This is just short blogpost integrating some important information concerning US life expectancy. The US is a global outlier with its poor health outcomes, particularly if you consider that it's also a global outlier with how much it spends on health care.
- First, it should be said that The Washington Post ran a great series on US life expectancy earlier this month (October 2023.) They show life expectancies diverging between "red" (conservative) and "blue" (progressive) states since 1980. Inequality has been going up in the US since about 1978, so I wondered whether these facts were related? But it's hard to tell if your graphs start in 1980...
- So I hunted around for some graphs going back earlier, and found a report by the Population Reference Bureau showing that in fact in every US state, life expectancy is either flat or increasing. How can this be?
- Well, it's called a Simpson's Paradox. The reason that US overall life expectancy is dropping is because people are moving from the healthy states to the unhealthy ones. Simpson's paradox means that even if no category (here: state) is getting worse, people shifting themselves between categories can lead to declines. [Of course if more immigrants went to conservative states, or if states attracting more immigrants became more conservative, that could also shift numbers too. edit from 1 April 2024.]
- This of course, leaves at least two questions standing. First, what makes a state less healthy? The Washington Post says it's Republican (conservative) policies.
- Or as Jeremy Ney said “You can have policies that can meaningfully change life expectancy: reduce drug overdoses, expand Medicaid, adopt gun control, protect abortion and maternal health.” The same regions that have some of the longest life expectancies also do well for "Black longevity and life expectancy for residents of the poor counties." That's all from this really interesting article by Colin Woodward at the Nationhood Lab, which also shows life expectancy by county rather than by state.
- And that starts to get at the second question, which is then why move there? The Nationhood Lab article talks about who settled these different regions and what their policies are.
- But I still wonder whether part of what's going on is to do with inequality. Let's say that you want to have a house as big as the one you grew up to raise your own children. You might well have to move state to be somewhere cheaper. Or maybe your company just moved your job to a cheaper state to lower costs (that happened to my dad and family; fortunately for me after I'd already left home to go to University of Chicago.) So declining buying power caused at least in part by the false scarcities of rocketing, under-regulated inequality may be driving some people and/or corporations to choose places with weaker health-related regulation, and therefore shorter lifespans.
- In 2016, I was already blogging about the fact that the decline in uneducated, white lifespans looked somewhat like race was becoming less of a factor in determining life expectancy. Now perhaps we know why – uneducated whites may have been moving to the states that had long had less public health investment, perhaps because they also were the most racially diverse. That page from the US census bureau also shows some trend for African Americans to be moving more towards the places the other charts aboce show us there is better health care.
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| More discussion of this graph (including link to source) in my 2016 blogpost, Greater Equality Shouldn't Mean the End of Americans' Dreams, (linked, please click through.) |
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