People of Low Income have Hope for Achieving Longevity

Tags: Leadership, Equity

New research reveals that lower income people may not be doomed to a shorter life as prior studies have implied. Reporters Neil Irwin and Quoctrung Buil share their hopeful findings that some locations in the U.S. seem to foster greater longevity for the less fortunate. This opens up an exciting discussion in healthcare regarding a mix of positive habits and public health variables that may buffer the negative effects of poverty. Surprisingly, some large cities like New York and Los Angeles and some small cities like Birmingham are experiencing increased life expectancy in lower income individuals. However, many areas in the U.S. are showing decreased longevity in the same group.

A large concern is that the gap in life expectancy in the U.S. between rich and poor markedly increased from 2001 to 2014.  Men in the top one percent of income lived fifteen years longer than the poorest one percent. In women, the same gap differs by ten years.

I found it particularly interesting that the wealthy benefit from longevity no matter where they live — gaining three additional years in the past fifteen years alone. In contrast, for low income Americans, the results and lifespan vary greatly according to geographic location.

So what’s the big deal about this research? Well, for the first time there is evidence that longevity can be elongated without fixing the more challenging income disparity problem. It is now clear that some geographic locations foster some healthy behaviors that catalyze longevity. In Dr. Raj Chetty’s research he concludes that differences in life expectancy were correlated with health behaviors and local area characteristics.

When I look at the actual journal research report, Chetty found some interesting results such as:

  • In whites across all income levels, mortality rates increased most rapidly for people with low levels of education.
  • In looking at geographic locations, some fostered a lower life expectancy than others. These locations included Oklahoma City, Gary-Indiana, and Toledo-Ohio. In these areas, lower length of life was correlated with smoking, obesity, and exercise; as well as differences in medical care. Therefore I am struck by how health behaviors surface as key factors in life span.
  • Lack of access to care did not appear to be as strong a predictor as health habits.
  • Low income people lived longer if they lived in a city with inhabitants who were highly educated, had large incomes, and had high levels of government expenditures. Examples include New York City and San Francisco. My thought it that there is some mysterious spillover effect from wealthy to low income residents of the same city.

Raj Chetty and colleagues stated that these findings are rough and recent. In the future there will need to be a better designed study with validation and expansion of these findings. So health care initiatives can begin to target the low scoring cities with efforts to improve healthy behaviors among low income residents. As an example, New York City has a trans fat ban and an aggressive anti-tobacco campaign. Cigarette prices rose to more than $12 for a single pack and subsequently the smoking rate plummeted in the last fifteen years.

It is clear we need to identify the elusive health and social variables that foster living a long and healthy life. Trying to identify the keys for longevity will be the goal of future research. It appears that improving access to health care may not have the effect that people had hoped. The preliminary findings reveal that targeting behaviors or disease groups on a population level may be the way to go instead of improving direct care. Targeting behaviors and disease groups is how large health systems are attempting to improve how people manage and prevent disease.

It will be exciting to follow how future research continues to identify key variables in living and a long and healthy life.



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