County by County Life Expectancy: How Many Americas are There?

Over the past couple of weeks Josh Eveleth and I have answered journalists’ enquiries from many different pockets of the United States about the recently published paper by Majid Ezzati and colleagues. The research, which analyzes mortality data for every county in every US state over four decades, finds a steady increase in mortality inequality across counties between 1983 and 1999.

It provoked an intense debate and discussion nationally, but also at a very local level (the local discussions are particularly interesting for someone whose travels in America have not gone much further than visiting the PLoS San Francisco office and whose experience of Vineland is the Thomas Pynchon novel rather than the New Jersey counties covered by the Vineland Daily Journal).

For example, by making the supporting datasets (and figures and video files) that demonstrate the changes in life expectancy county by county freely available in PLoS Medicine, the Roanoke Times was able to report statistics for Pulaski and Radford counties in Virginia. (An alarming finding from the study – as the New Scientist reported – is that there has been a decline in life expectancy in some of the poorest sections of the population, primarily among women in the Southern States). On a national level, the paper was on the cover of the New York Times Week in Review with former Democratic Vice Presidential Nominee John Edwards commenting that the findings demonstrate how “the wealth and income disparity effectively infiltrates all parts of people’s lives.” Edwards was asked to comment because of his national campaign to end poverty in America by 2036.

Worth listening to are the interviews on NPR’s Science Friday show and the shorter broadcast on Voice of America. As Ezzati makes clear in both of them, on average life expectancy has risen for American men and women since the 1960s, but is from the 1980s that the troubling geographical disparities have worsened and some counties have experienced stagnation and even a decline. This kind of worsening of life expectancy for segments of the population is not something usually associated with developed high-income countries – in the Voice of America interview, Ezzati observes it that this worsening is something that happened after the fall of the Soviet Union when the health and social networks in Eastern Europe collapsed.

In an online interview with the Washington Post Ezzati fields questions and theories about the trends from readers in the West and the East of the country, from San Francisco, California to Eastern Shore, Maryland. He illustrates the point that this worsening of life expectancy is a phenomenon occurring in the United States and not Europe by referring to the Human Mortality Database. This is a project set up by researchers at the University of California, Berkeley and at the Max Planck Institute for Demographic Research in Rostock, Germany, to provide historical mortality data for many countries.

The Economist and the Wall Street Journal (which embedded one of our video files in the blog to complement the story) focused on the impact that diseases linked to smoking or obesity, such as lung cancer and diabetes, have had on life expectancy. ABC News quoted Ezzati to demonstrate that these negative trends have affected women particularly: “one out of five American women have had their health either getting worse or at best not getting better.”

The study is a troubling but fascinating reminder of how huge the United States is and how wide the disparities within it are. Whilst John Edwards spoke of “two Americas” in the 2004 Presidential election campaign, a 2005 PLoS Medicine paper by Majid Ezzati and colleagues established “eight Americas” in terms of mortality disparities across race and counties. In the Voice of America interview, Ezzati says he hopes the new study raises awareness about health care in America and prompts monitoring of those being left behind in order to understand what kind of policies and interventions can reverse the decline in life expectancy.

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