Mind the gap in life expectancy WITHIN America

We read a lot about the growing political divide in America and we hear a lot of commentary about the two Americas in terms of income inequality.  But a bigger inequality problem is the gap in life expectancy.  Here’s a map of life expectancy at birth in 2014:

JAMA Internal Medicine, 2017

It is hard to claim that there is equal opportunity in America when there is a gap of over 20 years in life expectancy between different counties in the US.  Generally speaking, the worst areas are Native American reservations and the parts of former slave states that have been the least transformed by massive immigration since the abolition of slavery.

And the inequality in life expectancy keeps getting worse. The following map shows where life expectancy got better between 1980 and 2014 (in blue) or got worse (in red):

JAMA Internal Medicine, 2017

In general, the healthiest areas have been getting better and many of the worst areas have been falling further behind.  At a state-by-state level, the following graph shows that some states have been getting healthier (in blue) whereas other states have been backsliding (red).

The fall in life expectancy in the red areas is so bad that it has been dragging down average life expectancy in the US overall for the past three years in a row. This is the biggest crisis in American life expectancy in a century.

The nation is in the longest period of a generally declining life expectancy since the late 1910s, when World War I and the worst flu pandemic in modern history combined to kill nearly 1 million Americans. Life expectancy in 1918 was 39. Aside from that, “we’ve never really seen anything like this,” said Robert Anderson, who oversees CDC death statistics.

Unlike a century ago, this time around few of our national political leaders seem to care.  This is why we need better statistics of economic well being like MELI which incorporate life expectancy.  Politicians care more about GDP than about life expectancy even though life expectancy is much more important for well being in a rich country.

The decline in life expectancy is mainly affecting people who earn less than the median income as I wrote about earlier. Here is the relationship between life expectancy and economic class:

Richer people live longer and the gap in life expectancy has been steadily growing. The following graphs show how much the gap rose over just 13 years:

Although Americans above the median income have similar life expectancy no matter where they live, life expectancy among lower-income Americans varies widely from place to place.  Rich Americans have similar life expectancy no matter where they choose to live, but because of the variance in life expectancy among the poor, some regions, like Detroit, have much greater inequality in life expectancy than other areas, like New York City.

Whereas most people think of country living as being healthier than stressful city life, country music famously describes country life as a sad ballad and the statistics paint a sad picture too.  Life expectancy is lagging more in rural areas and progressing in urban areas. The following map shows premature mortality which is worse (darker) in rural counties.

Now compare the mortality rate above with the following map counties with big urban populations where the darker counties have cities. The high-population counties with cities generally have lower mortality on the above graph than rural counties.

The gap in lifespan is also increasing between college graduates (basically the top 30% most educated as represented by the orange line below) who continue to progress and high-school dropouts who are in trouble (the black line showing the rising mortality of the bottom 10%).  Vox explains:

An October 2018 working paper out of Dartmouth College sliced the mortality data along lines of education and found a similar trend. Researchers looked at the rising mortality among middle-aged, non-Hispanic whites by education status. The rise, they discovered, is almost entirely driven by the least-educated 10 percent of the population, while the most educated among us are seeing their mortality rates go down:

Novosad/Rafkin at Darmouth College

“Like the poor, the least educated experience a range of socioeconomic disadvantages,” the researchers, Paul Novosad and Charlie Rafkin, wrote, “such as high unemployment, low insurance coverage, poor nutrition, and exposure to harmful environmental factors.”

In particular, it is mainly poor, rural, white Americans who have been seeing the biggest drop this year, and this has been a trend since at least 1990 as Nobel Prize winner Angus Deaton famously documented.  White mortality due to “deaths of despair” have almost tripled in the US unlike in all other countries studied.  The main reasons life expectancy is dropping is are increases in suicide, alcohol and drug deaths, and heart disease. In a way, they are all diseases of broken hearts.

How much would you give up to be able to live twenty years longer? Life expectancy varies so much across the United States it is twenty years longer in some counties (like wealthy Marin County, California) than in the worst counties (like Oglala Lakota County, S.D.)! That is a bigger gap in life expectancy among the counties within the United States than the gap between the United States and any country in the world except a handful of the very worst basket cases.

If we used median life expectancy rather than mean, this would look slightly different, but (almost) nobody uses that.

One of the preventable ways American health is getting worse is mothers dying during childbirth more frequently than in the past.  America had one of the best records for maternal health in the 1950s through the 1970s, but progress in America ended in 1979 and since then the US maternal mortality rate has gotten worse whereas nearly all other nations on earth have improved.  Even North Korea has slightly improved its maternal mortality rate since 1979.  Meanwhile, the US has gotten worse–so bad that the US is now worse than any other industrialized nation.

The mortality rate of American moms has more than doubled in the past 20 years and is continuing to rise.  Those are healthy young women in their prime.  This should be considered a crisis folks!