Linking Data on Constituent Health with Elected Officials’ Opinions: Associations Between Urban Health Disparities and Mayoral Officials’ Beliefs about Health Disparities in their Cities

Original Scholarship Health disparities

Policy Points:

  • Mayoral officials’ opinions about the existence and fairness of health disparities in their city are positively associated with the magnitude of income-based life expectancy disparity in their city.
  • Associations between mayoral officials’ opinions about health disparities in their city and the magnitude of life expectancy disparity in their city are not moderated by the social or fiscal ideology of mayoral officials or the ideology of their constituents.
  • Highly visible and publicized information about mortality disparities, such as that related to COVID-19 disparities, has potential to elevate elected officials’ perceptions of the severity of health disparities and influence their opinions about the issue.

Context: A substantive body of research has explored what factors influence elected officials’ opinions about health issues. However, no studies have assessed the potential influence of the health of an elected official’s constituents. We assessed whether the magnitude of income-based life expectancy disparity within a city was associated with the opinions of that city’s mayoral official (i.e., mayor or deputy mayor) about health disparities in their city.

Methods: The independent variable was the magnitude of income-based life expectancy disparity in US cities. The magnitude was determined by linking 2010-2015 estimates of life expectancy and median household income for 8,434 census tracts in 224 cities. The dependent variables were mayoral officials’ opinions from a 2016 survey about the existence and fairness of health disparities in their city (n = 224, response rate 30.3%). Multivariable logistic regression was used to adjust for characteristics of mayoral officials (e.g., ideology) and city characteristics.

Findings: In cities in the highest income-based life expectancy disparity quartile, 50.0% of mayoral officials “strongly agreed” that health disparities existed and 52.7% believed health disparities were “very unfair.” In comparison, among mayoral officials in cities in the lowest disparity quartile 33.9% “strongly agreed” that health disparities existed and 22.2% believed the disparities were “very unfair.” A 1-year-larger income-based life expectancy disparity in a city was associated with 25% higher odds that the city’s mayoral official would “strongly agree” that health disparities existed (odds ratio [OR] = 1.25; P = .04) and twice the odds that the city’s mayoral official would believe that such disparities were “very unfair” (OR = 2.24; P <.001).

Conclusions: Mayoral officials’ opinions about health disparities in their jurisdictions are generally aligned with, and potentially influenced by, information about the magnitude of income-based life expectancy disparities among their constituents.

Keywords: health disparities, urban health, small area estimation, local policymaking.

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Citation:
Purtle J, Joshi R, Lê-Scherban F, Henson RM, Diez Roux AV. Linking Data on Constituent Health with Elected Officials' Opinions: Associations Between Urban Health Disparities and Mayoral Officials' Beliefs About Health Disparities in Their Cities. Milbank Q. 2021;99(3):794-827. https://doi.org/10.1111/1468-0009.12501