April 22, 2008


For the first time since the Spanish influenza of 1918, life expectancy is falling for a significant number of American women.

In nearly 1,000 counties that together are home to about 12 percent of the nation's women, life expectancy is now shorter than it was in the early 1980s, according to a study published today.

The downward trend is evident in places in the Deep South, Appalachia, the lower Midwest and in one county in Maine. It is not limited to one race or ethnicity but it is more common in rural and low-income areas. The most dramatic change occurred in two areas in southwestern Virginia (Radford City and Pulaski County), where women's life expectancy has decreased by more than five years since 1983.

The trend appears to be driven by increases in death from diabetes, lung cancer, emphysema and kidney failure. It reflects the long-term consequences of smoking, a habit that women took up in large numbers decades after men did, and the slowing of the historic decline in heart disease deaths.

It may also represent the leading edge of the obesity epidemic. If so, women's life expectancy could decline broadly across the United States in coming years, ending a nearly unbroken rise that dates to the mid-1800s.

"I think this is a harbinger. This is not going to be isolated to this set of counties, is my guess," said Christopher J.L. Murray, a physician and epidemiologist at the University of Washington who led the study. It is being published in PLoS Medicine, an open-access journal of the Public Library of Science.

Said Elizabeth G. Nabel, director of the National Heart, Lung and Blood Institute of the National Institutes of Health: "The data demonstrate a very alarming and deeply concerning increase in health disparities in the United States."

The study found a smaller decline, in far fewer places, in the life expectancy of men in this country. In all, longevity is declining for about 4 percent of males.

The phenomenon appears to be not only new but distinctly American.

Now it would be easy to take the Republican route and blame this on individual lifestyle choices rather than looking at this as a symptom of inequality of care. PBS has just recently offered a series titled "Unnatural Causes: is inequality making us sick?" showing how our position in society affects our health. Executive Producer Larry Adelman wrote about it at the AFL-CIOblog:

The single best predictor of one’s health is not diet, exercise or even smoking but class status. But it’s not only the poverty-stricken who are afflicted—after all, what would be so surprising about that?—but the middle classes as well. At each descending step down the class pyramid, from the rich to the middle to the poor, people tend to be sicker and die sooner. Top executives have, on average, better health than managers, managers fare better than supervisors and technical personnel, supervisors do better than line, service and clerical workers, and the unemployed have the worst health of all. High school dropouts die, on average, six years sooner than college graduates. In other words, it’s not CEOs who are dying of coronary heart disease but those who work for them. [..]

But many health risks have nothing to do with behaviors. Government and business decisions over which individuals have little say can expose us to health threats or health promoters: the location of toxic dumps, the quality of schools, whether plants stay open or shift jobs overseas, where parks and freeways get built, wages and benefits, shifting mortgage rates, even tax policy.

According to the MacArthur Research Network on Socioeconomic Status and Health and the work of Peter Schnall, June Fisher and others, high-demand coupled/low-control jobs in particular create damaging levels of chronic stress. Those who cannot control the pace of their work and have limited opportunity for autonomy and decision making experience higher rates of depression, heart disease, diabetes and premature death even when they face no physical hazards at work.

But if we look overseas, where citizen health and life expectancy are often considerably higher than ours, we can see the importance of national social policies that “treat” not just the individual but the larger environment. One set of policies—such as free universal pre-school, quality schools no matter the neighborhood, paid parental leave, four to six weeks of paid vacation—make sure health promoters are available to everyone, not just the affluent.

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