Average life expectancy in the US is increasing, but among lower income people it is not, and the lifespan gap between rich and poor is increasing. Even middle class people have shorter lifespans than the rich. Experts discuss how a large income buys extra years of life, and why a lower income produces barriers to a longer life.
- Dr. David Kindig, Emeritus Professor of Population Health Sciences, University of Wisconsin-Madison
- Dr. Michael Reisch, Daniel Thursz Distinguished Professor of Social Justice, University of Maryland
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Income and Life Expectancy
Reed Pence: For most of the last hundred years, American life expectancy has been on a slow increase. In the early 1920’s, the average person could expect to live to around 60. Today, life expectancy is nearly 80. Even since 1960, life expectancy has risen by about eight years. But not everyone is enjoying the same increase. Overall, life expectancy is increasing. But in many places, and for many people, it’s not.
Dr. David Kindig: In U.S. counties in a recent period almost 42 percent of the counties showed falling life expectancy for women.
Pence: That’s Dr. David Kindig, Emeritus Professor of Population Health Sciences at the University of Wisconsin, Madison. His studies show that counties where life expectancy is dropping are almost invariably poor. Where lives are getting longer is in richer counties.
Kindig: We actually find across counties by income there can be a three or four fold difference in mortality rates
from high to low-income counties. Life expectancy differences due to social factors that can be as much as five, six, eight years of life expectancy, depending on the situation. It varies a bit from study to study, but education and income are often found to be as strong a predictor of life expectancy as a smoking rate or obesity or some of our behaviors.
Dr. Michael Reisch: On average Americans in the top five percent of income can expect to live about nine years longer than those in the bottom ten percent.
Pence: Dr. Michael Reisch is the Daniel Thurz Distinguished Professor of Social Justice at the University of Maryland.
Reisch: To put it at the most local level in the city that I’m sitting in right now in Baltimore, two neighborhoods that are pretty much equidistant from my office, but are only two and a half miles apart have average life expectancies that differ 20 years between those two neighborhoods regardless of race, based solely on income. Just to give you one specific example in terms of education, is that if you don’t finish high school in this country, you live on average, all other things being equal, six years less than someone who graduates college.
Pence: But it’s not just people living in deep poverty who are affected by the gap in longevity. If you’re middle class, your life expectancy is less than that of the one percent as well.
Kindig: Some people think it’s just poor people versus rich people. Rich people live longer and are healthier and poor people are not. It’s actually quite a gradient. That’s one of the research advances of the last 28 years that any of these social factors like income and education, they play out over the whole social gradient. It’s true that the poorer or less educated you are the lower your life expectancy is and the sicker you will be. But it’s greater if you move up. So people in the middle class they do better on these things than lower income and lower educated people, but nearly as well as those at the top. So we’re all in this boat to some degree; it’s not just a rich/poor thing.
Pence: Now, some of this may be no surprise. People in poverty obviously don’t have the resources of the well to do, and don’t have access to as much healthcare as money can buy.
Kindig: People with higher incomes and higher education — and those things go together and are tightly woven together — they have more resources so they can obviously get better medical care, they can afford healthier foods, they can go to fitness centers. All those kinds of things that having better income and higher education provides.
Reisch: People who are lower income have less access to adequate and affordable healthcare. Often because of cultural differences a health care may not be appropriate for their particular need. Second, and this is widely publicized especially recently that people who are lower income have much poorer diet and as a result have much poorer health. American adults who are in poverty for example, are more than five times as like to report being in fair or poor health as adults with income who are at the higher end of the income spectrum.
Pence: It’s well known that lower income people are more likely to be obese than the upper class. And that’s a direct result of a poor diet. Some people say that’s a choice. But Kindig says… far from always.
Kindig: People do need to pay attention to their own behaviors. There’s no question about that. We all have to do that. I had oatmeal this morning instead of ham and eggs. But particularly with people of lower income and lower educational background, the ability to make those good choices is difficult.
Pence: For example, Reisch says it’s hard to have a healthy diet when you live in a food desert, where affordable, nutritious food is unavailable. That’s how it is in many inner cities.
Kindig: They also not only have fewer quality food stores, but most poor people lack access to either public or private transportation, which makes it more difficult for them to get to market. Which has better quality and more affordable food. When I was working in Michigan between 1999 and 2008, I did some work in Detroit and at the time, I don’t know if things have changed, but at the time in Detroit there were two supermarkets in the entire city, which had a population, then of over 900,000 people.
Pence: Reisch says those who are most seriously affected by a poor diet are children. A lack of nutritious food at the beginning of life contributes to shortening it.
Reisch: It’s been established that hunger, chronic hunger, particularly in the first three years of life has dramatic implications for children’s future physical and mental health, for their academic achievement, for their future economic productivity. There is documentation that it contributes to a wide range of health problems as well as psychological development, greater prevalence of learning disabilities. For example, children who grow up in poverty are more likely to be hospitalized. They are more likely to have oral health problems. They may be at higher risk for chronic conditions such as enemia and asthma. For adults, even though it’s slightly less severe, it’s still very serious.
Pence: Inadequate healthcare and too little nutritious food are among the more obvious ways that a lack of money means fewer years of life. However, there are also a lot of indirect reasons. For example, Reisch says employment makes a difference in lifespan. The jobs lower income people have are more likely to be dangerous. Lower income people are also less frequently employed, and when they are, their jobs are less secure. That’s stressful.
Reisch: Studies have shown that the consistency of employment has health effects which last well into old age. Another factor is that people who are low income are more socially isolated and are more likely to be stigmatized on the basis of their income or race or ethnicity, all of which adds to their stress. People who are low income live in neighborhoods where they are more likely to be exposed to a variety of pollutants and environmental toxins. They live in unsafe housing and in more dangerous neighborhoods, which restrict the opportunity to get outside, get exercise and for children to play and increase their risk of being a victim of violence.
Pence: All of that creates stress, and Reisch says stress is often underestimated as a threat to our health and our lifespans.
Reisch: It’s been well established that chronic stress particularly is a major factor that contributes to higher rates of cardiovascular disease, including heart attacks and stress and diabetes among another serious ailments. Everybody’s lives especially today have stress, but people who are poor or near poor in terms of official statistics experience for all the reasons I just mentioned a much greater chronicity and intensity of stress. Studies have show that stress produces increased levels of cortisol and excessive cortisol in our blood causes a greater likelihood of developing those cardiovascular and other chronic diseases. Also of developing them earlier in life even in childhood, and that leads to an accelerated aging process. These people also have an increased severity and more rapid progression of these diseases.
Pence: Poverty takes its toll on the other end of the age spectrum, as well.
Reisch: Among the elderly, nearly one third of the households that are elderly have to choose each month between purchasing food and paying for medical care. Over one-third of those households choose between buying food and paying their utility bill. These numbers are likely to grow as the population ages.
Pence: Reisch says the longevity gap is getting worse between rich Americans and everybody else. One reason is that these days, very few middle and lower class people have much economic security. You may be middle class today, but that’s no guarantee you will be tomorrow. He says poverty today is deeper and more persistent than it’s been in some time.
Reisch: More individuals and families are chronically poor, which means that they remain poor for a year or more. And more individuals and families experience what policy makers call deep poverty. Perhaps the most dramatic statistic of all is that about 60 percent of the entire population of the United States experiences an episode of poverty during their lives of one year or more. And about three-quarters of the population experiences a year of near poverty. For African-Americans the statistic is even more striking. It’s over 90 percent. We know, as I’ve said before that an extended episode of poverty particularly in childhood and the early life adversity which accompanies it has a long term negative effect on a person’s health, mental health and life chances.
Pence: So what can be done to help close the gap? Some advocates say if income among the lowest is the problem, then raise the minimum wage.
Reisch: It would be helpful, but it would not be sufficient on its own. But to have a sustainable impact on the longevity gap we need to do a lot of other things. We need to provide accessible and affordable health care with an emphasis on primary care and preventive care for everybody. We need to make our work places safer. We need to give all children a quality education and a quality preschool experience so they can achieve their full potential. And we need to eliminate the structural barriers that create stress by perpetuating inequality on the basis of things like race, ethnicity, gender and social class.
Pence: Reisch contends that a whole variety of remedies will be needed to raise life expectancies among lower income people and the middle class as well. Those include tax policy and social security. Yes people also need to take responsibility for their own actions, but they can‘t make healthy choices if barriers mean they‘re out of reach. Lifestyle does determine a great deal of our lifespan. But we’re not always free to choose the way we live.
You can find out more about all of our guests on our website...Radiohealthjournal.net . I’m Reed Pence.