Hi. This is Michael C. Patterson, and welcome to the 2026 version of the Flourish As You Age podcast, which I’m calling Flourish In Times of Struggle.
Each episode of this series is an invitation to think together about how older adults—and really, people of all ages—can stay steady, compassionate, and engaged in a time when cruelty, corruption, and division have become increasingly normalized.
This series focuses on what helps us—and the people we love—to flourish even when the social and political landscape feels unstable.
My hope is that these conversations help prepare us for the hard, necessary discussions with our families, communities, and neighbors—and for the meaningful actions this moment requires. Together, we can begin to envision, and work toward, a future in which we and our grandchildren can flourish with dignity and purpose.
In this episode, I want to explore the connection between flourishing and geography.
What if I told you that simply crossing a state line could change how long you live—by years?
Not because the air suddenly becomes magical.
Not because your DNA rearranges itself.
But because the rules of the game are different.
The wages you earn.
The schools your children attend.
Whether you can afford healthcare.
The safety of your streets.
And the amount of stress your body carries every single day.
Today, we’re exploring the research of sociologist and demographer Jennifer Karas Montez, whose work delivers a blunt and unsettling message:
In today’s United States, life expectancy is increasingly shaped by the state you live in.
This is not just about medicine.
It’s about policy as a life-shaping force.
Across U.S. states, the gap between the places with the longest and shortest life expectancy is now about seven years—the largest gap in modern American history.
That means a child born in one state can reasonably expect to live into their mid-80s, while a child born elsewhere may struggle to reach their late 70s.
Same country.
Same medical technology.
Radically different outcomes.
Montez and her colleagues analyzed decades of life-expectancy data alongside state policy decisions—covering wages, labor protections, Medicaid access, education funding, environmental rules, gun safety, and family support.
Their conclusion is stark:
State policies—what our elected officials choose to do or not do—have become major drivers of how long we live.
If every state enjoyed the health advantages of the most protective policy environments, U.S. life expectancy would be more than two years longer nationwide.
That’s a stunning impact—from laws alone.
Let’s make this concrete.
Across multiple decades of data, the states with the longest life expectancy consistently include:
Hawaii, California, Oregon, Washington, Colorado, Minnesota, Massachusetts, Connecticut, New York, New Jersey, and Vermont.
These states tend to share common features:
- Stronger labor protections and higher wages
- Broader access to health insurance through Medicaid expansion
- Greater investment in public health
- Stronger environmental protections
- More robust education funding
- Tighter tobacco and gun regulations
These are also states governed largely by Democratic majorities over the last generation, reflecting what Montez calls “liberal policy bundles.” Their life-expectancy curves rise steadily.
At the other end of the spectrum are states with the shortest life expectancy and highest disability burdens:
West Virginia, Mississippi, Alabama, Arkansas, Louisiana, Kentucky, Oklahoma, Tennessee, and South Carolina.
These states tend to have:
- Lower minimum wages
- Weaker worker protections
- Reduced public-health spending
- Limited Medicaid access
- Higher poverty and food insecurity
- Looser gun regulations
- Fewer family supports
They are also states governed primarily by Republican majorities, reflecting more conservative policy environments. Their life-expectancy gains have stalled—or reversed—especially since 2010.
What’s striking isn’t just that these differences exist.
It’s that they have widened as states have grown more politically polarized.
As states drift apart ideologically, they are also drifting apart biologically.
In case you’re wondering, Texas isn’t counted among the states with the very shortest life expectancies—but it is below the national average, and the trend in recent years has been moving in the wrong direction.
We usually think of health as personal.
Did I exercise?
What did I eat?
Do I smoke?
Do I meditate?
All of that matters. But Montez shows that policy is a powerful upstream health technology—one we rarely name as such.
Her team examined 18 domains of state policy, from labor and taxes to healthcare, guns, tobacco, and civil rights.
They found that:
- States adopting more protective social and economic policies gained years of life
- States adopting more restrictive policy regimes lost ground
Shifting a state toward a more protective policy environment can add roughly two years of life expectancy. Shifting in the opposite direction subtracts years.
In other words:
The law book is quietly shaping your biology.
This isn’t just about survival. It’s about functional life.
Montez also studied disability-free life expectancy—how long people live without major mobility or health limitations.
For women, that number ranged from about 46 years in West Virginia to more than 52 years in Hawaii. Men show the same pattern.
In the Deep South, people don’t just live shorter lives. They spend more of those years living with disability and chronic illness.
Montez calls this a double disadvantage:
Shorter lives.
Sicker lives.
So when we talk about healthy aging, we are also talking about healthy states.
Two groups stand out in Montez’s findings: women and people without college degrees.
State policy environments shape:
- Paid leave
- Minimum wages
- Childcare access
- Reproductive autonomy
- Workplace protections
These factors disproportionately affect women’s health trajectories across the lifespan—from early adulthood through old age.
Education matters, too—but not in isolation.
A high school diploma in a state with higher wages, Medicaid expansion, safer workplaces, and stronger public services produces a very different life course than the same diploma in a low-investment environment.
Place magnifies—or mitigates—personal resources.
In childhood, policy shapes schools, nutrition, environmental safety, and healthcare access.
In working adulthood, it shapes job security, medical coverage, family leave, and debt burdens.
In later life, it shapes housing access, mobility supports, long-term care, and social connection.
These influences accumulate biologically—through chronic stress, immune function, cardiovascular strain, and brain health.
Place literally shapes tissue.
Where you live influences how your organs function, how well they recover from disease, and how resilient they remain over time.
So what do we do with all of this?
One of the most important lessons from Montez’s research is this: policy isn’t abstract.
It’s not just ideology or budget lines. Policy shapes how long we live, how healthy those years are, and how hard daily life feels along the way.
The people we elect—and the choices they make—affect far more than our pocketbooks. They shape our access to healthcare, education, housing, transportation, and social support. In very real ways, they shape our chances to stay healthy and to flourish.
When states cut back on social supports, they aren’t just “saving money.” They are making life harder—harder to manage illness, harder to recover from setbacks, harder to age well. Over time, those choices show up in shorter lives and wider health gaps.
That’s why it matters to pay attention close to home. Look at your state’s trajectory. Look at local budgets. Ask where your tax dollars are going. In many places, far more money is spent on policing and crisis response than on healthcare, prevention, or community well-being.
That imbalance has consequences—not just for public safety, but for long-term health.
And when you vote, it helps to vote with lifespan in mind. Not just, “Will this help me this year?” but, “What kind of health environment does this create over decades—for children, for elders, for people living on the margins?”
Health isn’t produced only in hospitals or doctors’ offices. It’s shaped locally—by the supports that help people absorb stress, weather hardship, and stay connected. Strengthening those supports may be one of the most powerful things communities can do to protect health, even when larger systems fall short.
And that brings us to a different way of thinking about responsibility—not as blame placed on individuals, but as the design choices we make together.
When people are struggling, the question isn’t simply, “Why didn’t they try harder?” or “What’s wrong with them?”
It’s: “What kind of system are they being asked to survive in?”
Who does that system actually work for?
Does it support general flourishing—or does it enrich one sector of the population at the expense of everyone else?
Is it designed to be fair and sustaining—or quietly rigged to concentrate power and opportunity at the top?
Before we close, we need to look honestly at the national moment we’re living through.
Montez’s research makes something unmistakably clear: strong democratic institutions and robust social supports are not luxuries. They are the scaffolding that holds up health, longevity, and shared well-being.
When those systems weaken, life expectancy falls.
When rights erode, stress rises.
When safety nets shrink, people live shorter, sicker lives.
Many of those systems are now under open threat.
Donald Trump has made clear his intention to dismantle democratic guardrails, weaken the civil service, centralize executive power, roll back environmental protections, undermine public-health agencies, and slash social supports. We have already seen what this looks like in practice—from attacks on voting rights to the erosion of institutions that support families, workers, elders, and those with the least economic security.
From a public-health perspective, these are not abstract political disputes.
They are predictors of shorter lives.
And here is the bitter irony: many of the regions that have suffered the steepest declines in life expectancy—Appalachia, the Deep South, and many rural communities—are also the places that have most strongly supported this agenda.
The policies offered in their name have not made life safer or healthier. They have made it harder, shorter, and more burdened by illness, poverty, addiction, and despair.
If where we live shapes how long we live, then who we choose to lead us shapes the health of the entire landscape.
Defending democracy still matters. But Montez’s work presses us toward something even more demanding: re-imagining democracy itself.
Too many of the systems we inherited were designed to stabilize power and concentrate wealth, rather than to cultivate shared flourishing. As those fragile and often unjust structures are now being torn apart, we find ourselves in a moment of real danger—but also one of rare consequence.
This rupture, however painful, invites us to redesign our institutions around care rather than control, dignity rather than domination, sustainability rather than extraction.
Because the final lesson here is simple—and profound:
It’s not enough to live longer.
The real task is to build a world where everyone can live longer and better—with more health, more meaning, more connection, and more years of genuine flourishing.
In that sense, creating a just and caring society may be the most important public-health intervention of our time—because the systems we build will decide not only how long we live, but how well.
