While the rich across the United States live longer than adults with the lowest incomes, life expectancy for the poor varies substantially depending on where they live, a study by the Health Inequality Project finds.
Published in the Journal of the American Medical Association, the report, The Association Between Income and Life Expectancy in the United States, 2001-2014, found that life expectancy rises with income and that disparities between rich and poor have widened since 2001. At the age of 40, for example, men and women in the top 1 percent of income can expect to live fifteen years and ten years longer, respectively, than those in the poorest 1 percent. The study also found that life expectancy for the bottom income quartile was lowest in several Midwestern industrial cities — including Gary, Indiana (74.2 years for men, 80.7 years for women); Detroit; and Cincinnati — as well as Oklahoma City and Las Vegas, and was greatest in New York City (79.5 years for men, 84.0 years for women), followed by cities in California and Florida, and Newark, New Jersey. The study also found that the poor in New York can expect to live six years longer, on average, than those in Detroit, while the difference for the rich is less than a year.
According to the study, the poor live longer in affluent cities such as New York and San Francisco with highly educated populations, high population density, and high levels of local government expenditures. Moreover, differences in life expectancy among the poor were strongly associated not with disparities in access to health care or levels of income inequality, but rather with health behaviors such as smoking and exercise. David M. Cutler, a Harvard University economist and co-author of the report, told the New York Times that life expectancy for the poor also is lowest across a region he calls the "drug overdose belt," a swath of the middle of the country where the nation's opioid epidemic is concentrated.
The fact that the researchers found little correlation between income inequality and life expectancy — and that some cities have seen an increase in life span among their poorest residents — suggests that improving public health doesn't necessarily require first fixing the broader, multi-decade problem of income inequality, the Times reports. Indeed, small-scale, local policies to help the poor adopt and maintain healthier habits may succeed in extending their lives, regardless of what happens with trends in income inequality. "You want to think about this problem at a more local level than you might have before," said Raj Chetty, a Stanford University economist and lead author of the study, which was funded in part by the Laura and John Arnold, Bill & Melinda Gates, Smith Richardson, and Robert Wood Johnson foundations.
But Nadine Burke Harris, a pediatrician in San Francisco and a founder of the Center for Youth Wellness, offered a caveat: "Poor people only have better health status when they’re living in a wealthy environment if the people in that wealthy environment believe in investing in the safety net."