The survival gap between American counties is like comparing Japan to Sudan.
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Last month, a Lancet report quantified the survival gap between the richest and the poorest Americans and found that the wealthiest 1 percent live ten to 15 years longer than the poorest 1 percent. Well, a new study has an even more bleak finding: some Americans are expected to die a full 20 years earlier than people born in a healthier (and often wealthier) county.
Researchers from the University of Washington's Institute for Health Metrics and Evaluation (IHME) looked at death rates across all US counties to measure the geographic disparities in longevity. Public health experts know that people who live in certain parts of the country don't live as long as others and they wanted to see the difference. For their study in JAMA Internal Medicine, the team used de-identified death certificates and federal census data to create annual estimates of life expectancy from 1980 to 2014.
The authors found that Americans' life expectancy at birth increased from 73.8 years to 79.1 years overall during this time period, but they noted that this increase "masks massive variation" at the county level. For instance, people born in Summit County, Colorado (home of ski resort town Breckenridge) could expect to live 86.8 years, compared to the lowest life expectancy in the country of just 66.8 years for those born in Oglala Lakota County, South Dakota, which is home to the Pine Ridge Native American reservation.
IHME director Christopher Murray told NPR that the 20-year life expectancy gap between the longest- and shortest-living counties is "enormous." It's close to the difference between people living in Japan (83.1 years) and in India (66.9) or Sudan (67.2), per a news release. That gap has increased by about two years since 1980 and the authors expect it to widen in the future if these trends continue.
Here's what the life expectancy map looks like. People in red and orange areas live the shortest and blue and purple areas live the longest; you can see lots of red in the Dakotas, Kentucky, West Virginia, and along the southern half of the Mississippi.
This GIF from the team shows how these numbers have changed over the study period. Blue represents living longer and, in most places, the blue slowly takes over the map and starts to get darker. But people in the yellow areas aren't predicted to live as long; they're getting left behind.
If that GIF hurts your brain, here's a static map showing the changes in years. Blue means bigger improvements in longevity while red shows places where people's lives are actually getting shorter by as many as 2.3 years—meaning people born there in 2014 won't live as long as their parents did. There are 13 counties where life expectancies decreased; eight of the ten counties with the biggest decreases were in eastern Kentucky and the other two were in Alabama and Oklahoma.
So what's going on? They can't say for sure, but they found some associations between health problems and longevity. They estimated that 74 percent of variations in life expectancy could be explained by behavioral and metabolic risk factors including differing rates of obesity, smoking, exercise, diabetes, and high blood pressure, but socioeconomic and demographic factors like race, income, and education level also played a significant role, accounting for 60 percent of the variation. Access to healthcare and, the quality of said care, explained 27 percent of the differences. Taken together, these factors accounted for 74 percent of the variation.
The authors connected their findings to the debate raging over healthcare. "The inequality in health in the United States—a country that spends more on health care than any other—is unacceptable," Murray said in a release. "Every American, regardless of where they live or their background, deserves to live a long and healthy life."
Co-author Ali Mokdad told the Guardian that our country needs to increase the number of people who have health insurance—you know, the opposite of what Trumpcare would do. But it's not enough to just have a bare bones, catastrophic plan: People need to be able to get preventive care, too. "In the US, do we want to wait for people to come to the hospital so we can treat them? That's a failure," he said. "We need to make an investment in prevention. People who are sick need the best treatment, we all agree, but that investment shouldn't be at the expense of what is really important: planning the health of a nation and prevention of disease. I'm hoping the policymakers will look at this and say 'whatever we are doing is not about politics any more, it's about the future of the United States.'"