Inequality Matters: Only the Poor Die Young?

Gap in Life Expectancy Widens for the Nation – New York Times:

In 1980-82, Dr. Singh said, people in the most affluent group could expect to live 2.8 years longer than people in the most deprived group (75.8 versus 73 years). By 1998-2000, the difference in life expectancy had increased to 4.5 years (79.2 versus 74.7 years), and it continues to grow, he said.

After 20 years, the lowest socioeconomic group lagged further behind the most affluent, Dr. Singh said, noting that “life expectancy was higher for the most affluent in 1980 than for the most deprived group in 2000.”

“If you look at the extremes in 2000,” Dr. Singh said, “men in the most deprived counties had 10 years’ shorter life expectancy than women in the most affluent counties (71.5 years versus 81.3 years).” The difference between poor black men and affluent white women was more than 14 years (66.9 years vs. 81.1 years).

One of the most interesting findings reported in this story disputes the inevitability of the link between income inequality and gaps in life expectancy:

Some health economists contend that the disparities between rich and poor inevitably widen as doctors make gains in treating the major causes of death.

Nancy Krieger, a professor at the Harvard School of Public Health, rejected that idea. Professor Krieger investigated changes in the rate of premature mortality (dying before the age of 65) and infant death from 1960 to 2002. She found that inequities shrank from 1966 to 1980, but then widened.

“The recent trend of growing disparities in health status is not inevitable,” she said. “From 1966 to 1980, socioeconomic disparities declined in tandem with a decline in mortality rates.”

The creation of Medicaid and Medicare, community health centers, the “war on poverty” and the Civil Rights Act of 1964 all probably contributed to the earlier narrowing of health disparities, Professor Krieger said.

I don’t have any particular insight into the phenomenon, but I thought the story was worth posting. The various sources to which the gap (and its increase) is attributed are quite interesting – everything from a ‘blame the victim’ set of behavioral sources (poor diet, unsafe behavior, etc.) to racism (doctors treating black patients, who tend to be poorer, worse than whites) to more directly economic (poor people are less likely to be able to afford the best health care, or have health insurance at all). Which sources you see as most important will wildly alter the kind of policies this finding would be mustered to support – anything from health education programs in inner cities to a bill of rights for patients with some sort of teeth to universal health care.

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