I am not a lawyer. I am an epidemiologist with an interest in how laws, policies, and regulations affect health outcomes. But, as a scientist, I can’t help noticing when current events combine to produce what is known as a natural experiment. Whenever politicians or six Supreme Court justices (aka politicians in judicial drag) make decisions that affect our lives, there is always a before and an after. In some places laws, policies and regulations don’t change, while in others they do, and we can exploit this kind of variation to understand the public health effect of what these people—some elected, some unelected—have done to us.
Let’s start with a hypothesis: The Supreme Court of the United States (SCOTUS) is hazardous to your health. In the language of epidemiology, we think of exposures and outcomes, one leading to the other: For example, we know that smoking cigarettes (exposure) causes cancer (outcome). But we have to refine our hypothesis here, make it more specific: The current Supreme Court, with its six conservative justices, is hazardous to your health.
Health is a broad term, so can we narrow down the court’s impact on our survival and well-being? Let’s try. In fact, SCOTUS has supplied us with a series of natural experiments—two in the past week alone—and several others over the past few months.
First up, Dobbs v. Jackson Women’s Health Organization, in which the six conservative justices on the current Supreme Court struck down Roe v. Wade, paving the way for abortion to become illegal immediately or soon in 16 states, with more to follow. The first outcome to consider is maternal mortality. Despite the protests on the right, the evidence on the relative safety of legal induced abortion in the United States compared with childbirth is clear: The risk of death associated with childbirth is approximately 14 times higher than the risk from abortion, according to a 2012 study. This stark difference has been well-known for decades, although the precise magnitude of the effect has varied in studies and over time.
But health isn’t just about survival; it’s also about well-being and human flourishing. In that light, we might consider the broader impact of this decision on pregnant and postpartum people’s lives. Some 150 economists have already weighed in with an amicus brief to the court in Dobbs. As Caitlin Myers, the John G. McCullough Professor of Economics at Middlebury College, has noted: “Access to abortion has been found to increase women’s educational attainment, labor force participation, entrance into professional occupations and earnings, and to decrease financial stress and poverty for women and their families.” That is, the experiments have been done comparing states that have already drastically curtailed abortion access with those where abortion is more accessible—but data be damned, John Roberts waved away any discussion of such evidence during oral arguments last December.
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Next up: New York State Rifle & Pistol Association v. Bruen, in which the six conservative justices struck down New York’s law against carrying a firearm in public without a specific reason or “proper cause” to do so (e.g., a pattern of physical threats). Clarence Thomas, who wrote the opinion, paved the way for further erosion of gun control measures, according to some legal commentators. What will be the impact of this decision and possible subsequent actions by the court?
Federal funding for gun violence research has been banned since 1996 under the Dickey amendment, which makes collecting such data, analyzing it, or publishing it incredibly difficult. However according to one Rand Corporation study, implementing combinations of gun control measures could have small but significant effects. And, as another Rand study notes, even if “the empirical evidence remains ambiguous, there are sufficiently compelling theoretical or logical arguments to justify individuals and policymakers choosing to assume that gun availability does increase” health risks.
In March 2020, federal funds started flowing again for gun violence research—and it could not have come at a better moment. We’ve lost precious time in documenting the effects of American gun policy as the body count continues to mount. (Incidentally, it’s not just on guns that vital research has been impeded. President Reagan and Surgeon General C. Everett Koop undermined research on abortion at the Centers for Disease Control and Prevention in the 1980s.) John Roberts isn’t the only one who dismisses empirical evidence; Republicans don’t want anyone to know the answers.
These two rulings from last week have momentous implications for public health, and epidemiologists and economists—who share a goal of understanding how policy impacts people and estimating the causal effects of exposures on outcomes—have a lot to do to understand what Roberts, Alito, Kavanaugh, Thomas, Gorsuch, and Barrett have wrought. Because, as the social epidemiologist Nancy Krieger at Harvard has said, causal stories transform problems from the realm of fate into the realm of human agency—which means we can do something about them. These five men and one woman would like to hide behind the bench or their judicial robes, appealing to the law and history as they conceive it.
But the tools of science can be used to document the grave harms they will cause, in measurable detail. This evidence can then be used, not to change their minds (which have been shown to be impervious to evidence) but to make the case against them and the politicians who put them in these lifetime posts, to tell the tale of the deadly, immiserating consequences of their actions. It’s up to all of us to prosecute this case, to organize with this evidence in our hands, to do justice where these justices will not.
