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:
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 old slave states, especially their rural areas. And the inequality keeps getting worse. The following map shows where life expectancy got better between 1980 and 2014 (in blue) or got worse (in red):
In general, the healthiest areas are getting better and many of the worst areas are falling further behind. The fall in life expectancy in the red areas is so bad that it has been dragging down overall average life expectancy in the US 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.
But unlike a century ago, this time around few of our national political leaders seems 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 wellbeing 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 has risen over 13 years recently :
Although Americans above the median income have similar life expectancy no matter where they live, life expectancy also varies widely from place to place within America among lower-income people. Some areas, 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 musicians know that life in the country is a sad ballad. In reality, the gap is widening between lagging rural areas and progressing urban areas. By comparing the following two maps you can see that premature mortality is worse in rural counties (especially in former slave states) than in counties with big urban populations:
The gap is also increasing between college graduates (basically the top 30% most educated in the orange line below) who continue to progress and high-school dropouts who are in trouble (the black line showing the bottom 10% below). 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:
“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 than in others! That is a bigger gap in life expectancy within the counties of 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 measure.