If You're Poor, A Long Life May Depend On Where You Live

A new study out today in the Journal of the American Medical Association finds that the gap in life expectancy between the rich and the poor has grown in the last 15 years. It also finds that if you're poor, how long you live may have a lot to do with where you live. Here & Now's Peter O'Dowd speaks with Michael Stepner, a Ph.D. candidate at MIT and one of the study's co-authors.

What are we learning about the life expectancy gap between the rich and poor?

“We’re able to provide a more detailed picture than has been available of that ever before in the United States, and so we can both tell you how large those gaps are for the very richest Americans and the very poorest Americans, as well as how fast those gaps have been growing.”

How big is the life expectancy gap?

“The richest men in America are living 15 years longer than the poorest men in America. For women, that gap is 10 years. Just to give you a sense of how large that is, the gap in life expectancy between a lifetime smoker and someone who’s never smoked a cigarette is about 10 years. We’re talking pretty large gaps here.”

Where are the biggest gaps as it relates to geography?

“As far as geography goes, they’re a little bit different from what people have identified from past work on, say, upward mobility or different aspects of income inequality. We see that the lowest life expectancy places for low-income Americans are in Nevada, and in this geographic belt that connects Michigan to Kansas, kind of looping down through that area of the United States.”

Straight through the center of the U.S., and why is that?

“One of the most pervasive patterns that we see is that places with poor health behaviors, high rates of smoking, high rates of obesity, low rates of exercise are consistently areas with poor life expectancy for the poor in the United States. Some other factors that you would have thought would be correlated, like the lack of health insurance, just don’t seem to explain these patterns. So health behaviors are one of the key factors that we found are associated with these national patterns and with these low life expectancy areas.”

Why are there trends in certain cities of poorer residents living almost as long as people in the middle or upper class?

“One thing you might have thought is that it would be hard to be poor in some of these really expensive cities, like New York City. New York City is an expensive place to live. On the flip side, New York City is a place that has high government expenditures, highly educated population, and in particular in New York, you have a very selective group of people who are choosing to live there, high rates of immigrants. So, you can tell a couple stories, and in this paper we don’t pick apart that one causal factor that tells us this is why New York City is doing great, but we’re really hoping, with all of the data we’ve published, that public health researchers and other researchers interested in this topic, which we think is very important, are going to dig in and try to assess, what are the things that tie together these places that have rising life expectancy?”

What would you recommend for states with lower life expectancy among the poor?

“I want to be cautious in advocating policy, because we have a correlational study. That being said, the correlations between health behaviors and life expectancy for low-income Americans are very strong, and so there’s suggestive evidence that interventions that improve health behaviors, such as reducing smoking rates, would be successful. The one thing that I do want to highlight is a lot of the conversation on reducing inequality in health in the United States has been focused on the national level. But our paper suggests that there is a large opportunity for local, targeted policies to address these gaps and improve life expectancies for low-income Americans.”