Live Poor, Die Young

Want to live longer? Move. Or make more money.

During the decades when life expectancy in the U.S. rose from 67 to 74 years for men and from 74 to 80 for women, the rising tide was lifting all boats: although death rates in poorer counties exceeded those in better-off counties, everyone experienced steady improvement. No more. From 1961 to 1983, the death rate in every county fell largely because deaths from cardiovascular disease (heart disease and stroke) did; the spread in death rates between poorer and wealthier counties also fell. “In the 1960s and 1970s the improvements seemed to reach everybody,” says Majid Ezzati of the Harvard School of Public Health, as people in poor as well as wealthy counties adopted such heart-healthy habits as controlling blood pressure and not smoking.

Since the early 1980s, however, the difference in death rates between counties has increased. Death rates in poorer ones have stagnated and, in some counties, have actually risen, Ezzati and colleagues report this evening in PLoS Medicine.

That means health inequality is rising. The spread between the counties with the greater life expectancy and the worst is now 18.2 years for men and 12.7 years for women. In 1983 it was nine years for men and 6.7 years for women.

The authors call the increased inequalities in mortality “particularly troubling because an oft-stated aim of the U.S. health system is the improvement of the health of all people, and especially those at greater risk of health disparities.” “There has always been a view in U.S. health policy that inequalities are more tolerable as long as everyone’s health is improving,” Ezzati said. “There is now evidence that there are large parts of the population . . . whose health has been getting worse for about two decades.”

Between 1961 and 1983, no county suffered a statistically-significant decline in life expectancy; not so in the years since. From 1983 to 1999 (the last year for which the National Center for Health Statistics would give the scientists the data it collects from counties--a story in and of itself), life expectancy actually fell in 11 counties for men and 180 counties for women, averaging a drop of 1.3 years. So much for "the best health care system in the world."

Most of the counties where mortality is rising—counties populous enough and numerous enough that 4 of men and 19 of women experienced either decline or stagnation in mortality beginning in the 1980s—are poor. They’re in the Deep South, along the Mississippi River and in Appalachia, extending into the southern portion of the Midwest and into Texas. Those are among the counties that experienced the greatest improvements in life expectancy in the 1960s and 1970s, because they had the most room for improvement. But progress there has come to a screeching halt since the 1980s.

You can see life expectancy at birth between 1961 and1999 for men here and for women here, and life expectancy in 1961, 1983 and 1999 here. The absolute change in life expectancy, also by country, in 1961–1983 and 1983–1999 is here.

It’s even sadder than those blue and red maps that show the country’s political divide. This one is literally a matter of life and death.