The conclusion of a study recently released by the Government Accountability Office (GAO) states that poor Americans are nearly twice as likely as rich Americans to die before they reach old age.
New data from the US Census Bureau also confirms that the gap between the richest and poorest households in the US is the largest it has been in over 50 years, and economic power is more concentrated than ever before. Across the 500 largest cities in the US, income inequality is directly associated with life expectancy. That is, economic inequality maps directly onto health inequality.
Nationally, the latest evidence shows that life expectancy in the US actually declined in the last three years, to 78.9 years, after decades of uninterrupted increases. However, at the city level, it varies from 71.4 years in Gary, Indiana, to 84.7 in Newton, Massachusetts. These gaps are generated and maintained by the structural and social determinants of health.
The GAO report also revealed racial differences in life expectancy. In Chicago, there is a nine-year gap between the life expectancy for black and white people. Chicago’s excess deaths were generated by premature mortality among black Americans from heart disease, cancer, stroke, diabetes and kidney disease—all conditions that an equitable health care system would address. Patterns of segregation are built on decades of “structural violence,” social and political arrangements that harm economically-disadvantaged populations. Decades of research are coming to a consensus: Inequality kills.
2020 Presidential candidates Bernie Sanders and Elizabeth Warren say the answer is “Medicare for All,” which would undoubtedly provide more equitable access to the health care system. But public health research demonstrates the true root causes of illness extend beyond the healthcare system. Lowering premature mortality in the US requires something even more radical than Medicare for All; it requires action to reshape the concentration of wealth and power.
In Chicago, a coalition of health care institutions, residents, community-based organizations, and government agencies have come together under the banner of “West Side United.” The coalition strives to narrow the 16-year life expectancy gap that exists between the city’s downtown loop and West Side communities. It focuses on four areas: health care, neighborhood and physical environment, economic vitality and education. WSU works to address the root causes of poor health by increasing hiring from West Side neighborhoods, supporting business development and expanding the use of community health workers.
Effective public policy can impact all of these related issues, and research can measure changes at the community level over time. Without this kind of data, the mirage that the economy is great because macroeconomic indicators say so will continue to mislead us. Until the factors contributing to who lives and who dies are addressed, inequality will continue to be a killer.
Fernando De Maio, “We Must Address the Roots of Inequality to Keep It From Killing Us,” Truthout, December 21, 2019, https://truthout.org/articles/we-must-address-the-roots-of-inequality-to-keep-it-from-killing-us.
Patrick Martin, “US Study Shows: Poverty and Social Inequality Are Killers,” World Socialist Website, September 12, 2019, https://www.wsws.org/en/articles/2019/09/12/pers-s12.html.
Student Researcher: Maria Meyer (San Francisco State University)
Faculty Evaluator: Kenn Burrows (San Francisco State University)