
Life-Expectancy Inequality Grows in America - rafaelc
http://www.newyorker.com/news/daily-comment/life-expectancy-inequality-grows-in-america/
======
mpweiher
“A medical journal article reporting that income is significantly associated
with life expectancy is a call to arms,..."

Yet the _gender_ disparity is much greater (and rising), and that is a call
to...[crickets]

~~~
rubidium
Here's the worldwide data:
[http://www.who.int/entity/bulletin/volumes/90/8/BLT-11-09737...](http://www.who.int/entity/bulletin/volumes/90/8/BLT-11-097378-F2.jpg)

and artile:
[http://www.who.int/bulletin/volumes/90/8/11-097378/en/](http://www.who.int/bulletin/volumes/90/8/11-097378/en/)

Short version: low income is worse for everyone, but (not surprisingly) more
worse for men than women. For high income, men and women have almost achieved
parity.

~~~
mpweiher
That's interesting. The article talks about "shortfall", not about absolute
lifespan. What is the baseline for that shortfall?

It almost looks like it might be the gender-segregated data for "high income",
which would explain why those have (a) no shortfall at all and (b) no gender
disparity.

Reading the article, it does look like the "shortfall" is gendered, being
based on gender-specific maxima.

------
medymed
There may be some reverse causation--in a country where devastating and
chronic illness frequently bankrupts people, it's not too surprising that at
least this subset of poor people would be living quite a bit shorter than the
average citizen.

~~~
jdietrich
The disparity is still significant in countries with state-funded healthcare.

[http://www.kingsfund.org.uk/sites/files/kf/field/field_publi...](http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/inequalities-
in-life-expectancy-kings-fund-aug15.pdf)

~~~
VLM
However the socioeconomic class of the neighborhood as per the linked graphs
depend on employment status not hospital bills, and thats constant across US,
UK, etc.

For example. Take a senior airline captain. Toward the end of their career
they're almost as well paid as us IT people, maybe 90th percentile. That
relies on a 1st class med cert, updated every six months. The day after you
fail, you're unemployed (more or less). Suddenly his income, and inevitably
his neighborhoods social class, starts dropping. Perhaps he works in an office
as a clerk. Optimistically maybe 50% percentile income. But he didn't fail
that med cert for fun, its because of developing heart disease.

Now you can pretend to be surprised a 50th percentile file clerk has a lower
life expectancy (due to his heart disease) than a 90th percentile airline
captain. But its not an elaborate conspiracy. Its just that higher income jobs
assume health.

Its even worse, in that most employers have low tolerance for employee
illness, but even lower tolerance for employee family member illness. A mother
who's kid has some terrible disease is much more likely to get poorer and
downwardly mobile, than the opposite. Shouldda started that startup, but dad
was dying of cancer at that time, and kids of cancer victims tend to become
cancer victims, so "mysteriously" lower income people seem to be at higher
risk of cancer. Not to forget the destructive effects of mental illness on
employability in stereotypical higher income jobs.

------
300bps
Stopped reading here:

 _A child born in 1900—little more than a century ago—was likely, on average,
to die by the age of thirty._

This is so misleading, suggesting that people typically died before they were
30.

The misleading average here is caused by infant mortality. That's the #1 way
that life expectancy has risen in the last 116 years.

To illustrate how big we've reduced infant mortality, look at this:

[http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm](http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm)

 _From 1915 through 1997, the infant mortality rate declined greater than 90%
to 7.2 per 1000_

~~~
jackcosgrove
This is the same problem with claims that life expectancy in the middle ages
was 25 years or so.

------
jpwagner
_" The reasons for the difference are not clear, although the authors point
out that cities like New York often have aggressive anti-smoking policies and
make it harder for people to eat trans fats, and drink sugary sodas—which are
implicated in common diseases like obesity and diabetes"_

Anti-smoking in NYC is ~14 years old and the sugary-soda crackdown is less
than 4 years old. How can these policies be proven to contribute to life-span
data?

~~~
LanceH
While the policies may not be causative, the attitudes which allowed these
bills to pass may have been present for much longer.

~~~
VLM
Gentrification pushes out poor people, therefore you can ban things poor
people like without backlash, and naturally fewer poor people means fewer sick
people, if most financial problems come from medical expenses and medical
expenses mostly come from sickness, then making it hard for poor/bankrupt
people to live there will naturally result in the remainder being healthier on
average. I would theorize the demographics of NYC are anything but constant.

Or it could be a bias toward authoritarianism naturally results in health,
although the cause and effect on that one is a bit fuzzy. The obesity rate in
NYC is about 1 in 3 but in Denver its about 1 in 5, and Denver isn't X% more
authoritarian than NYC.

------
cmdrfred
In a pay to play healthcare system, those who can pay the most get the best
toys. An important study but it shouldn't surprise anyone.

~~~
drzaiusapelord
Maybe people with money take care of themselves better? All my lower income
acquaintances and friends are fat and never work out. They drive everywhere
and are generally very unhealthy. It just blows my mind to see what they eat
at restaurants. There's a real issue here about the lack of proper eating and
exercise.

The middle class or higher group people in my life often take care of their
health, work out, eat right, etc. They ride bikes, stay active, walk a lot,
etc.

The idea that its purely healthcare dollars at work here is unrealistic to me.
I think there's more at play here and the knee-jerk answers that are political
correct is often wrong. Especially post Obamacare, where so many are now
insured and go the same doctors and hospitals everyone else goes to.

~~~
llamataboot
Think have some strange causation going on here. Have you ever had to figure
out how many calories you could get per dollar -- let me tell you it looks a
lot more like Taco Bell than grass-fed meat and a kale smoothie. Have you ever
had to work 2 terrible mind-numbing boring jobs for 60 hours a week and then
threw a couple kids or even grandkids into the mix? Not a lot of spare money
or time to get a gym membership. There's also social norms, a lack of future
orientation (that is a well known effect of living in poverty), etc. Being
poor is unhealthy -- blaming its effects on individual's not "being
responsible and eating and exercising right" is an individual cop-out for a
structural problems.

~~~
drzaiusapelord
When I was poor buying healthy meat and greens at the mexican grocery store
cost me very, very little. I don't believe for one second the "the poor must
eat big macs and drink full sugar colas or they will die" nonsense.

~~~
VLM
"we" have lived thru a major cultural shift where 30 years ago when I was a
starving student, we didn't have loans (or high tuition) and we did starve.
All of us, pretty much. Entire generations went to uni unable to afford junk
food because a meal at the restaurant was like one weeks groceries, its
unaffordable. I ate a lot of salad. Even pizza delivery was kinda an
investment to be budgeted and rarely experienced.

Economic changes over the last couple decades mean college students today are
poorer than ever on the balance sheet with $100K of college loans etc, but
have wealthy people level cash flows. So when your tuition alone is $30K, you
can squeeze the bank for an extra $6 for a big mac at any time. Or all college
students today have new iphones, new macbooks, etc. But this is a very new
phenomena and has lead to weird cultural beliefs among the very young (say gen
Y and younger), like "all poor people pig out on junk food" because modern
college students think they experienced real poverty in school when they used
the same macbook for two years instead of upgrading every six months like the
rich kids (LOL).

There are weird statistic warping exceptions, like homeless people have no
where to cook or eat, so they disproportionately eat at McDonalds. Also, for
very poor people, an occasional trip to the McDonalds for a value meal is like
my occasional trips to the $200/plate steakhouse, so their intake skews
junkfood, but its very low. And there are the struggling addict types where
the money is getting spent in the next 5 minutes and if its not food in the
belly it'll be injected death so they skew toward junk food as a preventative.

There is some truth to poor people are often poor because they find ways to
waste money, and junk food being a very expensive way to eat, it is in itself
a minor status symbol in that culture. My class level would show off the
expensive watch my aunt bought me when I graduated, even though my people
never wear watches anymore, but they'd show off they bought an entire 2L
bottle of corn syrup soda, because, thats what they can afford and their peers
can't afford.

~~~
llamataboot
whew! a lot of anecdata in that analysis. Why don't we just look at the
evidence? From one quick google.

[http://www.washingtonpost.com/wp-
dyn/content/article/2008/02...](http://www.washingtonpost.com/wp-
dyn/content/article/2008/02/21/AR2008022101091.html)

[http://ajcn.nutrition.org/content/79/1/6.short](http://ajcn.nutrition.org/content/79/1/6.short)

[http://archpedi.jamanetwork.com/data/Journals/INTEMED/12037/...](http://archpedi.jamanetwork.com/data/Journals/INTEMED/12037/ioi50100.pdf)

[http://www.sciencedirect.com/science/article/pii/S0002822307...](http://www.sciencedirect.com/science/article/pii/S0002822307016173)

------
yummyfajitas
I love how every reporter writing about this study implies that these gaps are
somehow related to income inequality and health care. It makes so much sense,
right?

In fact, the study directly contradicts this. See figure 8 - both income
inequality and health care were not shown to have a significant effect.

[https://jama.jamanetwork.com/article.aspx?articleid=2513561](https://jama.jamanetwork.com/article.aspx?articleid=2513561)

~~~
Retric
This study does not show what you suggest. The problem is when you have
several causes for the same effect some of all of them can fall below the
noise floor. Being poor means slightly worse health care, worse food,
increased risk of violence, etc etc. Trying to seperate each of them out in a
statistically meaningful way is difficult and expencive.

~~~
llamataboot
One might even say, "separating them out" uses fancy regression models to
obscure rather than explain the data. Being poor DOES mean all those things
and likely health outcomes are overdetermined. We know that reducing
inequality reduces all of these things - so let's just reduce inequality!

------
pc2g4d
> The researchers, led by Raj Chetty, a professor of economics at Stanford
> University, analyzed more than 1.4 billion federal tax returns, as well as
> mortality data from the Social Security Administration, from the years 2001
> to 2014. In that period, the life expectancy of the richest five per cent of
> Americans increased by roughly three years. For the poorest five per cent,
> there was no increase.

I find it hard to believe that over a period of 13 years a particular group of
Americans lived three years longer on average because they could afford more
and better healthcare. That's a very significant jump, and to me it seems more
likely to be explained by differences in the composition of the top 5 percent.
Did it become more white, more educated, more urban, etc.?

Can anyone who read the original paper comment on whether that was explored at
all?

------
trhway
when you think about medical advances in the next 20-40 years, especially the
custom ones which would require money, one would be wondering how much a
today's healthy person with a lot of money, like Zuck, would live... Probably
as long as they want :)

~~~
tzs
Medical advances have greatly increased the _average_ life span, and are
likely to continue to do so. However, there has been very little change in the
_maximum_ lifespan, and there is not really any good reason to believe that
this will change over the next 20-40 years.

------
guard-of-terra
Similar dynamics arose in late 60s in the USSR and 20 years later it
disintegrated.

~~~
lucozade
Fortunately, since then, someone spotted that causation and correlation
occasionally differ. Phew. Bullet dodged.

~~~
guard-of-terra
I was actually implying two non-interrelated casuations of same trend.

