Money Doesn't Buy as Long a Life as It Used To
Here’s some excellent news on inequality: Measured from birth, the gap in life expectancy between rich and poor in the U.S. has been rapidly narrowing. It appears that a variety of policy initiatives, including those designed to promote children’s health and cut smoking, are actually working.
These findings run counter to the widespread view that the economic gap increasingly means that the rich live longer while the poor don’t. That view has some solid research behind it: By some measures, rich people are indeed showing longevity gains, but in many parts of the country, poor people aren’t.
More evidence for the pessimistic view: If you measure life expectancy from the age of 40, the gap between rich and poor jumped between 2001 and 2014. Women in the top 1 percent are living 10 years longer than women in the bottom 1 percent; for men, the gap is a whopping 15 years.
But what if we measure life expectancy at birth? That’s the question recently posed by Janet Currie of Princeton University and Hannes Schwandt of Zurich University. Currie and Schwandt replicate the finding that among older people, the longevity gap between rich and poor is increasing. But they show that if you start at birth, the gap is going in the opposite direction.
What explains that? Since 1990, both rich and poor have enjoyed substantial gains in life expectancy. But among young people in particular, mortality has been falling a lot faster in poor areas than in rich ones.
Consider, for example, the mortality rate for those under age 5. In 1990, the mortality rate for young children in the poorest U.S. counties was 4.5 deaths out of every 1,000 kids. By 2010, it had fallen to 2.3.
In the richest counties, the mortality rate dropped too, but less dramatically, from 2.4 per 1,000 to 1.3. So young children in the poorest parts of the U.S. now have a lower mortality rate than those in the richest ones just 25 years ago. And the difference between rich and poor areas has been cut in half, from 2.1 deaths per 1,000 to just 1.
For those between the ages of 5 to 19, mortality rates also fell faster in the poorest counties, with especially large reductions for males. Males also did better in the 20 to 49 age group, showing a substantial decline in death rates, again concentrated in poorer counties. (For females from 20 to 49, there was little improvement in either rich or poor counties.)
One reason for that decline is what Currie and Schwandt call “stunning” reductions in mortality rates for young African-Americans between 1990 and 2010, especially among black men. And because good health in childhood predicts good health in adulthood, we are likely to see significant declines in mortality as today’s young people age.
These findings raise two questions. If longevity inequality is rapidly falling at birth, why is it increasing for those 40 and older? And what accounts for the significant progress in life expectancy at birth, above all for the poor?
Part of the answer to the first question involves smoking. After the 1964 Surgeon General’s report, well-educated and wealthy people stopped smoking fastest. Among less-educated women, smoking rates actually increased after that report, perhaps because of social norms promoting women’s independence. Decreasing smoking rates, concentrated among the wealthy, are a recipe for a longevity gap along economic lines.
Smoking is responsible for more than 480,000 annual deaths in the U.S., and smokers lose, on average, at least 10 years in life expectancy. The good news is that in more recent years, younger people, both rich and poor, have shown large reductions in smoking rates. For this reason, the recent growth in longevity inequality for those over 40 might well turn out to be temporary.
The policy implication here is straightforward: Both states and the national government should ramp up their anti-smoking policies. A simple initiative is to increase the cigarette tax, which cuts smoking among the young. The current federal tax is $1.01; it should probably be doubled. Tax increases are often criticized as regressive, because they come down especially hard on the poor. In the context of smoking, the objection is weak, because poor people have the most to gain.
As Currie and Schwandt note, existing research doesn't explain the shrinking mortality gap among young people. Potential answers include improvements in maternal education, expansions of health insurance for pregnant women, and the Special Supplemental Nutrition Program for Women, Infants and Children. They also cite expansions of the earned income tax credit, which I suspect have played a significant role, because the credit has been associated with large health benefits for the young.
On both right and left, this moment in American politics has a lot of talk about supposedly failing policies, supposedly rigged systems and supposedly intractable inequality. But the last quarter-century shows major progress in reducing the most serious problem of all: premature death. That progress offers major clues about how to make further gains, above all through the judicious use of state and federal authority.
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