Dying Sooner: The New US Pattern

What the hell is wrong with this country? That is what came to my mind when I read a recent PLoS article “The Reversal of Fortunes: Trends in Country Mortality and Cross-County Mortality Disparities in the United States.” The basic conclusion: life expectancy is going DOWN in parts of the United States. How can that be?!

Here is what the PLoS article tells us: From 1983 to 1999, life expectancy declined significantly in 11 US counties for men and in 180 (!) counties for women. Why? “Life expectancy decline in both sexes was caused by increased mortality from lung cancer, chronic obstructive pulmonary disease, diabetes, and a range of other noncommunicable diseases, which were no longer compensated for by the decline in cardiovascular mortality [driven largely by better drugs and interventions]. Higher HIV/AIDS and homicide deaths also contributed substantially to life expectancy decline for men, but not for women.”

In their conclusions, the authors Majid Ezzati, Ari Friedman, Sandeep Kulkarni, and Christopher Murray single out some specific health problems: “The epidemiological (disease-specific) patterns of female mortality rise are consistent with the geographical patterns of, and trends in, smoking, high blood pressure, and obesity. In particular, the sex and cohort patterns of the increase in lung cancer and chronic respiratory disease mortality point to an important potential role for smoking.” So cigarettes kill.

But before we blame it all on individual behaviors, recall that these data are also geographic, by county. Where did life expectancy go down for 4% of the male population and 19% of the female population? “The majority of these counties were in the Deep South, along the Mississippi River, and in Appalachia, extending into the southern portion of the Midwest and into Texas.” In the worst performing counties, life expectancy dropped SIX years for women and two and a half years for men. In contrast, in the best US counties, life expectancy rose by as much as five years.

In The Short End of the Longer Life, the journalist Kevin Sack places this research in a wider social context: Socioeconomic status matters. Inequality kills.

[T]he life expectancy gap is growing between rich and poor and between those with the highest and lowest educational attainment, even as it is narrowing between men and women and between blacks and whites. Pointing to the effects of smoking, obesity and chronic disease, the budget analysts wrote that ‘in recent decades, socioeconomic status has become an even more important indicator of life expectancy, whether measured at birth or at age 65. Among the implications, they wrote, is that Social Security payroll taxes will become less progressive as the wealthy increase their longevity advantage over the poor.

The relationship between income and health is not simple, in the statistical sense of clear correlations and cause-and-effect patterns. In another sense, it is extremely clear—greater wealth has two synergistic effects: greater access to resources (such as good health care and better food) and less despair and stress. Without resources and with greater despair, people have a whole suite of accompanying, often destructive, things they do to try and cope. Things like smoking, eating fast food, drinking too much, getting angry, and getting depressed, as I have discussed before in posts on stress and social status, inequality and substance abuse, and obesity.

Is there anything we can do? Here’s what Sacks tells us in his article. “Dr. Ezzati and his colleagues are realists. In a 2006 study, they concluded that ‘because policies aimed at reducing fundamental socioeconomic inequalities are currently practically absent in the U.S.,’ life expectancy disparities would have to be addressed through public health strategies directed at reducing the risk factors that cause chronic disease and injuries.”

And if you were an idealist? Well, you need to get at the roots of inequality. I wrote about that in a post back in The American Reality versus The American Dream. But today there is an editorial, Is Trade the Problem?, that lays out some of what might help.

There is a growing inequity in pay. From 1976 to 2006, the average salary of workers in the bottom 90 percent of the income distribution — nearly everybody — rose by only 2.3 percent, to $38,800, tax data show. Among the top 10 percent, average salaries rose 57 percent, to $195,000. While there are still high-paying jobs out there, more and more they are reserved for workers with high levels of education. Between 2000 and 2006, the only workers who saw an increase in take-home pay were those with doctorates or professional degrees.

Economists have other explanations [besides trade] for the stagnation of middle incomes and the mushrooming income gap. Lawrence Katz, a Harvard economist, argues that a big part of the problem is a shortage of educated, skilled workers at a time when demand for them keeps rising. High school graduation rates are flat, and there has been a slowdown in the growth of college graduation rates, partly because of the rising cost of college. This is weighing on wages of less-educated workers while increasing the pay of the most educated.

The government has to invest more in education to help produce better-prepared, better-paid graduates. To help American companies compete, it must invest in better roads and ports and address the country’s health care crisis. And it must move toward more progressive taxation to help redistribute the spoils of growth.

Education. Infrastructure. Health Care. Those are the basics. They are investments, and not simply redistributing the spoils of growth. But even with taxation, we can make changes. If I had to pick one issue, it would be using local taxes to support local schools. Seems like a good idea. But it then drives the educational segregation of people, of rich parents moving to rich school districts. Poor kids left with what they’ve got.

Why does it matter? Because environment makes a substantial difference in IQ. Because poverty poisons the brain.

Kids need a fighting chance. Material wealth, behavioral health, real opportunities—those are the basics. They will lead to a longer and a better life.

One thought on “Dying Sooner: The New US Pattern

  1. Daniel — I saw some of these articles, too, and it’s pretty shocking. The irony is that these backward trends in life expectancy are really limited to the US, and, as you point, only certain parts of the US. It seems like some of the more basic medical interventions, like drugs for hypertension, run up against limits when their effect is swamped by too many other negative influences on life expectancy (or if the drugs aren’t accessible due to health care affordability issues).

    Other places in the developing world are continuing long-term downward trends in mortality rates and increases in life expectancy. It’s very hard not to look at socioeconomic inequality as a primary culprit, but I think it’s helpful that you point out that there are other factors as well, like education and just investment in public health. We know that both education and health infrastructure bring down mortality rates in developing countries, so disinvestment in both could presumably cause mortality to increase. How sad that the US has run the experiment to demonstrate this (of course, so did the USSR with the break-up, as well).

    Overall, though, this is clearly a case where socioeconomic, political, and policy decisions on a macrosocial scale — national policies and federal budgets — wind up affecting the physiology of individuals.

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