Political Determinants of Health: Mayoral Governance and Deaths of Despair in Urban American Peer Counties

Deaths of despair (15+ years) are described for two peer county groups. Each county experienced competitive, transitional, or monopoly governance based on the duration of one political party’s control. Highest mortality among non-Hispanic Black (Black) people occurred in monopolies, affecting all age-sex-specific groups from 15–19 to 65–69. Transition to Democratic or Republican party monopolies produced similar overall trends. Governance by the same political party produced different rates depending on the length of one-party control. Black: White mortality rate ratios were reduced or reached 1.0 in competitive counties, and 51,801 fewer Black deaths might have occurred in monopoly counties based on competitive rates. The association between duration of one-party control and death rates was statistically significant and independent of state gun law strength. The data generate a hypothetical framework for structural racism based on political privilege/political monopoly rather than racial privilege/political affiliation. Analytic epidemiologic research is needed for testing.