Yet by the 2020s, demographic change, public policy and COVID-19 do not fully account for the widening gap in mortality rates. Public opinion data are consistent with a second mechanism: declining trust in medical professionals among right-leaning individuals, including lower willingness to seek care, follow clinical advice or believe in medication effectiveness, even for issues unrelated to COVID-19. These patterns suggest that growing ideological divides in health behaviours are leaving conservative Americans increasingly vulnerable to preventable health risks.