can been seen in one basic fact:
in the US life expectancy for both men in women puts the US in 37th place in the world, with that for women dropping in much of the country.
That immediately grabbed my attention as I read Living longer? Not in US by Derrick Jackson in today's Boston Globe
There I read
Researchers at the University of Washington’s Institute for Health Metrics and Evaluation this month published a county-by-county analysis of life expectancy. From 1987 to 1997, there were 227 counties where female life expectancy dropped. From 1997 to 2007, the number of counties where women’s life expectancy dropped exploded to 737.
In 2,054 of the nation's 3,147 counties, life expectancies for women fell further behind the 10 nations with the longest life expectancy.
Before I proceed with the contents of Jackson's column, I'd like to observe something as a teacher. Many like to bash our public schools because of the data on tests given internationally. As I and others have explained, most of the difference in that performance can be accounted for by the percentage of our children living in poverty: when the test scores are adjusted for degree of poverty, our school students perform as well as any in the world.
Poverty is one reason for the difference in life expectancy on a national level. There are other reasons, including the impact of smoking - we are now seeing some of the impact of the expanding percentage of American women who were heavy smokers.
But it is much more than that, as the report makes clear. It is a further illustration of our economic inequality:
life expectancy for black men in two-thirds of the nation’s counties is no better than what it was in other rich countries in the 1950s.
In about 4 weeks I will again head to Wise Virginia, for the 3rd year in a row, for the 12th annual health and dental fair cosponsored by Remote Area Medical and Mission of Mercy. I have written about my previous trips to Wise, and to Grundy, both in Appalachia. Wendell Potter has said how much his first visit, in 2007, affected him and lead him to becoming a leading voice against how our insurance companies operate.
Above the fold I gave some text that comes from a paragraph which continues like this:
The geographical inequality of who lives the longest or least in America is so stark that the maps from the University of Washington study almost perfectly mirror the national maps of obesity and diabetes done by the Centers for Disease Control and Prevention. Both maps show the Deep South and Appalachia at the epicenter of the nation’s health collapse. Massachusetts, more aggressive than most states at attempting to deliver health care, fares better than the national average, and even Suffolk County, which has significant pockets of poverty, has life expectancies for black men and women higher than the national average.
The Deep South and Appalachia - the former still the base of many Blacks, the latter a part of America that has never fully caught up.
The U of Washington researchers
determined that if the health risk factors of smoking, high blood pressure, obesity, and diabetes could be brought under control, life expectancy could be improved by five years for men and four for women.
I see all of those factors in Appalachia each time I volunteer. I know they are also paralleled in many of our inner cities. It may seem counter-intuitive, but obesity is very common among those of lower income, as they fill their bellies with cheap starchy and fatty foods. Hypertension and diabetes are also quite common. In Appalachia many still smoke, and many of those who don't chew tobacco.
Jackson writes in favor of a health-promotion system. It would include options such as
regulation of trans-fats and salts in commercial food, higher tobacco and alcohol taxes, greater access to and affordability of healthier foods, environments that encourage exercise, and expanding the number of primary-care physicians.
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regulation of trans-fats and salts in commercial food - Examine carefully the contents of the processed food we buy: in return for convenience we are trading long-term health. Use of transfats and salt makes for production that leads to higher profits for the corporations as well as higher health costs - if people can pay for those health costs.
higher tobacco and alcohol taxes - In theory we can discourage consumption if taxes are high enough. But also remember that those in poorer communities often seem to be targets for the companies that produce tobacco and sell alcohol, especially high alcohol content beer products like Colt 45. But tobacco and alcohol companies are often politically influential, states and the federal government seem to like taxes high enough to generate revenue but perhaps not high enough to effectively discourage consumption, media organizations benefit from the advertising. And some will argue that it is not the government's business to try to control consumption.
greater access to and affordability of healthier foods - Drive around an inner city neighborhood and see what options are available for food shopping. You probably will not have the kinds of options I do, where I can choose from multiple supermarket chains with a wide range of products including organic produce. You might even note the prices for healthy food in a middle class neighborhood chain supermarket and then compare them to those in inner city neighborhoods - if you can even find a chain supermarket. Or if no supermarket, in the stores that do offer food. The selection will be far narrower, and what is available is going to be more expensive. More rural areas have similar patterns.
environments that encourage exercise - Let me simply note that this is a problem even for the young, when we no longer require physical education as a regular part of each school day. Some schools lack facilities for exercise. Poorer communities often lack usable parks. We do not do a good job of encouraging life-long patterns of exercise, even of simply taking long walks, which is hard to do in many places.
expanding the number of primary-care physicians - This is certainly important. What is equally important is assuring appropriate distribution of health care professionals. Grundy is in Buchanan County, which has the lowest per family income in Virginia. In 2009, at the time of my first volunteering there, the county had a population of 26,000, and only 4 dentists, 3 of whom were beyond retirement age. Health care professionals need to be accessible. That includes have a sufficient number, that there is transportation to reach them, and that potential patients are able to pay for the care. Unfortunately all of these are issues in places like Appalachia, and even in cities with good public transportation often reaching a medical professional is still difficult: one may have to cross hostile gang territory, transportation in the poorer areas of the community is usually not as frequent as is necessary.
What happens with health also affects how our school children do. A child with rotting teeth, untreated asthma, needing vision or hearing correction, or any of a myriad of problems, is NOT going to learn effectively.
If you have money, either your own or an EFFECTIVE health insurance policy (and you are not limited by pre-existing conditions), you can have access to health care as good as any in the world. Certainly Members of Congress have health care as good as any in the world. For millions of Americans, they do not have the ability to pay for health care. That means they do not have health care. For too many of us who do have insurance, there are still holes in our coverage - things like the donut hole in Medicare. Now we hear the Medicare and Medicaid could both see cuts as a result of the negotiations over raising the debt limit.
The report gives county by county data that could help us better target our health care policies, although targeting is insufficient unless we address some of the issues that intersect with poor health: poverty, targeting by tobacco and alcohol companies, accessibility, affordability. The data does provide us with something else, as Jackson notes in his final two sentences:
What the data should do is end any boasting about the greatness of our health care system. There is nothing to brag about when three times more counties are seeing big drops in life expectancy for women.