Explores the Health Effects of the 1975 Voting Rights Act

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?

O’Brien: Correct. Revelation of the Tuskegee study of untreated syphilis in 1972 has been linked to increased medical mistrust and worse health outcomes among older Black Men. That could have confounded our findings for nonwhite men over 50. But the Tuskegee revelation happened three years before the VRA extension. For example, if this effect were the main driver, we should have seen mortality increases earlier and across all counties, not just those in VRA-covered areas after 1975. We did not see anything that can explain the specific, localized mortality patterns after the VRA extension.

ISPS: Science seeks to clarify, but it often presents a complicated or even counter-intuitive reality. What would you say to someone who might look at your study and argue against social justice reforms?

O’Brien: For one, this was 50 years ago. That was an extremely different time economically and politically. We cannot neatly extrapolate to the present. But I also think it’s important take seriously these processes of backlash. If a policy is perceived to benefit one group, you can have unintended and uneven effects. If you think other groups are getting ahead and you are not, that leads you to become frustrated.

ISPS: Which seems perhaps more of a communications issue than a policy design issue.

O’Brien: Exactly. There is a difference between the reality and the perception. The bottom line is that after the Voting Rights Act, everyone in newly covered counties was made materially better off on average.

ISPS: Do you see any other parallels to today?

O’Brien: I think our current political climate is shaped more by geographic inequality, declining economic mobility, cultural resentment, and politicians stoking aggrievement. American society feels increasingly like a hyper-competitive rat race. People feel like the system is rigged and the American Dream is getting harder to achieve. It leads to frustration. And frustration can have tangible effects.

ISPS: What would you like people to take away from this study?

O’Brien: In short, our study highlights complexity, not a case against equity. It suggests that health outcomes are shaped not only by material conditions but also by perceptions of status. Recognizing this can help policymakers design reforms that minimize unintended harms while advancing justice.