Guest post by Katie Leach-Kemon, a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.
This blog is primarily devoted to health and development issues in poor countries, but global health is global. So today we focus on the country with the highest health spending in the world, the United States.
Researchers at the Institute for Health Metrics and Evaluation (IHME) found that some counties in the US have life expectancies that resemble countries with much fewer resources. For example, in McDowell County, West Virginia, male life expectancy (64 years) is lower than life expectancy in Bangladesh while females in Sunflower County, Mississippi have a life expectancy (74 years) that is lower than females in Algeria.
Note: Recreate this map by choosing the following options from the drop down menus: “Life expectancy” from “Display,” “Male” from “Sex,” “McDowell County” from “Find county,” and “2010” from “Year.”
In contrast, counties with the highest life expectancies in the US, such as Fairfax County, Virginia for males (82) and Marin County, California for females (85 years), are greater or equal to countries with the highest life expectancies in the world, such as Switzerland and Japan for males and Spain and France for females. Go to this link of live data visualization tool highlighting counties with the lowest male and highest female life expectancies.
In addition to finding massive disparities in life expectancy at the county level, IHME researchers found the gap between counties with the highest life expectancies and lowest life expectancies has widened over time. In 1985, the gap was nine years for females and nearly 12 years for males, but increased to 12 and 18 years, respectively, in 2010.
This latest study also found disturbing trends in female life expectancy. Despite the fact that US spending on health increases every year, female life expectancy in 1405 counties (45% of all counties), showed no significant improvement between 1985 and 2010 (see figure below from the newly-published US policy report). The picture for males was very different. Only 154 counties (5% of all US counties) saw no significant improvements in male life expectancy between 1985 and 2010.
Map of significant changes in life expectancy by county, 1985-2010
Why are some counties in the US doing so well, while other counties are doing so poorly in terms of life expectancy? Why did progress in female life expectancy grind to a halt in nearly half the counties in the US? More in-depth research and case studies are necessary to pinpoint all the factors that are driving these troubling trends, but researchers found evidence that poor diets, obesity, and physical inactivity are contributing to poorer health outcomes in many counties. “If the US can make progress with dietary risk factors, physical activity, and obesity, it will see massive reductions in death and disability,” said Dr. Ali Mokdad, head of the US County Health Performance team for IHME and former director of the Behavior Risk Factors and Surveillance Survey at the US Centers for Disease Control and Prevention. “Understanding local trends in obesity and physical activity in both rural and urban areas will help communities develop successful strategies and learn from one another.”
IHME’s online tools allow you to visualize the magnitude of these public health problems. Eating too few fruits and vegetables and nuts and seeds and too much salt and processed meat contributed to nearly 700,000 deaths in the US in 2010 (see category “dietary risks” in screen grab below), and contributed to even more deaths than smoking.
Insight into the stalled progress in life expectancy among females in many US counties is illuminated by exploring obesity and physical activity levels across counties. The first screen grab of IHME’s US Health Map shows female county-level life expectancy in 2010, while the second and third show levels of obesity and sufficient physical activity among females in US counties in years 2010 and 2011, respectively. Sufficient physical activity was defined as 150 total minutes of moderate activity per week or 75 minutes of vigorous activity or equivalent combination.
Many counties in the Southeast and Appalachia with some of the shortest life expectancies in the US also weigh the most and exercise the least. You can use the “find county” option in the online tool to find statistics for specific areas. For example, females in Quitman County, Mississippi had the fourth-lowest life expectancy among US counties (around 73 years) in 2010 and ranked as the fourth-highest county for obesity (58% obesity among females) in 2011. Only 29% of females got sufficient exercise in Quitman County in 2011, making it the third-least-active state in the nation. On the opposite end of the spectrum, females in Pitkin County, Colorado, had the eighth-highest life expectancy in the country (84 years) in 2010 and ranked second and fourth, respectively, among counties with the lowest levels of obesity (19%) and highest levels of sufficient physical activity (72%) in 2011.