Contributor Post Created with Sketch. Link Between Health and Income Not What Most Assume

 

040516ShealthSo there’s a major new study out that looks at health inequality. Among the findings are that (a) the very rich live a lot longer than the very poor, and (b) geography matters. From the Health Inequality Project:

The richest American men live 15 years longer than the poorest men, while the richest American women live 10 years longer than the poorest women. The gaps between the rich and the poor are growing rapidly over time. The richest Americans have gained approximately 3 years in longevity since 2000, but the poorest Americans have experienced no gains. … Life expectancy varies substantially across cities, especially for low-income people. For the poorest Americans, life expectancies are 6 years higher in New York than in Detroit. For the richest Americans, the difference is less than 1 year.

But health inequality is one thing, income inequality another. And the relationship might not be what many might automatically assume:

Correlational analysis of the differences in life expectancy across geographic areas did not provide strong support for 4 leading explanations for socioeconomic differences in longevity: differences in access to medical care (as measured by health insurance coverage and proxies for the quality and quantity of primary care), environmental differences (as measured by residential segregation), adverse effects of inequality (as measured by Gini indices), and labor market conditions (as measured by unemployment rates).

Rather, most of the variation in life expectancy across areas was related to differences in health behaviors, including smoking, obesity, and exercise. Individuals in the lowest income quartile have more healthful behaviors and live longer in areas with more immigrants, higher home prices, and more college graduates.

Indeed, San Francisco and New York are high inequality cities. Anyway, there is a lot going on here, and I still need to dig down further in the paper. But let me end with this policy bit from the paper:

There are many potential explanations for why low-income individuals who live in affluent, highly educated cities live longer. Such areas may have public policies that improve health (eg, smoking bans) or greater funding for public services, consistent with the higher levels of local government expenditures in these areas. Low-income individuals who live in high-income areas may also be influenced by living in the vicinity of other individuals who behave in healthier ways. Alternatively, the low-income population in such cities might have different characteristics, consistent with the larger share of immigrants in these areas. Testing between these theories is a key area for future research.

The small area variation in the association between life expectancy and income suggests that reducing gaps in longevity may require local policy responses. For example, health professionals could make targeted efforts to improve health among low-income populations in cities, such as Las Vegas, Nevada; Tulsa, Oklahoma; and Oklahoma City, Oklahoma. The strong association between geographic variation in life expectancy and health behaviors suggests that policy interventions should focus on changing health behaviors among low-income individuals. Tax policies and other local public policies may play a role in inducing such changes. The publicly available data at www.healthinequality.org provide a way to monitor local progress.

The findings also have implications for social insurance programs. The differences in life expectancy by income imply that the Social Security program is less redistributive than implied by its progressive benefit structure. Men and women in the top 1% of the income distribution can expect to claim Social Security and Medicare for 11.8 and 8.3 more years than men and women in the bottom 1% of the income distribution. Some have proposed indexing the age of eligibility for Medicare and full Social Security benefits to increases in life expectancy. The differences in the increases in life expectancy across income groups and areas suggest that such a policy would have to be conditioned on income and location to maintain current levels of redistribution.

First, this suggests new or higher taxes on cigarettes and sugary foods and beverages or various prohibitions. Hmm. Second, think local — along with health interventions, maybe housing policy, too? Third, my colleague Andrew Biggs has been proposing Social Security reform that would increase benefits for the bottom third of retirees. He notes that “as a result of their short work histories, nearly one-fifth of the poorest quintile of retirees fail to even qualify for Social Security, and nearly one-third of those who do qualify receive a benefit below the poverty line.”

There are 14 comments.

  1. Ekosj Inactive

    One of the healthiest things one can do is walk. And New Yorkers of all income levels walk a lot more than most folks. So based on that anecdotal evidence alone I’m not surprised that the disparity between income levels is smaller than elsewhere.

    Why must everything be the result of some government program or policy?

    • #1
    • April 11, 2016, at 9:46 AM PDT
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  2. Fritz Member

    Not on topic of the article, but may I question the new fashion of starting every utterance with the word “so” as does this article?

    I hear it on TV news channels constantly. “So” has joined the mindless interjection, between observations, of the word “look,” which at least has the intention apparently to signal the listener that the speaker has more to say. But “so” is just annoying.

    / soapbox

    • #2
    • April 11, 2016, at 9:47 AM PDT
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  3. Ekosj Inactive

    I’m guilty. I’m a ‘so’-er. If ‘look’ can be understood as an indicator that the author has more to say, ‘so’ (at least for me) indicates I’m about to conclude.

    • #3
    • April 11, 2016, at 9:51 AM PDT
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  4. DrewInWisconsin, Oaf Coolidge

    My first (and continued) response is: “Ugh. Now some left-wing do-gooder will propose policy solutions to “fix” this health inequality.”

    • #4
    • April 11, 2016, at 10:04 AM PDT
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  5. Mendel Member
    Mendel Joined in the first year of Ricochet Ricochet Charter Member

    Rather, most of the variation in life expectancy across areas was related to differences in health behaviors, including smoking, obesity, and exercise.

    [Emphasis mine]

    I almost wish the entire article could be reduced to this one word.

    This is not a groundbreaking finding, but it’s a great confirmation of what was already well-known: the best way to ensure a healthy life in an industrial country is through one’s own behavior, not through access to this, that or the other thing. Kudos to the NYT for pointing this out fairly explicitly.

    • #5
    • April 11, 2016, at 10:38 AM PDT
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  6. Vicryl Contessa Thatcher

    DrewInWisconsin:My first (and continued) response is: “Ugh. Now some left-wing do-gooder will propose policy solutions to “fix” this health inequality.”

    Oh, truuuuuust me, they’ve been talking about health inequality for a long time in nursing and medicine. That’s why there are such rich benefits if you’re willing to go practice in an “underserved” area.

    • #6
    • April 11, 2016, at 10:53 AM PDT
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  7. Vicryl Contessa Thatcher

    Mendel:

    Rather, most of the variation in life expectancy across areas was related to differences in health behaviors, including smoking, obesity, and exercise.

    [Emphasis mine]

    I almost wish the entire article could be reduced to this one word.

    This is not a groundbreaking finding, but it’s a great confirmation of what was already well-known: the best way to ensure a healthy life in an industrial country is through one’s own behavior, not through access to this, that or the other thing. Kudos to the NYT for pointing this out fairly explicitly.

    Of course, they argue that these behaviors are indicative of low socioeconomic status and poor education, all of which would be fixed with money.

    In my classes, every disease has “low socioeconomic status” as a risk for contracting the disease.

    • #7
    • April 11, 2016, at 10:55 AM PDT
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  8. Mendel Member
    Mendel Joined in the first year of Ricochet Ricochet Charter Member

    Vicryl Contessa:

    Mendel:

    Of course, they argue that these behaviors are indicative of low socioeconomic status and poor education, all of which would be fixed with money.

    In my classes, every disease has “low socioeconomic status” as a risk for contracting the disease.

    If certain conditions correlate with low income, I think it’s fair to note that at the scientific level.

    However, the big take-home message of this article (and, to a lesser extent, of the underlying study itself) is the large fluctuations in life expectancy among the poor themselves. Those differences – and the fact that they don’t correlate with services provided – suggest that a lack of money/resources is not the causal factor.

    That’s why I tip my hat (a little) to the NYT – they laid out the case for personal behavior in causing favorable health outcomes fairly clearly.

    • #8
    • April 11, 2016, at 11:01 AM PDT
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  9. RiverRock Inactive

    DrewInWisconsin:My first (and continued) response is: “Ugh. Now some left-wing do-gooder will propose policy solutions to “fix” this health inequality.”

    What is the ultimate left-wing policy fix for:

    • health inequality
    • wealth inequality
    • Social Security viability
    • Medicare viability
    • ACA/Obamacare cost containment
    • VA hospital corruption and incompetency
    • housing shortage
    • anthropologic climate change
    • global over-population

    ==> Government mandated euthanasia for all at age 75.

    Guaranteed equal outcome for all.

    • #9
    • April 11, 2016, at 1:10 PM PDT
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  10. Hammer, The Member

    … new or higher taxes on unhealthy things.

    Because people cannot be allowed to make their own choices. And if they ARE going to choose things that lower their life expentencies, why not make them pay for it?

    • #10
    • April 11, 2016, at 1:46 PM PDT
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  11. Hammer, The Member

    Mendel:

    Rather, most of the variation in life expectancy across areas was related to differences in health behaviors, including smoking, obesity, and exercise.

    [Emphasis mine]

    I almost wish the entire article could be reduced to this one word.

    This is not a groundbreaking finding, but it’s a great confirmation of what was already well-known: the best way to ensure a healthy life in an industrial country is through one’s own behavior, not through access to this, that or the other thing. Kudos to the NYT for pointing this out fairly explicitly.

    … before suggesting that the government intervene to alter people’s behavior and limit their choices.

    • #11
    • April 11, 2016, at 1:47 PM PDT
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  12. EThompson Inactive

    The richest American men live 15 years longer than the poorest men, while the richest American women live 10 years longer than the poorest women. The gaps between the rich and the poor are growing rapidly over time.

    Three reasons: cigarettes, drugs, excessive use of alcohol. Also, if you care to skew the curve with urban residents, let’s talk murder:

    Chicago violence, homicides and shootings up in 2015

    • #12
    • April 11, 2016, at 8:01 PM PDT
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  13. Vicryl Contessa Thatcher

    EThompson:

    The richest American men live 15 years longer than the poorest men, while the richest American women live 10 years longer than the poorest women. The gaps between the rich and the poor are growing rapidly over time.

    Three reasons: cigarettes, drugs, excessive use of alcohol. Also, if you care to skew the curve with urban residents, let’s talk murder:

    Chicago violence, homicides and shootings up in 2015

    You forgot rock ‘n roll… ;-)

    • #13
    • April 11, 2016, at 8:04 PM PDT
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  14. EThompson Inactive

    Vicryl Contessa:

    EThompson:

    The richest American men live 15 years longer than the poorest men, while the richest American women live 10 years longer than the poorest women. The gaps between the rich and the poor are growing rapidly over time.

    Three reasons: cigarettes, drugs, excessive use of alcohol. Also, if you care to skew the curve with urban residents, let’s talk murder:

    Chicago violence, homicides and shootings up in 2015

    You forgot rock ‘n roll… ;-)

    Wait… how does this explain my good health???

    • #14
    • April 11, 2016, at 8:07 PM PDT
    • 1 like