Last week, my April 6 blog “Your Health: Where you Live Matters” talked about the uneven geography of health, a phenomenon that can be seen at relatively small scales, such as variations in health within a city, or broader scales such as the county or regional scale.
A new study (Chetty et al. 2017) sheds further light on the importance of geography of life expectancy, and ultimately health status and the factors shaping health status, in the United States. In short, geography matters more for the poor when we consider life expectancy. Before we look at the results of their work, lets start with statistics published by the Population Reference Bureau. Based on data in their 2016 World Population Data Sheet, a male in the US can expect to live 76 years from birth, and a female 81 years.
This data, of course, does not account for income, location, race and other factors that can lead to differential life expectancy. Chetty’s work better reveals the role of geography. Although the poor living in urban areas have life expectancies that are, on average, similar to middle income Americans, poor adults in other locations have some of the lowest life expectancies and that are equivalent to those seen in much poorer countries. In the Terre Haute, Indiana area for example, a 40 year old with a household income of less than $28,000 has a life expectancy of just 76.5 years (Chetty et al 2017). Corpus Christi (TX), Midland (TX), Elko (NV), and several other areas have life expectancies that are well below the national average. Compare that to the life expectancy of an individual living in the New York City area with an income below $28,000: 81.8 years. The poor living in the Bellingham, Washington area have an even greater life expectancy: 82.2 years. Moreover, the life expectancy of America’s poor is decreasing, and the gap in life expectancy between rich and poor Americans is growing.
So what accounts for these differences and what can be done to improve the health of poor Americans? To answer the first part of that question, it could be argued that the wealthier are able to buy more and better health insurance. But its much more complicated: the wealthy also live differently, with lower levels of smoking, lower rates of drug abuse, and a lower likelihood of being obese. The relationship may also be the reverse: being unhealthy makes it more difficult for an individual to maintain secure income and employment. The poor (on average), meanwhile, are more likely to smoke, more likely to abuse drugs, and are more likely to be obese.
The potential silver-lining of this work is that ‘big picture’ fixes are not the only remedies. Don’t get me wrong – national medical programs such as Medicare, Medicaid, and The Affordable Care Act (“ObamaCare”) are important in providing access to health care and improved quality of health for poor Americans that were previously uninsured. The danger in rolling back access is that millions of Americans would no longer have health care, creating further inequalities in the coming years. Instead, local policies, including access to education and job opportunities that help the poor adopt and maintain healthier lifestyles by addressing smoking, drinking, drug abuse or obesity, are at least equally important. Better access and uptake of preventative health care programs by the poor are also important. The question for local areas, and researchers more broadly, is to understand what works to improve health, while recognizing that it may not be a ‘one size fits all’ solution.
Neil Irwin and Quoctrung Bui. The Rich Live Longer Everywhere. For the Poor, Geography Matters, The New York Times, 11 April 2016.