The Inequity of Death in America

There is too much pain in America. The poverty, racism, job insecurity, anxiety, and inequities that are rife in almost every sector of society are killing us, as a parade of tragic data illustrates.

• On April 22 The National Center for Health Statistics reported that the suicide rate in the United States rose by 24 percent from 1999 to 2014, to its highest level in almost 30 years. Suicides were up 63 percent for women and 43 percent for men aged 45 to 64. Particularly alarming: the suicide rate for girls age 10 to 14 tripled.
• A few days earlier the Centers for Disease Control and Prevention (CDC) reported that life expectancy for white women in the United States declined by one month between 2013 and 2014, from 81.2 years to 81.1. That may not sound like much, but to demographers it’s a red flag – the first time since the federal government started keeping records that longevity for white women declined. CDC demographers blamed increases in suicide, drug overdoses, and alcohol-related diseases, particularly in the 25 to 54 age group.
• In early April a report by The Health Inequality Project found that the gap in life expectancy between rich and poor in America widened significantly from 2001 to 2014, with men in the top one percent of income now living 15 years longer than the poorest one percent. “The poorest men in the U.S. have life expectancies comparable to men in Sudan and Pakistan; the richest men in the U.S. live longer than the average man in any country,” researchers said.
• Last December a ground-breaking study found that the decades-long decline in the death rate of middle-aged white Americans has reversed in recent years. No other rich country has experienced a reversal. Study authors Angus Deaton and Anne Case wrote that “concurrent declines in self-reported health, mental health, and ability to work, increased reports of pain, and deteriorating measures of liver function, all point to increasing midlife distress.”

This midlife distress, manifested in suicide and substance abuse, is an outward signifier of deep and abiding financial and racial inequities that have led to terrible health outcomes for far too many. The Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin highlight similar connections through the annual County Health Rankings, which assesses the health outcomes of every county in the nation. This year the Rankings included the impacts on health of housing  segregation and deaths from drug overdoses, along with income inequality, level of education attainment, and unemployment.

Looking at the correlations between health and social and economic opportunities, its easy to conclude that in America, your zip code may be more important than your genetic code in predicting how long you’ll live. That dynamic can be seen at a glance in the series of 12 life expectancy city and regional maps  prepared by Virginia Commonwealth University, with funding from RWJF. The newest map, Philadelphia, shows that babies born in zip codes only five miles apart face up to a 20-year difference in life expectancy, from 68 to 88. In Las Vegas, babies born 11 miles south of the Las Vegas Strip can expect to live to 87, while 11 miles north, a mere 20 minute drive, life expectancy drops to 71 (see all the maps below).

Behavior and personal responsibility play an important role in achieving and maintaining health, but the choices people make depend on the choices that they have. The health of our country cannot flourish as long as so many continue to face steep and stubborn barriers to well-being.

Lower those barriers, however, and the benefits become quickly apparent. The Health Inequality study found that, in areas where local government spending on public health and welfare is higher, the longevity gap between rich and poor narrows. The lowest-income residents of cities that restricted smoking in public spaces, raised tobacco taxes, and restricted artificial trans-fats, tended to have higher life expectancies – because everyone benefits when the environment is healthier.

The Affordable Care Act is also knocking down barriers. A recent analysis by the New York Times found that by the end of 2014, the law’s first full year, so many low-income people gained coverage that it halted a decades-long expansion of the gap between health insurance haves and have-nots.

We all need to work together to further address the systems and structures that perpetuate glaring inequities. We must know and understand the people whose lives are affected by poverty and discrimination.  And we must strive to give everyone the opportunity to lead the healthiest life possible. That requires stepping out of our comfort zones, building unconventional alliances, and taking bold steps to combat poverty and improve the health of all our communities.

Our zip code does not have to be our destiny. As Philadelphia Daily News columnist Helen Ubi?as writes, in a letter to Philadelphia’s youth that can apply to people of all ages:

Here's the thing with numbers: They can tell us a lot - mostly how adults have let you down - but they never tell the whole story, and they absolutely do not have to tell yours. Consider the people who defied the same odds to be and do great things. Find them. They can make all the difference in your world. Trust me.

Like Ubi?as, I choose to be hopeful. The right mix of policies and initiatives, mentors and leaders, from all sectors of society, can help people live longer, regardless of how much money they make or the color of their skin. It’s well past time to make that happen.

I would love to hear from you about initiatives or ideas that can overcome the obstacles that keep too many of us from being as healthy as we can. Please share in the comments or at CultureofHealth.org.