Saturday, February 13, 2016

Life-span inequality and wealth inequality: Only the poor die young

With apologies to Billy Joel for his song Only the Good Die Young.

The NY Times has the report on a correlate of increasing wealth inequality: life expectancy. If you are at the bottom of the wealth ladder, you are likely to die sooner. And that trend in life expectancies of rich and poor, like wealth inequality, is on the increase. The numbers are stunning. Select snippets follow.

Experts have long known that rich people generally live longer than poor people. But a growing body of data shows a more disturbing pattern: Despite big advances in medicine, technology and education, the longevity gap between high-income and low-income Americans has been widening sharply.

The poor are losing ground not only in income, but also in years of life, the most basic measure of well-being. In the early 1970s, a 60-year-old man in the top half of the earnings ladder could expect to live 1.2 years longer than a man of the same age in the bottom half, according to an analysis by the Social Security Administration. Fast-forward to 2001, and he could expect to live 5.8 years longer than his poorer counterpart.

New research released on Friday contains even more jarring numbers. Looking at the extreme ends of the income spectrum, economists at the Brookings Institution found that for men born in 1920, there was a six-year difference in life expectancy between the top 10 percent of earners and the bottom 10 percent. For men born in 1950, that difference had more than doubled, to 14 years.

For women, the gap grew to 13 years, from 4.7 years.

What accounts for these differences? Smoking, obesity, and prescription drug abuse hit poor communities the hardest, presumably because of the higher degree of education in the top income brackets. But access to health care does not account for the difference.

Limited access to health care accounts for surprisingly few premature deaths in America, researchers have found. So it is an open question whether President Obama’s health care law — which has sharply reduced the number of Americans without health insurance since 2014 — will help ease the disparity.

At the heart of the disparity, said Elizabeth H. Bradley, a professor of public health at Yale, are economic and social inequities, “and those are things that high-tech medicine cannot fix.”

Another, not so obvious effect of wealth inequality, operating via the life expectancy correlate, is a disparity in social benefits. When only the poor die young ...

... the National Academy of Sciences convened a panel of experts to study the implications. It concluded disparate life expectancies are making the country’s biggest entitlement programs, like Social Security and Medicare, increasingly unfair to the poor and suggested officials consider policy changes to address the problem.

The correlation between wealth inequality and life expectancy marks America as exceptional among rich countries.

Poor health outcomes for low-income Americans have dragged the United States down to some of the lowest rankings of life expectancy among rich countries. The Social Security Administration found, for example, that life expectancy for the wealthiest American men at age 60 was just below the rates in Iceland and Japan, two countries where people live the longest. Americans in the bottom quarter of the wage scale, however, ranked much further down — one notch above Poland and the Czech Republic.

“It’s embarrassing,” Professor Bradley said.

Many researchers believe the gap in life spans from lower- to upper-income Americans started widening about 40 years ago, when income inequality began to grow. ...

As a result:

“There are large swaths of the population that are not enjoying the pretty impressive gains the rest of us are having in life spans,” said Christopher J. L. Murray, director of the Institute for Health Metrics and Evaluation in Seattle. “Not everybody is sharing in the same prosperity and progress.”

In some conservative circles, it is fashionable to trash comparisons between America and other developed countries which have better health outcomes. But now consider this.

The experience of other countries suggests that disparities do not necessarily get worse in contemporary times. Consider Canada, where men in the poorest urban neighborhoods experienced the biggest declines in mortality from heart disease from 1971 to 1996, according to a 2002 study. Over all, the gap in life expectancy at birth between income groups declined in Canada during that period. And a study comparing cancer survival rates found that low-income residents of Toronto had greater survival rates than their counterparts in Detroit. There was no difference for middle- and high-income residents in the two cities.

So perhaps we can learn from other countries about how to improve our health care for all of our citizens. For starters, if our policy makers really want to "make America great again" they should be addressing wealth inequality and its consequences for public health.

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