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Life Expectancy Fell in Many Counties in the US BEFORE the Crisis

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A rising tide did not lift all boats even when the economy looked a lot better than it does now. As Francois T, an MD and medical researcher, wrote:

If you need ONE Indicator of how a nation is doing, it ought to be female life expectancy at birth. It is a tell tale sign that a lot of good things, (or bad things) are happening in the nation under study. Hence, forget about CDOs, CDS, RMBS, Pure BS, Official BS and what have you. Female LEAB will tell you something much more fundamental. It will also be a proof that everything you wrote about the deleterious societal impacts of financial high crimes is correct. As a matter of fact, people severely underestimate the real repercussions and total costs of a decrease in female life expectancy at birth.

He pointed to a just-released study, Falling behind: life expectancy in US counties from 2000 to 2007 in an international context. Some of its major findings:

Large swaths of the United States are showing decreasing or stagnating life expectancy even as the nation’s overall longevity trend has continued upwards, according to a county-by-county study of life expectancy over two decades.

In one-quarter of the country, girls born today may live shorter lives than their mothers, and the country as a whole is falling behind other industrialized nations in the march toward longer life…

Some US counties have a life expectancy today that nations with the best health outcomes had in 1957 … Five counties in Mississippi have the lowest life expectancies for women, all below 74.5 years, putting them behind nations such as Honduras, El Salvador, and Peru. Four of those counties, along with Humphreys County, MS, have the lowest life expectancies for men, all below 67 years, meaning they are behind Brazil, Latvia, and the Philippines.

And get a load of this:

Despite the fact that the US spends more per capita than any other nation on health, eight out of every 10 counties are not keeping pace in terms of health outcomes. That’s a staggering statistic.

Note that we’ve written that income disparity is highly correlated with a deterioration in social well-being indicators, including life expectancy. Russia saw a plutocratic land grab after the USSR collapsed, and already-high rates of drinking increased, with the result that male life expectancy fell an eye-popping four years, from 62 in 1980 to 58 in 1999.

The study found that some states had very high disparities within their borders. The main culprits are obesity and smoking:

The researchers suggest that the relatively low life expectancies in the US cannot be explained by the size of the nation, racial diversity, or economics. Instead, the authors point to high rates of obesity, tobacco use, and other preventable risk factors for an early death as the leading drivers of the gap between the US and other nations.

Yet looking at this map (click to enlarge), I’m a bit puzzled at the singling out of those factors, since from my visits to the South, I see obesity rates just as high in the Upper Midwest, which scores well on life expectancy. Are there really more heavy smokers or fat people in the South? The article tiptoes around the fact that blacks and Hispanics (as well as Chinese) are more prone to get Type 2 diabetes than Caucasians.

And remember, the data in this study goes through 2007. It will take a few years to find out what impact the crisis has had on the health of America’s citizens.

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30 comments

  1. Foppe

    Three remarks: Life expectancy strongly correlates with SES, and this happens in two ways. First there are the obvious differences in the quality of the diet, smoking, and environmental pollution, as pollutants are often dumped in poorer areas, often because the counties are paid tiny sums and they need the revenues. (And I know this is a huge issue in Mississippi, Louisiana, Alabama etc., where poor rural communities have and are being turned into the dumping ground of the US.)
    Secondly, and this probably the most insidious contributing factor of all, health (and life expectancies) are also influenced by perceived social status differences because of the constant stress this causes. So in countries or areas (or industries) where status differences are emphasized more strongly, those who (perceive themselves to) score badly become sick more often, and actually die at a younger age. This is an especially large problem for factory workers who have little to no say over how they organize their day (they are often not even allowed to go on toilet breaks more than once or twice every few hours), and for mid-level managers, who are constantly confronted with the fact that people can order them around. (This is also an important contributing factor for domestic abuse issues caused by displacement aggression.) There has been a lot of work done on this looking at the British Civil Service by Marmot, and I find it very convincing.

    Lastly, and this connects to the previous point: it is probably interesting to disaggregate these LEAB and other figures by SES quintile or decile.

    PS. A hugely interesting lecture series on the topic of the impact of social stress is Robert Sapolsky’s Teaching Company series called Stress and Your Body. The lecturer is a very distinguished neuroscientist/primatologist. Highly recommended.

    1. Anonymous Jones

      “health (and life expectancies) are also influenced by perceived social status differences”

      There is also a good amount of literature that tends to show that certain “objective” factors of happiness correlate well with *relative* consumption.

      I would imagine that happiness (or the lack thereof) probably correlates pretty well with the desire to maintain one’s own health.

      Yes, impossible to prove, but it is certainly not outrageous to believe that the widening wealth gap is deleterious to certain health outcomes *even if* nominal income is not decreasing for certain classes.

      1. Harold

        life expectancy stats also reflect infant mortality rates, which explains why many of us will still kick off at seventy or eighty something even though the graphs show a steady increase in live expectancy

        or put another way all of the action has been at the short end of the curve

  2. yoganmahew

    During the war in Bosnia, the incidence of type-2 diabetes fell in Sarajevo, due to a shortage of sugar (and food in general). Aside from being a poor method to increase health, I think the same is unlikely to happen in the US during this crisis as the movement is towards cheaper food packed with high-fructose calories.

    1. Foppe

      Yes, I suspect that the fact that the Mid-West has more access to real food (grains, vegetables) helps rather a lot. As has been reported elsewhere, in a lot of inner cities supermarkets don’t even offer vegetables any more, so anyone who lives there cannot even choose to eat healthily.

      1. yoganmahew

        And unfortunately, Foppe, it is more expensive to eat healthily. With, what, 45 million Americans on food stamps, fructose is frugal…

        1. Foppe

          Yeah, especially so because HFCS production is so heavily subsidized. Never mind that an ever-increasing body of evidence has already shown that fructose is a lot more demanding on the liver to break down than glucose. European poor people are quite lucky in that regard, simply because they do not have to digest HFCS products. (And then there are, iirc, the consequences that high-fat foods have for blood pressure levels.)

        2. issacread

          Furthermore that HFCS comes from GMO corn. The US population is the world’s lab rat for GMO food consumption the real effects of which are just beginning to hit the fan. Just wait til that one really kicks in. 80 to 90 percent of mothers and babies carry GMO toxin in their bloodstream from the milk and meat of animals fed GMO feed. Consequences unknown.

          1. John Emerson

            This map shows the area in which life expectancy decreased over a ten year period. http://motherjones.com/kevin-drum/2011/06/map-day-falling-life-expectancies

            This map looks like a mix of Appalachia and the Black Belt and coincides with the heavy smoking map and also with a poverty map. But the heavy smoking has always been there so probably the cause is an increase in poverty, decrease in accessibility of medical care, etc. The already poor are getting worse off.

            It’s seldom explicitly spoken of except by the nastiest libertarians, but plenty of conservatives think that some worthless people deserve to suffer and deserve to die, and that it’s wrong for government to interfere with that natural and godly process.

            Regarding SES, here’s a freak result. Poor whites in the Upper Midwest actually live longer than the average American. They’re the second healthiest population in the country after Asian-Americans, and are better off than well-off whites in the same area: http://www.usatoday.com/news/health/2006-09-11-map-8Americas_x.htm

            By contrast, the worst off white population is poor whites in Appalachia. Smoking may be the main difference.

            Here’s a fuller version, if anythong’s interested: http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030260

  3. Maju

    If you look at the paper, you almost immediately notice that the affected counties are essentially the “Deep South” and almost totally overlap with any map of counties reporting a plurality of African ancestry in the census. The main exception could be East Kentucky, which is known to be the most depressed area in Appalachia but is surely mostly white.

    It is therefore an indicator of marginalization and (largely) racism. Considering that in the USA health care is (or has been until recently) a private business, people who cannot pay for health care are more likely to die early. Other factors that may contribute is that poverty feeds depression and depression kills in many ways (suicide, disinterest for one’s health, etc.)

    The paper is not oblivious to this fact (and never mentions smoking, obesity or diabetes specifically):

    “The lack of insurance and associated health risks will play out differently across US counties both because of huge variations in the numbers of people lacking insurance and behavioral, environmental, and social risks to health”.

    Let’s not forget that, in spite of the huge wealth accumulated, the USA is one of the countries worldwide where income differences (and their effects) are most brutal on Earth (and notably among developed countries). This sharp inequality is for real but it becomes a bit more visible in this geographical study, where the poorest areas of the federation are highlighted. And most of those poorest areas are essentially Black counties.

  4. rcyran

    Fappe nails most of the factors. Also, people of African descent are more likely to get hypertension if they eat salt than caucasians.
    http://www.medscape.com/viewarticle/407741_3

    People down south tend to eat a lot of packaged food from what I’ve seen, so my guess is salt intake is high.

    Combine this with obesity, smoking, and poor education we’ve got a big problem in the south.

  5. XRayD

    Yes, obesity is obesity and the body has to deal with it.

    But I wonder if obesity in the Southeast (say) is different from that in the Midwest because it is caused by DIFFERENT types of diets, creating a different “set” of health issues – hypertension, diabetes, cholesterol … and even cancer?

    We know individual bodies are different, which is why the same diet does not always produce the same result in all people. And all medicines do not work identically in all people.

    While the access to abundant foods of different types may at one time extended life expectancy, after a certain point, could it not do the opposite? Specially when one considers the differences in genetic make up?

    Eating right and exercise perhaps works the same everywhere, but not doing so seems to produce different outcomes in different regions!

    1. Foppe

      You are largely correct. To give a very general example, people who are overweight, but who live on a mediterranean diet, are generally healthier than people who are similarly overweight on a bread, sugar and plant fat-based diet. (Unless the diet is heavy on whole grains and rye and the like.)
      Anyway, sugar is almost never good. While it’s fairly quick to digest, especially fructose is very hard on the liver, while the ‘shorter’ a sugar is, the more violently it makes your blood sugar levels bounce all over the place, which is stressful to your body. Never mind that sugar also causes your body to get rid of certain minerals (and vitamins? I don’t recall the details) more quickly than you otherwise would, which can lead to deficiencies. As for fats, it really depends on the type of fat whether it is healthy. The polyunsaturated ones are best, which is also (roughly speaking) why olive oil and sunflower oil are healthier than lard and butter.

      1. cheale

        While I don’t disagree with the general thrust of what you are saying, olive oil is monounsaturated (like fish oils) and these are meant to be the most healthy, some polyunsaturated like sunflower oils are not as good for you as these…

        1. Foppe

          True, and apologies for being unclear/sloppy there. But sunflower oil is still an order of magnitude healthier than butter, and especially those horrid margarines and other plant fat products.

        2. gepay

          Well the nutritional fat issue is undergoing revision. I can remember from the late 50s how polyunsaturated fats were the best for you> margarine is good for you. Now the we know that lard is better for you than margarine. In fact cottonseed oil is the worst as cotton is not a food and so pesticide use is not regulated like a food crop and many pesticides are fat soluble. Sunflower oil is probably one of the better polyunsaturated.Hard to say about canola as it is mostly GM and the solvents used to extract it are not the best. There are nutritional benefits one gets from animal fats that one doesn’t from say sunflower. Everyone agrees that olive oil is good for you. That said it is the balance of different fats that we need for good health – the whole omega 3 omega 6 thing and why some fish oils are good supplements for most people.
          What is the worst for you is rancid fats – filled with free radicals – some of the fats used to make say french fries at a fast food restaurant.Use only fresh oil/fats of any kind.

  6. Deb Schultz

    The paper does, in fact, discuss preventable factors of early mortality. The point of the method of analysis, I believe, was to understand performance variation in the US with regard to life expectancy. The study’s authors point out that counties of above median income ranged from 16 years ahead of their established ‘frontier’ to 47 years behind. Therefore, they argue, some of the discrepancy must be related to “differences or less favorable trends in critical risks to health such as tobacco smoking, hypertension, diabetes, physical inactivity, obesity, LDL cholesterol, diet, and alcohol[.]“

  7. ambrit

    Friends;
    Someone needs to do a metastudy correlating as much in our society as possible. Living here down south, (Mississippi,) I can testify to the subtle and not so subtle effects of poverty and class differences. Education is a major factor I suspect. The Black Belt arguement would gain traction if anyone could correlate race with direct effectors. (Why do southerners stick with a high fat diet?) Etc.. Notice that the West is strangely green (hidden bias built in?) even though it has huge pockets of poverty just like the South. (Being closer to the valley and mecican growing areas, could they have better access to healthier foods, and cheaper?)

    1. bmeisen

      Numerous organs gather and analyze data on Americans. The usefulness of their subsequent reports depends on the integrity of their data. While the national census consistently refreshes databases, the United States is fundamentally challenged by fragmented and competing data collection methods. For example, the integrity of arguably the most important database in a democracy – the list of eligible voters – has been the subject of substantial and repeated dispute.

      Data collection efforts would be facilitated by the introduction of locally-organized citizen registration offices empowered by law to record the basics on each resident of a given area. For example citizens and resident aliens would be required by law to register with the local office when moving to a new area. This would require providing name, birthdate, address to the authorities and little more. These databases would be poolable.

      The report discussed here on female mortality by county is particularly valuable because mortality databases enjoy an unusual degree of integrity.

  8. Harmanszoon Van Rijin

    FLAAB, Female Life Anticipation At Birth has decreased within many counties that do not provide proper entertainment that includes a rousing session or two of Tractor-Pull. When your FLAAB is under-performing, just remember to support my organization. Additionally if you have an excess of mega-Humphrey-s of live in Humphreys County, MS, just remember folks :

    Support your local cellulite
    !

  9. Bam_Man

    It was pointed out on The News Hour last night that a male child born in Fairfax County Virginia (considered within the DC Beltway Bubble) now has a TWENTY YEAR LONGER life expectancy than one born in Humphreys County Mississippi.

    Two nations, under God.

  10. jaymaster

    I think some folks are misinterpreting part of this report. If you watch the animated maps, you will see that the life expectancy increased for a huge amount of the US population. In fact, they say that, “ Nationally, life expectancy increased 4.3 years for men and 2.4 years for women between 1987 and 2007.”

    There were only a few counties where life expectancy actually fell.

    They chose some poor wording that adds to the confusion. For example, “The researchers found that women in 1,373 counties – about 40% of US counties – fell more than five years behind the nations with the best life expectancies.”

    That does NOT mean that life expectancies in those counties dropped over the time frame. In fact, in most of those counties, the life expectancy increased. However, the increase wasn’t enough to bring them in line with the highest nations.

    1. Francois T

      “However, the increase wasn’t enough to bring them in line with the highest nations.”

      Isn’t this fact the kernel of the matter? Why do we lag behind other advanced nations that spend much less than we do on health care?

      And more to the point, when will Americans accept to believe the facts instead of plugging their ears, rock their bodies and repeating: “I can’t see that! I can’t see that”?

  11. curlydan

    “Are there really more heavy smokers or fat people in the South?”

    Yes. And it would be interesting to compare the map above with the Crisco sales per capita in each county.

  12. Floppy Boot

    Forget weight, it’s the stress from cognitive dissonance that does it. That’s why the deep south is hit so hard. It is very difficult to align Southern Baptist teachings with the actual workings of the world at large, throw in that their political meme-space is a bag of snakes and such things have a cumulative effect on the collective health of the herd.

  13. mk

    Let’s not forget the Corexit poison used to disperse all the oil from deepwater horizon oil volcano that is working its way through the food chain in the gulf of mexico. Doesn’t most of the fishmeal used to fertilize U.S. corporate farms come from the gulf of mexico? That should take a few years off life expectancy too.

    1. Maju

      This study ended in 2007 and most affected counties are inland ones. You won’t see the effects of corexit until the next survey, whenever it is and IF it is.

  14. LAS

    Great topic, Yves. There is a growing body of evidence in epidemiology and public health literature that INEQUALITY is positively correlated with lower life expectancy for whole populations. Epidemiology has the evidence that growing inequality really does hurt a population.

  15. Jean

    Defeated peoples develop, in fits and starts, self-destructive traits. Lest we forget, I doubt that the rural south has yet to reach the level of deprivation of Pine Ridge.

    • Life expectancy on the Pine Ridge Reservation is the lowest anywhere in the western hemisphere, except for Haiti. A recent study found the life expectancy for men is 48 years, for women it is 52 years on the Reservation.
    • The Pine Ridge Reservation has the highest infant mortality rate in the United States.
    • The unemployment rate in Shannon County is 70% and the average family income is $3,800
    • Many families have no electricity, telephone service, running water, or sewers and must use wood burning stoves to heat their homes.

    http://www.indianyouth.org/pr-reservation-sd.html

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