Declining Life Expectancy in the Richest Country in the World

A new paper (discussed in this New York Times article) shows what many demographers have suspected for a while.  Life expectancy in the nation's poorest counties has actually declined since 1983, while life expectancy continues to rise for the more affluent counties.  This finding stands in stark contrast with the trends recorded from 1961-1983.  During this period, life expectancy increased in nearly every county in the United States.  The basic idea is that if you were well off when Ronald Reagan entered the White House, you have done well in terms of mortality since.  However, if you had the misfortune of being poor, then you have typically fared less well.  The result? Diverging health fortunes among the haves and the have-nots in American society.  

This finding relates to what my colleagues Shripad Tuljapurkar and Ryan Edwards refer to as "the ultimate inequality."  The manifestation of inequality does not get much more stark than through systematic differences in the number of years lived by people of different socioeconomic or ethnic backgrounds.   

In the 1983-1999 period, mortality from the largest cause of death, cardiovascular disease, declined in both rich and poor counties.  So what has caused the divergence in life expectancy between rich and poor counties?  It appears to be driven largely by increased mortality among the poor from diabetes and other non-communicable diseases on the one hand, and lung cancer and chronic obstructive pulmonary disease (COPD; of which emphysema is an example) on the other.   Among men in the poor counties, the probabilities of death from homicide or HIV/AIDS have also increased.  While the probabilities of death due to either homicide or AIDS increased only a little, homicide and AIDS can have a big impact on life expectancy for a population.   This is because victims of homicide and AIDS are usually young, so that every homicide or AIDS death leads to a relatively large number of lost years for the sub-population. So much for that goal of  "accelerat[ing] CDC’s health impact in the U.S population and to eliminate health disparities for vulnerable populations as defined by race/ethnicity, socio-economic status, geography, gender, age, disability status, risk status related to sex and gender, and among other populations identified to be at-risk for health disparities."  We can do better...

2 thoughts on “Declining Life Expectancy in the Richest Country in the World”

  1. Luxembourg may have the highest per capita GDP, but the USA has the highest aggregate GDP by a long-shot. This seems like the relevant measure of "wealth" when thinking about aggregate measures of health.

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