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Why Poor Americans Die Younger: How To Overcome The Health Adversity Of Poverty

The challenges of being poor are greater than we generally appreciate. Poverty requires both social and personal commitment to live longer and prosper.
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Poor Americans have shorter lives than wealthy Americans. An article by R. Chetty and his coauthors from Stanford, Massachusetts Institute of Technology, Harvard, McKinsey and Company and the U.S. Treasury (an impressive panel) has examined why this might be so.

In their huge analysis of about 1 million Americans followed from 1999 to 2014, representing 1.4 billion life-years (with 6.8 million deaths in that population over those years), the authors compared high and low income individuals and differences in the geography of where they lived. In men, individuals in the highest 1% of income lived 14.6 years longer than men in the lowest 1% of income (87.3 years age at death versus only 72.7 years). In women, that difference was 10.1 years (88.9 years versus 78.8 years). Women live a lot longer than men! But while women in the highest income bracket live only 1.5 years longer than men, women in the lowest income bracket live 7.6 years longer. Since these later times in our lives can also be some of the most cherished years of our lives with our expanding families, these differences are very important on a truly personal level.

Because this was a study across many years, the authors were able to look at which people in the population were experiencing increasing length of life over this time, and which were not. With all our medical advances, Americans in the highest quartile of income experienced 2.8 years longer live span from 2001 until 2014. However, the increased length of life for people in the lowest quartile of income had only 1.1 years longer life.

And since the study included all of America, local variation could also be evaluated. Surprisingly, there was no difference in the life span of highest income individuals in 4 large cities (New York, San Francisco, Dallas and Detroit). But there were important differences in the length of life of lowest income individuals who lived longer in New York (79 years), compared to San Francisco, compared to Dallas, and compared to Detroit (only 72 years in Detroit). Over time from 2001 to 2014, there were greater increases in length of life in some areas (4 years longer) such as Hawaii and Massachusetts, compared to actually shorter length of life in other areas (2 years shorter) such as Alaska and Wyoming.

What correlated with these changes? Most important were lifestyles of these individuals. Smoking, obesity, and less exercise resulted in shorter lives. Death in lower income individuals was much more commonly due to heart disease and cancer, rather than to other causes of death such as violence or accidents. In lowest income individuals, longer life was associated with more immigrant populations in the community (possibly due to better social-cultural networks), increased education of people in the community, and increased local government expenditures.

On a societal level, the frustrations of poorer Americans mean communities and government must continue to take steps to maximize opportunities to overcome the challenges of the lowest income Americans. This study emphasizes this is not just about money and jobs, but also about education and access to care that can improve length and quality of life. On a personal level, each person must individually try to overcome the obstacles to living a longer life.

Here are Dr. Cary's tips:
• Be sure you and your children have health insurance and have access to medical care. The Affordable Care Act has many provisions to make care more accessible (for examples, Medicaid expansion, subsidized health insurance plans, and new value-based health care delivery systems such as accountable care organizations). Use health insurance agents and social workers to be certain you find health insurance you can afford. For advice on where you can find such health insurance agents, see my website and book Surviving American Medicine.
• Use your physician or nurse practitioner to improve your healthful lifestyle (no smoking, better diet, less obesity, more exercise) and provide you with preventive healthcare.
• Use social programs to improve your focus on good health (for examples, social workers, community organizers, government supported health programs, or healthcare navigators).
• Have a good support network to encourage a culture of good health (through family, friends, schools, workplace, clubs, and religious institutions).
• Be committed to your children and relatives to help them improve health habits, get more education, increase their personal health, and participate in positive social networks.
• Use your physicians to get screening and prevention, not just care for minor ailments.
• When choosing a physician or health clinic, be sure to find a caring doctor or nurse who will be committed to your personal health habits and achieving better overall health.

The challenges of being poor are greater than we generally appreciate. Poverty requires both social and personal commitment to live longer and prosper.

The opinions expressed in this article are those of Dr. Cary Presant and do not represent opinions of City of Hope or any other organizations.

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