Are culture wars costing lives?

Culture wars have pitted conservatives against moderates and liberals and Republicans against Democrats in a struggle for dominance of beliefs, policies and laws. 

Culture wars have existed for decades but have been escalating in ferocity over the past several years in many states. Current culture wars include calls against critical race theory, restrictions on transgender athlete competition, banning books in school libraries, abolition of diversity, equity and inclusion programs, restrictions on transgender medical care for children, challenges to reproductive rights and the anti-woke movement.  

Lost in this conversation is the notion that cultural wars, like other wars, are claiming lives. 

When one examines the leading causes of death in the U.S., we find major age-related differences. We also see that culture war issues affect leading causes of death in all age groups.

In children, the leading causes of death are unintentional injury, suicide and homicide.  A common link among these pediatric deaths is firearms. Just over the past year, firearms passed accidents as the leading cause of death in children. Despite recognition of this problem and a seemingly endless stream of mass shootings using assault-style weapons, there has been little, if any, legislative action to address gun safety issues. In fact, gun control regulations may be moving backward.  Five years after the shooting massacre in Parkland, Fla., which resulted in the murder of 14 children and three adults, culture wars are now calling for open carry laws with minimal restriction in that state. 

Conservative culture war proponents claim that mental health issues underlie mass shootings and mental and behavioral health should be addressed to curb the problem.  We also see bipartisan recognition of the escalating mental health crisis affecting children and in the U.S., along with a clarion call to address it.  

However, culture wars are interfering with these efforts.  Under the guise of parental rights, guidance counselors in some states are banned from having open, confidential conversations with children about what bothers them. School mental health programs in some areas are prohibited from focusing on social and emotional learning, which can help children deal with stress. Culture wars now mean that the notion of parental rights is also being applied to education in unclear ways, but not when it comes to gender-affirming care where personal parental and child medical decisions are ignored.   

During the pandemic, in-person versus remote learning was a fractious issue, with the consequences of remote learning and lack of socialization recognized. We also saw anti-mask movements spill over into the school setting with claims that mask-wearing disrupts the child’s education and socialization. As recommended by the pediatric community, it is wonderful to see children and adolescents back in school and socializing. Yet the mental and behavioral health consequences of the pandemic linger, and children are under more stress and are more despondent than at any time in recent history, stress that is also affecting parents.  

At a time when children need less, not more stress in their lives, students and teachers in many states are having to deal with political-induced stresses. Culture clashes in schools for the sake of parental rights now reach down into influencing what books children can read at a time when fewer children read books, what subject matter teachers can discuss at a time there are massive teacher shortages, and how Black studies can be taught.  

We are also seeing states now refusing to participate in a critically important national survey to assess the well-being of youth, meaning that assessing the state of pediatric mental health will be even more challenging. These clashes are also spilling over into higher education. One must ask, are these restrictions a greater imposition on student speech, thought and socialization than face masks? 

Without making a judgment related to causality, we need to recognize that gun-related deaths, suicides and homicides are greater in states where these culture clashes are influencing legislation than in those where they are not.  But it is important that we recognize causality. 

In young adults from 25 to 45 years old, the leading cause of death is unintentional injury, with drug overdoses predominating.  Rates of overdose deaths have increased by 30 percent over the past three years. In 2022, more than 100,000 people died of drug overdoses, with young adults predominating. 

Culture wars have led to the stigmatization of the drug user rather than the recognition that action is needed for death prevention efforts and treatment. Whereas some states have attempted to stop acute deaths by making the opioid antidote naloxone widely available and encouraging treatment program access, there is a pervasive notion that increasing naloxone availability or supporting needle exchange programs to combat drug-use-related infections will promote drug use rather than being useful public health measures. It is gratifying to see some states now pivoting to implement programs that will reduce drug-related deaths and encourage treatment programs.  Yet, we must recognize that opioid deaths are high in many states with culture wars.   

Shifting to those individuals who are 55 years of age and older, we find that COVID-19 is the third leading cause of death, following cancer and heart disease. When COVID-19 vaccines became available at the end of 2020, there was national enthusiasm for vaccination and long lines at vaccination centers.  However, by early 2021 we saw the rise of COVID-19 vaccine disinformation and the rising influence of the anti-vaccine movement in Republican Party politics as this was recognized as a political wedge issue. By the spring of 2021, the U.S. saw a decline in vaccination rates.  The sad fact about vaccination culture wars is that political affiliation is one of the greatest risk factors for COVID-19-related deaths.   Adjusting for age, COVID-19 deaths are higher in red counties than in blue counties, with rural America hit particularly hard.  

Whereas it might be tempting to believe that the impact of culture wars is limited to policy decisions related to ideology and morality, data show otherwise. The culture wars directly affect our health and mortality, and that of our children who have little say in these matters.  We need to ask ourselves are these political wedge issues worth it. 

Scott A. Rivkees, M.D. is a professor of practice at the Brown School of Public Health. He is the former state surgeon general and secretary of health of Florida.