Parts of the U.S. where gains in life expectancy during recent decades fell below the national average were also areas where Donald Trump was more likely to outperform Hillary Clinton in the 2016 presidential election, according to recent research.

“If you’re in a county with above-average life expectancy gains, you were much more likely to vote for Hillary, and if you were in a county with below-average life expectancy gains, you were much more likely to vote for Trump,” Jacob Bor, author of the study, published online in the American Journal of Public Health in August, told HuffPost.

While life expectancy in the U.S. grew by an average of 5.3 years between 1980 and 2014, that increase failed to reach some parts of the country, with 781 counties reporting less than three years in life expectancy gains during that time.

Bor, an assistant professor of global health at Boston University’s School of Public Health, compared Trump’s vote totals with that for Republican nominee John McCain in 2008 (the most recent presidential election in which a White House incumbent wasn’t on the ballot), and compared the numbers to country-level life expectancy data from the Institute for Health Metrics and Evaluation.

Bor found that in the 781 counties with the below-average life expectancy gains, the GOP vote increased by 9.1 percentage points in 2016 compared with 2008.

In counties where life expectancy gains exceeded seven years, meanwhile, the Democratic vote increased by 3.5 percentage points in 2016 compared with 2008.

Also, Bor’s study found that for each additional year of life expectancy a county gained above the norm, the Republican vote share fell by 2.3 percentage points.

Bor noted that “a lot of the dialogue” about the 2016 election has been about the divergence in “economic opportunity” between Trump and Clinton voters. But he said his research shows that health disparities also define the two camps. 

Although U.S. life expectancy continues to increase nationally, those gains have slowed in recent years. According to a research published in the Journal of the American Medical Association this month, national life expectancy only increased by two years ― to 78.8 years ― between 2000 and 2015.

Trump’s administration so far has advocated for repealing and replacing the Affordable Care Act, reducing food stamp funding and cutting budgets for medical and public health research. 

“A vote for Trump is a vote that’s essentially against public policy, against public action, including government action to support public health,” Bor said. “There’s this deep irony here, in that people are voting for the president and party that are promising to enact policies that are very likely to further harm their health.” 

“The standard of living and quality of life of the majority of the working class of the U.S. has been declining,” Dr. Vicente Navarro, a health policy researcher at the Bloomberg School of Public Health at Johns Hopkins University told Reuters.

“They are angry and channel their anger against what they consider the political establishment, voting for Trump.”

Bor said he believes his research underscores the potential for build political coalitions around addressing health deficits. 

People in many parts of the U.S. “had lots of very real grievances and here’s one very real life-and-death grievance: population health stagnating, amid massive gains in population health in other parts of the country,” Bor said. 

“I would hope that if a political party could deliver massive life expectancy gains to people in this country, then it would be rewarded.” 

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