What Is Causing The Longevity Inequality?

It will take hard work to help all Americans make healthy choices enabling them to live longer. getty You’ve heard about wealth and income inequalities in the U.S. Now add to that the “longevity inequality.” In recent years, a substantial body of evidence has emerged, showing there’s a growing inequality […]

You’ve heard about wealth and income inequalities in the U.S. Now add to that the “longevity inequality.” In recent years, a substantial body of evidence has emerged, showing there’s a growing inequality in expected U.S. lifespans that have been attributed to the differences in wealth, income, and education between various demographic groups.

For example, one study, led by respected Harvard economist Raj Chetty, found that the richest 1% of the U.S. population lived, on average, 15 years longer than the poorest 1%. Another study reports that in 2008, U.S. white men with 16 years or more of education lived, on average, 14 years longer than U.S. black men with less than 12 years of education. The comparable gap for women in the same groups was 10 years. These gaps have only been growing larger since 2008. (If you’d like to read some of these research studies, please see the links at the end of this column.)

When studying the potential causes of these inequalities, it’s instructive to understand how we’ve dramatically increased lifespans in the past 100 years. Let’s take a look.

One of humankind’s greatest achievements

Comparing average life expectancy from the beginning to the end of the 20th century, the U.S. added about 30 years to the average expected lifespan of its citizens. For example, according to statistics published by the U.S. Centers for Disease Control and Prevention, people born in 1900 could expect to live 47.3 years on average. Fast-forward to 2000: People born in that year can expect to live 76.8 years on average. Undoubtedly, this is one of humankind’s greatest achievements. 

This significant accomplishment is the result of advantages that accrued widely to most of the population, regardless of their circumstances, including: 

  • Efficient waste disposal
  • Availability of clean water
  • Vaccinations against deadly, infectious diseases
  • Abundant food supplies, which helped reduce food insecurity
  • Widespread use of electricity and refrigeration, which helps keep food safe
  • Reduction in deaths due to violence and war
  • Expansion in public school systems, leading to a more educated citizenry
  • Improvements in transportation, including cars, highways, and public transportation, and improvements in communication, including telephones, television, and the Internet

It’s important to realize that the environment people lived in automatically provided these advantages—people didn’t need to make many choices to reap these advantages that improved their health and longevity. As you’ll see, however, that’s not necessarily the case if we want to continue improving life expectancies today. 

Potential causes of lifespan inequalities

In the 21st century, it’s becoming apparent that future improvements in expected lifespans will rely on the ability of individuals to make choices that help them navigate a complex environment with features that are both supportive and unsupportive of increased longevity. And often, people with lower education and financial means are more vulnerable to the features of the environment that aren’t supportive of increased longevity. For example, the first study mentioned above found that the poorest Americans were more likely to smoke, drink, and be overweight compared to their wealthier counterparts.

Specifically, here are the potential factors in our current environment that aren’t supportive of increased longevity:

  • Unequal access to health care and health insurance
  • Persuasive and widespread advertising of unhealthy, processed foods and beverages with high amounts of sugar and sodium
  • Unequal access to healthy food
  • Increased vulnerability to violence and crime among individuals of lower economic status
  • Reduced exercise and movement, ironically partially attributed to more efficient transportation systems

In 2016, the Stanford Center on Longevity published its landmark “Sightlines” study, which summarized compelling scientific evidence that living long and living well is most realistic for those who adopt healthy behaviors, are financially secure, and are socially engaged. The study investigated how well Americans did and are doing in each of these three areas over historical time and identified 26 factors that are associated with health, financial security, and social engagement. 

StanfordTHE SIGHTLINES PROJECT – Stanford Center on Longevity

The Sightlines study specifically measured how Americans of all ages are doing with respect to healthy behaviors, financial security, and social engagement. It examined differences due to race, education, and income. The study found that:

  • Non-whites are more likely to live in poverty or near poverty, have less access to health insurance and health care, are less likely to participate in retirement savings plans, and realize lower educational achievement. Financial insecurity is associated with increased susceptibility to illness and shorter lifespans. 
  • Similar to the first study mentioned above, the Sightlines study found that obesity levels and the prevalence of smoking are both higher in people who have lower levels of education and in ethnic minorities. 

The COVID-19 pandemic has highlighted these challenges, since the hardest-hit groups have been the ones more likely to have below-average income and wealth, and are more likely to be non-white.

In 2021, the Stanford Center on Longevity will update its 2016 report and drill down further on the practices recommended for all Americans to live long, healthy, financially secure lives.

It’s becoming apparent that to continue increasing lifespans for all groups of Americans, we’ll need to tackle the negative influences of poverty and the unequal access to health care and healthy foods that some citizens have, and we’ll need to investigate interventions that can encourage healthier choices. We have our work cut out for us!

PubMed Central (PMC)The Association Between Income and Life Expectancy in the United States, 2001-2014: Association Between Income and Life Expectancy in the United States
The National Academies PressThe Growing Gap in Life Expectancy by Income: Implications for Federal Programs and Policy Responses
PubMedDifferences in life expectancy due to race and educational differences are widening, and many may not catch up – PubMed

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