What really accounts for how long we'll live?
Last Sunday, the New York Times business section featured a powerful and long overdue piece about the social determinants of health. In the article, Annie Lowrey compares two communities—Fairfax County in Northern Virginia and McDowell County in West Virginia—and shows how far apart they are on virtually every measure of economic and social well-being despite being separated by only 350 miles.
But, as Lowrey makes clear in the title of her story, “Income Gap, Meet the Longevity Gap,” profound differences also arise in terms of the health and survival of the people who live in these two communities. Residents of McDowell die about 20 years earlier than those in Fairfax. Many other measures of health (including rates of disability, obesity, and various types of chronic illness) are also far worse in McDowell.
The close relationship between income and health is well known and documented, both across place and time and among individuals, communities, and even nations. What has been less appreciated and understood—especially here in the United States—is the importance of other social determinants of health. These are the very issues that the New York Times piece highlights: things like employment, education, social services, food availability, and peace of mind.
As the article explains, “dollars in a bank have never added a day to anyone’s life…. Instead, those dollars are at work in a thousand daily-life decisions—about jobs, medical care, housing, food, exercise —with a cumulative effect on longevity.”
What may come as a surprise to many Americans, even to residents of Fairfax Country and readers of Annie Lowrey’s piece, is how unhealthy even the most advantaged Americans are relative to their counterparts in other wealthy democracies. While there are a host of reasons why this may be the case, social and economic conditions once again appear to be major factors. A National Research Council/ Institute of Medicine study panel (which I directed) examined the US health disadvantage relative to other high-income countries and found:
Although the income of Americans is higher on average than in other countries, the United States also has higher levels of poverty (especially child poverty) and income inequality and lower rates of social mobility. Other countries are outpacing the United States in the education of young people, which also affects health. And Americans benefit less from safety net programs that can buffer the negative health effects of poverty and other social disadvantages.
Over the next several months, the Urban Institute and the VCU Center on Society and Health will be taking a much closer look at the issue of income and health, as well as state-level variations in the social determinants of health. This work will be critical to supporting evidence-based health-promoting policies outside the formal healthcare system and to bringing a stronger understanding of “health in all policies” to many areas of public policy and the private sector. These are critical needs for communities such as McDowell County, and may even help places like Fairfax County too.
Illustration by Daniel Wolfe, Urban Institute.