The Congressional Budget Office recently released a report on life expectancy in the United States. While there were some positive findings -- average life expectancy is increasing, and the gaps in life expectancy between men and women and between blacks and whites are narrowing -- there are some troubling developments as well.
The most disturbing finding is that the gap in life expectancy between rich and poor, and between those with low and high education levels, is growing. To quote from the report:
"In 1980, life expectancy at birth was 2.8 years more for the highest socioeconomic group than for the lowest. By 2000, that gap had risen to 4.5 years. The 1.7-year increase in the gap amounts to more than half of the increase in overall average life expectancy at birth between 1980 and 2000.
"In 1980, the difference in life expectancy at age 65 between the highest and lowest socioeconomic groups was 0.3 years. By 2000, the difference had grown to 1.6 years. That increase in the gap equals more than 80 percent of the increase in overall average life expectancy at age 65 over that period."
I find that stunning -- on average, you get 4.5 more years of life if you're lucky enough to just be born into the highest socioeconomic group rather than the lowest. When the social costs of inequality are discussed, the difference in life expectancies are generally not addressed, but they should be, because they are very real, and carry immense moral weight.
The report attributes four possible causes for the increase in income-based inequality in life expectancy: smoking, obesity, self-management of disease (since more highly educated people are more likely to adhere to medical treatments), and healthy lifestyles and use of health care (people with higher socioeconomic status are more likely to engage in healthy behaviors and to have access to health care).
The report doesn't provide much detailed explanations for those four causes, and I for one have my doubts about the impact of obesity. The research on the impact of obesity on health and life expectancy is actually a lot less clear than it is often presented to be. In fact, there's reason to believe that the correlates of obesity, such as a sedentary lifestyle, may be what cause poor health, not obesity in and of itself. Paul Campos has made this argument in this book. An excerpt of it was published in The New Republic and I wish I could link to the article, but unfortunately, TNR's archives are still screwed up, as they have been for -- what? a year now? That is a disgrace, and seems all too symbolic of what a deeply dysfunctional institution TNR has become.
Getting back to obesity -- another reason why obesity may be correlated with poor health, but not actually be the cause of poor health, is that prejudice against the obese often results in obese people getting much lousier health care than the rest of us. See this TNR article for more on this subject, and go to this Fat Health to read some horrifying true stories of anti-fat prejudice in health care.
Returning to the CBO report -- the authors caution that, since poor health can cause lower income, it may be the case that the impact of poor health on income is increasing over time. If that's true, it's possible that differences in health status, rather than differences in economic status, may be driving the inequality in life expectancy. But it seems more likely that economic status is the root cause.
Finally, the report notes that Great Britain, like the U.S., has experienced growing inequality in life expectancy among different socio-economic groups. In Canada, however, the income-based life expectancy gap has narrowed. It's not clear why these trends are different in Canada, but it's certainly a question that bears looking into.
The author Kathy G. is in the process of completing her Ph.D. in the social sciences.