Life "Expectancy Decreases by 4 Years Among Poor White People in the US"

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Life Expectancy Decreases by 4 Years Among Poor White People in the US

by Kathleen Geier at Common Dreams

http://www.commondreams.org/view/2012/09/22-3

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What are the reasons for the disturbing drop in life expectancy among poor white folks, and in particular for the unusually large magnitude of the decline? According to the Times, researchers are baffled: one expert said, “There’s this enormous issue of why … It’s very puzzling and we don’t have a great explanation.” Undoubtedly, the increasing numbers of low-income Americans without health insurance is a major contributor factor. Researchers also say that lifestyle factors such as smoking, which has increased among low-income white women, play a role; poor folks tend to engage in more risky health behaviors than their more affluent counterparts.

I will offer an alternative hypothesis, one which is not explicitly identified in the Times article: inequality. In the U.S., the period between 1990 and 2008, which is a period that saw such steep declines in life expectancy for the least well-off white people, is also a period during which economic inequality soared. Moreover, there is a compelling body of research that suggests that inequality itself — quite apart from low incomes, or lack of health insurance — is associated with more negative health outcomes for those at the bottom of the heap. One of the most famous series of studies of the social determinants of health, Britain’s Whitehall Studies, had as their subjects British civil servants, all of whom health insurance and (presumably) decent enough jobs. Intriguingly, these studies

found a strong association between grade levels of civil servant employment and mortality rates from a range of causes. Men in the lowest grade (messengers, doorkeepers, etc.) had a mortality rate three times higher than that of men in the highest grade (administrators).

The Whitehall studies found that while workers in the lower grades were more likely to be at risk for coronary heart disease due to factors such as higher rates of smoking, higher blood pressure, etc., even after controlling for those confounding factors, these workers still experienced significantly higher mortality rates. So what was behind such disparate health incomes among high-status and low-status workers? Researchers pointed the finger at inequality, hypothesizing that various psychosocial factors associated with inequality — such as the higher levels of stress at work and at home experienced by the lower tier workers, as well as their lower levels of self-esteem — were behind the dramatic differences in mortality rates.
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