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September 22, 2012 7:24 AM Shocker stat of the day: life expectancy decreases by 4 years among poor white people in the U.S.

By Kathleen Geier

Yesterday, the New York Times reported on an alarming new study: researchers have documented that the least educated white Americans are experiencing sharp declines in life expectancy. Between 1990 and 2008, white women without a high school diploma lost a full five years of their lives, while their male counterparts lost three years. Experts say that declines in life expectancy in developed countries are exceedingly rare, and that in the U.S., decreases on this scale “have not been seen in the U.S. since the Spanish influenza epidemic of 1918.” Even during the Great Depression, which wrought economic devastation and severe psychic trauma for millions of Americans, average life expectancy was on the increase.

What are the reasons for the disturbing drop in life expectancy among poor white folks, and in particular for the unusually large magnitude of the decline? According to the Times, researchers are baffled: one expert said, “There’s this enormous issue of why … It’s very puzzling and we don’t have a great explanation.” Undoubtedly, the increasing numbers of low-income Americans without health insurance is a major contributor factor. Researchers also say that lifestyle factors such as smoking, which has increased among low-income white women, play a role; poor folks tend to engage in more risky health behaviors than their more affluent counterparts.

I will offer an alternative hypothesis, one which is not explicitly identified in the Times article: inequality. In the U.S., the period between 1990 and 2008, which is a period that saw such steep declines in life expectancy for the least well-off white people, is also a period during which economic inequality soared. Moreover, there is a compelling body of research that suggests that inequality itself — quite apart from low incomes, or lack of health insurance — is associated with more negative health outcomes for those at the bottom of the heap. One of the most famous series of studies of the social determinants of health, Britain’s Whitehall Studies, had as their subjects British civil servants, all of whom health insurance and (presumably) decent enough jobs. Intriguingly, these studies

found a strong association between grade levels of civil servant employment and mortality rates from a range of causes. Men in the lowest grade (messengers, doorkeepers, etc.) had a mortality rate three times higher than that of men in the highest grade (administrators).

The Whitehall studies found that while workers in the lower grades were more likely to be at risk for coronary heart disease due to factors such as higher rates of smoking, higher blood pressure, etc., even after controlling for those confounding factors, these workers still experienced significantly higher mortality rates. So what was behind such disparate health incomes among high-status and low-status workers? Researchers pointed the finger at inequality, hypothesizing that various psychosocial factors associated with inequality — such as the higher levels of stress at work and at home experienced by the lower tier workers, as well as their lower levels of self-esteem — were behind the dramatic differences in mortality rates.

I believe that inequality-related stressors are likely to be the determining factors in declining American life expectancies, as well. I’m surprised, in fact, that the Times article did not specifically identify inequality as a causal factor, because the health risks associated with economic inequality are well-established in the scientific literature. For decades, the United States has been making a series of political choices that has distributed wealth and power upwards and left working Americans not only poorer and sicker, but also feeling far more burdened and distressed, and experiencing far less security and control over their lives. The consequences of these choices have been devastating, and absent a dramatic reversal in our political course, they are likely to get even worse. Where inequality is concerned, Republicans have their foot on the accelerator, while the best the Democrats seem to be able to do is to (temporarily) put their foot on the brake.

We are on a trajectory all right, and it’s not a good one.

Kathleen Geier is a writer and public policy researcher who lives in Chicago. She blogs at Inequality Matters. Find her on Twitter: @Kathy_Gee

Comments

  • RepublicanPointOfView on September 22, 2012 9:34 AM:

    So what!

    We republicans will still argue that the eligibility ages for social security and medicare should be raised.

  • Hedda Peraz on September 22, 2012 9:48 AM:

    I suspect the answer is quite simple:
    In a word, Diet.
    ( for the folks in Rio Linda, diet is the cause of obesity, diabetes, heart disease, cancer, and forgetting to look both ways when crossing the street.)

  • Jack Lindahl on September 22, 2012 9:55 AM:

    Couple this information with recent news that, here in NYC, poor people are spending up to 25% of their income on cigarettes! It ain't fun being poor.

  • Anonymous on September 22, 2012 10:10 AM:

    If the white folks have jobs at all, they’re always on the brink of losing them – both, or all three of them.

    Most of those jobs don’t have benefits.
    If they don’t, and buy health care, that cost has escalated dramatically.
    If they had any savings, they’re gone/Pensions – sold out from under them.
    If they had a home, the value has gone down in the past 4 years.
    If they have children, the cost of higher education has skyrocketed.

    On top of that, hating on “The Other” people is very stressful.
    They drink more.
    Take take drugs – legal and illegal.

    All of that stress, the lack of cheap, quality health care, and little time to go to doctors if they wanted to, and little or no hope for the future, adds up to shorter lifespans.

    Of course, the fact that they voted against their best interests, causing some, if not most of those problems, will never occur to them.

    And many of them will go out on November 6th, and vote the straight Republican ticket – possibly shortening the lifespans of the rest of us, as well.

    White folks - there is no better proof than this study, that shows that racism kills - not just the ones you want to see killed, but yourselves.

  • John B. on September 22, 2012 10:17 AM:

    I am reminded of a series of news reports and medical studies in the waning days of the former Soviet Union (under Gorbachev) reporting on a strikingly similar precipitous drop in average life expectancy of Russian males. Western news reports, at least, claimed the numbers had caused panic within the Politburo.

    As today, so then the best researchers could offer was a list of speculative explanations -- increased alcoholism, poorer diet, more smoking, etc. etc. But none seemed confirmed by available data. In the end, as I recall, something of a consensus emerged that it must have been the result of a statistically dramatic increase in poverty along with a statistically significant increase in the wealth of a small number of the very well-to-do.

    Sound familiar?

  • Milt on September 22, 2012 10:26 AM:

    In addition to your influences let me add another - Wal-Mart. I live in a small city with filled with low income people. It is also a city dominated by Wal-Mart and so we do some of our shopping there. Its food section is mostly junk food. Aisle upon aisle of candy, chips, crackers and soft drinks. Even in those areas that supposedly mainstream foods it is mostly high calorie, high fat, high sugar items that bear little resemblance to similar home made dishes. In the frozen food aisle, the selection frozen vegetables is gradually getting smaller and frozen waffles are taking their places. I could go on but you get the idea.

    Combine this situation with the commonly held belief that Wal-Mart is the cheapest place to shop and you end up with poor,overweight families buying stuff which they think is good for them or perhaps they just don't care. Multiply this scenario thousands of times across the country and you get a truly depressing picture.

  • DIane Rodriguez on September 22, 2012 10:28 AM:

    Although Black women, with no HS education have lower life expectancies and Latino women with no HS education have higher life expectancies than white women, both of these groups saw an increase in life expectancy rather than the decline experienced by white women.

    Researchers stated that lack of health care is a factor. However, the same lack of health care applies to women of color without high school educations. An equally important question is what factors influence the longevity of women of color as opposed to white women in the same group.

    Provocative study on several levels.

  • Joe Davidson on September 22, 2012 10:28 AM:

    The same study shows that Hispanic's lifespan exceeds that of blacks or whites. Does that fit into the above theories?

    My two cents is that many Hispanics, from the old country, still have the social and family capital that has diminished in the US.

  • Robert on September 22, 2012 10:30 AM:

    Well, actually, differentials in health and mortality are a pretty big area of research and if you follow it, many people have hypothesized that inequality of various kinds (not only in income but also in other socioeconomic variables) is important. However, the magnitude of the drop has been so large that the first step was to verify that it was real and not an artefact of data collection. It now appears that we've verified that the decrease is real. In particular, the drop is not across the board but appears to be focused in certain causes-of-death, so a key part of the analysis has been trying to verify those. That's on-going. In addition, death certificates don't record information on income or wealth or educational attainment, or the time history of income or wealth or educational attainment, so a part of any "inequality"-type analysis is finding indirect measures of those things. The reason the inequality link isn't talked about much isn't because it hasn't been thought of, or thought about, or dismissed as unimportant -- it's because doing mortality-inequality research is kinda complicated.

    But I like very much that you brought this up. Most of the researchers in this area have difficulty expressing why what we do is important, and what the stakes are.

  • Anonymous on September 22, 2012 10:32 AM:

    Ta-Nahisi Coates: We are all welfare queens now.

  • dalloway on September 22, 2012 10:35 AM:

    I agree with most of the above, but I'd venture a guess that the most health-damaging thing about being poor (and I know from personal experience) is the unrelenting stress of trying to juggle bills, never being able to take time off from work because you might be fired, terror of any unexpected expense, especially a trip to the emergency room and the general attitude (now even more prevalent in our society) that if you're poor, you're worthless. All that induces a low-grade depression that's hazardous to your health. And if Republicans get control, a lot more than 47% of the population will suffer from that kind of depression, not to mention the economic kind.

  • Robyn Tonkin on September 22, 2012 10:39 AM:

    Are my husband and I the only well-educated, thinking, observing people who live where lots of poor Americans live, and pay attention to them? The vast majority of poor Americans live on a diet composed of cheap refined carbohydrate and cheap refined vegetable oil. They get little to no animal protein, and they hardly ever eat a vegetable that is not corn or potatoes--which are mostly carbohydrate. The people are not only morbidly obese from eating this awful stuff-- they are sick, too--men, women and children. Good food is expensive, and must be prepared, which takes time. These people have been habituated to instanteous food gratification-- they fix the frozen pizza or pocket, they slam into the drive through at the fast food joint. One of the truly shocking facts about poor people's diet is the complete lack of variety-- people will eat the same thing, each and every day--the same corn oil, corn flour, white sugar melange, washed down by the same high fructose corn syrup sweetened soda. That people can persist at all with little to no high quality protein and vitamin cofactors, and a disgusting chemical soup in each prefab portion they do consume is the amazing part-- not the reduced longevity.

  • hells littlest angel on September 22, 2012 10:40 AM:

    And many of these people will vote for Republicans who want to shut down the EPA, restrict the FDA, neuter OSHA, and deregulate companies that pollute. Go figure.

  • c u n d gulag on September 22, 2012 11:48 AM:

    Anonymous at 10:10 was me - gulag

    When is CRAPTCHA'A execution date?

    I meant, of course, termination date?
    (WITH EXTREME PREJUDICE!)

  • tsts on September 22, 2012 12:04 PM:

    Kathleen Geier: "Between 1990 and 2008, white women without a high school diploma lost a full five years of their lives, while their male counterparts lost three years."

    This is not really true. Nobody "lost" years. In fact, we are not even talking abut the same people in 1990 and 2008. The group in 2008 is much smaller - in 1990 22% of all Americans did not have a high school degree, and in 2008 is was only about 13%. For people above a certain age, the decrease is probably even more dramatic since high school graduation rates increased significantly from the 50s to the 70s. So, ignoring age, we are comparing the bottom 13% in educational achievement to the bottom 22% in 1990. Among 60-year olds, we may even be comparing the bottom 50% in educational achievement to the bottom 20% (guessing here as I could not find those stats), since we are comparing people not finishing high school around 1950 to people not finishing around 1970.

    This is not to say the the study is not valid. And I agree with most of what is being said here about inequality, problems with health care etc. But it is important to not misinterpret the study. I think at least part of what we see may be a statistical echo of the large increase in high school graduation rates between the 50s and 70s.

  • cwolf on September 22, 2012 12:41 PM:

    Does this mean we have to LOWER the Social Security eligibility age for dropout rednecks?

  • Dr Lemming on September 22, 2012 12:55 PM:

    Robyn, your argument makes a lot of sense to me. Diet could very well be a key factor. The friendly amendment that I'd offer would be that good food isn't necessarily more expensive than the highly processed stuff. Whole grains can be quite affordable even when organic -- at least when you buy in bulk. Fruits and vegetables can vary in price but -- if you are a strategic shopper -- can generate a lot more meals than your typical high-cost, packaged product.

    My point is that I don't think high cost is as much of a factor as knowledge about nutrition, money-saving shopping techniques, and having access to alternative sources of good food such as from food co-ops.

  • Rick B on September 22, 2012 1:02 PM:

    My observation of the more poor families in this neighborhood would support the allegation that they tend to live on carbohydrates, sugar and in many cases, alcohol. My recent studies in geriatrics suggest that another reason why lower class individuals die sooner is the lack of feeling of being in control of their lives.

    The second is based on studies I have read of geriatric patients. Those who feel they have control of their treatment and circumstances tend to live longer than those who feel their treatments are simply imposed on them without consultation or considerations. This is true even of those with dementia. When you do not feel in control of your life, you may still feel in control of when you die. With lack of control of your own life why bother to live longer?

    When you have to work two and three jobs just to pay the rent and transportation costs and still have to juggle them, how much control do you have of your own life?

    This view of personal control of your life is my argument against the libertarian idiots who want to make Social Security and Health care into private vouchers. Such vouchers remove the personal predictability of income and health care and give control of your life over to the vendors. It WILL kill a lot of people wherever it is attempted. But not high status wealthy people or popular preachers.

  • FlipYrWhig on September 22, 2012 1:07 PM:

    I like the points about nutrition several people made -- but is middle-class nutrition really that much better? I certainly eat plenty of pre-packaged close-to-junk. My sense is that carb-rich, protein-low, chemically-enhanced diets prevail across the class spectrum. Am I off base on that?

  • KazooGuy on September 22, 2012 1:18 PM:

    We seem to suffer from a deep human need to establish black and white answers. "It's food quality." "It's access to health care." "It's the quality of the delivered health care." "It's the emotional impact of social status."

    Human beings are organic creatures which will respond to any and all of the above. What proportion each plays is probably too difficult to determine. Followup studies can at least verify that each such cause plays some part.

    In the meantime, the caution about misusing the quick summary of this study in light of the broader demographic questions is important so that we can maintain some integrity in the discussion. As Steven Colbert just quoted George Packer this past week: "Ideology knows the answer before the question has been asked."

    The real issues are touched upon by several commenters: How is that these things are happening and the end result is that this particular population votes for a political party whose policies exacerbate the identified problems ... and ... what is to be done about it?

    The Obama administration's sweeping public emphasis on creating greater access to health care, education, job training, and job creation are about the only things we can do on a political level. The rest has to happen in neighborhoods and in families.

  • Bob on September 22, 2012 1:33 PM:

    I can't say I'm surprised. Poverty is increasing. 40% of the nation needs help in one way or another or doesn't have health insurance. It's not just the Republicans, who by their own admission don't care about this 47%, but also Democrats who are all-too willing to suck up to the Gods of the Market by dropping the public option. Health care may not be a Constitutionally-mandated "right" -- but the Right to Life, Liberty, etc. does include the word "life" and only an idiot thinks that life can be maintained without healthcare. That's why were 20-something-th in life expectancy. Even Mexico takes care of all its people. What a country we live in.

  • skeptonomist on September 22, 2012 1:53 PM:

    Mortality rates are usually dominated by infant mortality and it is the higher infant rate that makes the US inferior to other developed countries. So I'm guessing that a change this great is due to deterioration in infant care, either in hospitals or homes. Stress on adults and post-infant nutrition are unlikely causes, though there might be something in obesity-related diseases like diabetes.

  • emjayay on September 22, 2012 1:58 PM:

    The statistical apples and oranges analysis may certainly be part of this, but there is at least one more factor in the increased stress on lower income people.

    It used to be that if you were working class you probably worked a day shift or at a job like most people's that was only somewhere around 8am to 5pm. Or maybe you worked the swing shift or in some cases a night shift. If you worked in a retail related job, the store was probably open from 10am to 8pm or something like that. Maybe closed on Sunday. You were probably in a union that maybe (?) required a consistent schedule besides. Your job was probably for 40 hours a week.

    Now big employers like Walmart and Home Depot are virulently anti-union, while continually insisting they are not. The stores are open often 24 hours or at least 12 or 14 hours a day, 7 days a week. In order to keep from paying benefits and have the number of employees conform to the expected number of customers on each day of the week and each time of the day, and probably to keep employees constantly worried about their job, employees are kept part-time and their schedules may vary from day to day and week to week in both days worked and times. They can be fired at any time for any reason. Home Depot keeps 70% of their employees part-time. Any employee might work 6 hours starting at 6 am one day and 8 hours starting at 3 pm the next.

    It seems to me if I remember correctly (besides it just making sense) that research has shown that attempting to cope with inconsistent sleeping and waking patterns has negative health effects. Plus the stress of uncertainty about when and how many hours you will get work and whether you will have a job tomorrow probably as well.

  • fred on September 22, 2012 2:37 PM:

    @pretty much everyone on this thread (notable exception of Robert)

    1. Explanations regarding diet, lifestyle, access to medical care etc do not fit the data. For example, the change in life expectancy with socioeconomic status is linear over the entire range. This means that the life expectancy of people in the 99.9% level is greater than those in the 95% level. Conversely life expectany for those in the 10% level is lower than those in the 15% level.
    2. See Table 4 in this SSA document: http://www.ssa.gov/policy/docs/workingpapers/wp108.html At 60, those in bottom half of income in the US have a 6 yr lower life expectancy than those in the top half. Raising the age for either SS or Medicare will hurt those who need it most.
    3. If you are really interested in the topic you should read "The Status Syndrome" by Sir Michael Marmot, the author of the Whitehall Studies. He has an entire chapter on what happened to life expectancy in Eastern Europe following the collapse of the Soviet Union. In chapter after chapter he also carefully and systematically shows that all of your favorite hypotheses do not fit the data. The precise reason for the correlation between status and life expectancy remains a mystery.

  • Equal Opportunity Cynic on September 22, 2012 3:15 PM:

    I'm glad that Robert, apparently doing research in this field, chimed in above. I hope he or someone can point the rest of us in this thread to some sources to give us a feel for the ongoing research. Thanks to all who make this a constructive discussion.

  • Rick B on September 22, 2012 3:32 PM:

    @FlipYrWhig

    It's a matter of percentages. Go look at the dollar menu at the fast food places, and assume that for the working poor that menu is what they use to feed their family - especially the children. It's what they can rapidly grab on the way between two jobs and can hand the kids to put into the lunches.

    Then add sugared drinks to that. . I've read that 40 years ago Mexico had real problem with famine. Then Coca Cola and Pepsi started selling sugared drinks in Mexico. Now they have a problem with obesity.

    [There was also NAFTA which required Mexico to drop the tariffs that protected the subsistence farms in Northern Mexico. With the elimination of tariffs on corn, beans and pork America's factory farms could provide the food cheaper than the farmers could grow it. Besides being factory food, that also killed over 2,000,000 subsistence farms in Northern Mexico and drove the families into the cities for jobs. The only jobs were in America.

    The most the immigration could by law provide was 18,600 green cards per year. Normal temporary employment migration for a century has been over 2,000,000.

    Want an explanation for Mexican obesity and for the number of "illegal" immigrants from Mexico in the last 20 years? There it is.

    You can always create illegal immigration by passing a law against the normal employment migration across borders. The law was in 1983. But this is somewhat off topic. It's just closely related.]

  • Rick B on September 22, 2012 3:46 PM:

    @emjayay

    Right! Stress leads to obesity and lack of sleep is a major obesity-creating stressor!

    Again, when you make life more unpredictable for people you do not add to their "freedom." you increase their stress.

    Most of the things in life should be routine and predictable, especially for families raising children. The children will add more than enough stress - I promise. Retirement and health care decisions should be prearranged for people.

    If you are wealthy and face some personal crisis, money is not part of that crisis. If you are middle class or working class, then the crisis becomes much more complicated by the need to obtain the money to deal with the basic crisis.

    If you are poor, uninsured or facing a crisis for which the government or your employer does not provide insurance then you not only face the crisis, you also face the stressing problem but also the problem of how to pay for the solutions.

    Such added stress will always cause an increase in mortality rates. Ask any reputable demographer.

  • tsts on September 22, 2012 4:10 PM:

    @skeptonomist: mortality rates in poor countries and in earlier times (the romans, middle ages) are dominated by infant mortality. But even if the US rate is higher than in other developed countries, I don't think it is high enough to make much of a difference in life expectance. A 1% increase in infant mortality translates to less than one year in life expectance, and the rate in the US is less than 1% higher than that in other countries.

  • thebewilderness on September 22, 2012 4:30 PM:

    After going down for many years the maternal mortality rate and the infant mortality rate in the US is going up.

    http://www.arhp.org/publications-and-resources/contraception-journal/march-2011

  • MuddyLee on September 23, 2012 10:17 AM:

    Bad diet, low income, too much stress, low level depression - I agree with all of this and observe it in my daily life. Rather than attack "the government" I think people should attack businesses that exploit the poor, the young, and the elderly. All business is not good business - we need government regulations and more emphasis on preventative health care efforts. We need more public service type announcements on tv to help educate people about the harm in "cheap" calories (also need more anti-litter ads - at least in SC). And contrary to what my repub friends think, I am not a socialist - I am a business person with a brain and a conscience, who also hates the modern republican party.

  • boatboy_srq on September 23, 2012 1:44 PM:

    [R]esearchers have documented that the least educated white Americans are experiencing sharp declines in life expectancy.

    I can't decide whether the GOTea will use this as proof that healthcare reform is no longer necessary because people will be dying younger and thus consuming less medical care, which will allow costs to drop organically without Big Gubmint intervention, or as justification for cuts to Medicare/Medicaid because people will be living fewer years and collecting less in benefits. Either way it's a Darwinian/Dickensian win for their agenda.

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  • Linda Vij on September 26, 2012 4:58 AM:

    There was more poverty in the Great Depression but life spans did not broadly drop. Modern diet (high sugar and carbs, low protein and veges)must be a key factor in the drammatic drop in life span in the US over 2 decades. And does not bode well for GM crops. Their impact has already began.

    Gross over-use of drugs must also be relevant. What's the use of going to a night club,drug store or doctor if it kills you? Universal health cover will only become truly meaningful upon parity between natural and "standard" medicine. The latter over-emphasizes drugs. Psych drugs (given for subjectively defined conditions)are especially dodgy in the cost benefit analysis but even kids receive them these days! Would you give your 6 year old, whiskey?

  • crebtetry on October 31, 2012 9:00 AM:

    Political Animal - Shocker stat of the day: life expectancy decreases by 4 years among poor white people in the U.S.
    longchamp

    xowz