US Life Expectancy

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US life expectancy: the eight Americas

16 September 2006

From New Scientist Print Edition.

Aldhous

http://www.newscientist.com/channel/health/mg19125694.600-us-life-

expectancy-the-eight-americas.html

ONE nation under God, indivisible, with liberty and justice for all. "

So concludes the Pledge of Allegiance, that cornerstone of American

patriotism.

But when it comes to life expectancy, the US is far from one nation.

According to a new analysis of health disparities, there are in fact

eight Americas - some of them more reminiscent of developing

countries than a global superpower.

Life expectancy in the US varies widely by race and socioeconomic

status. Now researchers led by Majid Ezzati of the Harvard School of

Public Health have thrown geography into the mix. They examined death

records for people in more than 3000 counties and divided the

population into eight groups according to race, income and geographic

location. Some groups were confined to a relatively small area -

Native Americans in the western states, for example. Another group,

labelled " Middle America " , was mostly white, fairly wealthy, and

accounted for the majority of the population.

There were dramatic differences in life expectancies: in 2001, urban

black male babies could expect to live for just 68.7 years, whereas

for Asian females the figure was 86.7. Such differences across

the " eight Americas " have not narrowed over the past two decades (see

below).

International comparisons reinforce the picture of a deeply divided

country. When Ezzati examined the probability of dying during youth

(15 to 44 years) or middle age (45 to 64), the figures for black men -

whether in the rural south or inner cities - looked more like those

seen in the developing world than in other rich countries. In

contrast, the results for Asians and Middle Americans were similar to

those of the UK and Japan (Public Library of Science Medicine, DOI:

10.1371/journal.pmed.0030260).

" The figures for black men that die young look more like those seen

in the developing world than in other rich countries " Income and

access to healthcare explained little of the variation. For instance,

poor white people living in the northern plains are similar to those

in the Mississippi valley and Appalachia by these measures, yet tend

to live longer.

While political conservatives may seize on these results to argue

that taxing high earners to improve welfare and healthcare for the

poor would be unproductive, Ezzati says that would be a

misinterpretation. " We're not trying to say that broader

socioeconomic factors don't matter, " he says. Indeed, studies

controlling for other causes have shown that low income is linked to

poor health.

Ezzati is focusing on the conditions that cause early deaths in the

low-life-expectancy groups. These include injuries and cardiovascular

disease linked to risk factors such as obesity, tobacco and alcohol.

He believes public health campaigns targeted at particular groups

could yield big returns. Others argue that these may not be enough

without stimulating economic development in high-risk communities.

From issue 2569 of New Scientist magazine, 16 September 2006, page 13

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Carruthers

Wakefield, UK