New research indicates being poor is worse than smoking cigarettes in terms of life expectancy – except in affluent regions of the United States, such as New York City or San Francisco.
The study, led by Stanford economist Raj Chetty, is the first to examine how the link between income and life expectancy varies from one area to another within the United States. The major takeaway from the research is that location plays a role in estimated life expectancy across all differentiating factors, like gender and race, but mostly just for those without money.
“We find very large differences across areas for the poor but very small differences across areas for the rich. Where you live matters much more if you are poor than if you are rich,” said Chetty in a statement.
In other words, poor Americans who live in expensive, well-educated cities tend to have longer life spans than equally poor people in less affluent places.
According to the researchers, who studied more than a billion Social Security and tax records from 1999 to 2014, men in the bottom 5 percent of the income distribution who live in New York City can expect to live five years longer than men with comparable incomes in Gary, Indiana. To place a five-year life expectancy disparity in perspective, the Centers for Disease Control and Prevention estimates that eliminating cancer as a cause of death would only increase life expectancy in the U.S. by three years.
Most of the states with the lowest levels of life expectancy for the poor form a geographic belt from Michigan to Kansas – including Ohio, Indiana, Kentucky, Tennessee, Arkansas and Oklahoma – while the poor had significantly longer life expectancies in some coastal states like California, New York and Vermont.
The study did not provide evidence that explains the location disparity.
“We don’t know exactly why that is,” said Chetty in a statement, “but what I find striking is that the results go against the view that the poor do better in cities that are more affordable with less inequality.”
One explanation posed by the researchers is that cities are often the first to enact public health policies such as smoking bans, restrictions on trans fats or imposing taxes on sugary drinks. Another possibility is that poor people are positively influenced by living around more affluent people, who are more likely to eat healthy and exercise.
Even without the location factor, the findings reveal that the difference in life expectancy between America’s poor and elite is even higher than previously thought.
“There are vast gaps in life expectancy between the richest and poorest Americans,” Chetty said in an interview with NPR. “Men in the top 1 percent distribution level live about 15 years longer than men in the bottom 1 percent on the income distribution in the United States.”
For men, this life expectancy is 87 (for the wealthiest) and 72 (for the poorest), a gap greater than the estimated years lost due to a lifetime of smoking which, on average, subtracts 10 years from the human lifespan.
Despite disheartening statistics, Chetty’s study does provide some good news for America’s poorest cities. If cities like San Jose and Seattle have managed to increase the lifespan of their poorest residents, it is possible to adequately improve public health on a small scale.
“You want to think about this problem at a more local level than you might have before,” Chetty told the New York Times. “You don’t want to just think about why things are going badly for the poor in America.”
So while inequality and poor access to health care are issues across the country, they may not be national issues. Public health research will be important to determine what specific differences are seen in America’s richest cities that help low-income residents live longer than in other areas across the country.