The geography of life and death
The headlines reflect a tragic reality: “The rich live longer everywhere. For the poor, geography matters.” “Where living poor means dying young.” “What income and geography mean for life expectancy.”
Americans, especially those who struggle to make ends meet, are unwell and dying. As a new study further confirms, life expectancy varies depending on where you live. Here’s what you should know about place and disadvantage, and how they work together to cut lives short.
“Location, location, location” isn’t just a platitude expressed by eager real estate agents. Not all communities are created equal; that’s why most house hunters think about things like school districts, crime stats, job opportunities, traffic fatalities, and housing costs before settling down.
But these considerations are about more than amenities and potential resale value. The place you call home—what country, what city or town, what neighborhood you live in, or even what metro stop you’re near—affects your health and longevity.
Where you live affects what kinds of schools your kids attend and whether they can walk to a park safely and play with friends. It affects your access to jobs and training opportunities. It affects your access to nutritious food, reliable child care, healthy housing, and quality health care.
Being disadvantaged—by low income, poor educational attainment, or exposure to blight, violence, or trauma—affects our very survival. This is not new: it’s a consistent pattern that we see each step down the income and education ladder, across time and place, and even in countries with far better health outcomes than the United States.
What is new and alarming is how steep these health and survival gradients are, especially in the United States and among certain groups and in certain places. And we know that it’s the most disadvantaged people and places that suffer the most.
Much of our attention has focused on deaths or life expectancy—a clear eye-popping measure. But deaths are just the tip of the iceberg. Before these (early) deaths are years of disability, illness, and suffering—years that burden entire families and communities financially, emotionally, and socially.
Disadvantage characterizes both people and places
In the United States and around the world, there are places of concentrated social and economic disadvantage (which undermine health) and places of concentrated advantage and opportunity (which promote health).
At any level of income or education, but especially at the lower ends, you’re better off living in a wealthier community where you, your family, and your neighbors are supported by strong and stable community conditions. People who are better off can move to a new neighborhood or city in search of those conditions, but not everyone has that option.
For some families who are stuck in place, it’s much harder to break the cycle of poverty and disadvantage. For example, 80 percent of African Americans who live in poor neighborhoods have done so for at least two generations, even those who move tend to move from one low-income community to another. Fewer poor white Americans live in poor neighborhoods, and they are much less likely to have lived there for extended periods of time.
This concentration of poverty and disadvantage over time and place has enormous implications for social and economic mobility, reductions of inequality, health and addiction, and other crucial outcomes.
Attending to people and places
The situation is dire, but it’s not hopeless. Through policy changes, we can do more to ensure Americans have the support they need to live healthy, productive, and fulfilling lives. We must
- invest early in life, ideally in early childhood;
- invest for the long term (for lifelong, multigenerational benefits);
- invest in efforts that are preventive rather than remedial;
- invest in efforts that respect and advance a community’s unique priorities;
- invest in people, places, or systems that have been traditionally underserved or unattended; and
- invest in ways that foster safety, stability, and continuity (at neighborhood, community, state, or federal levels).
We must make smart decisions about where we place schools, housing, jobs, and transportation hubs. Local zoning laws, economic development strategies, and regional planning policies all play a role.
It means building more mixed-income housing, strengthening underperforming schools, creating strong pathways from adolescence into young adulthood, and providing Americans with employment and training opportunities that allow them to support their children and other dependents.
It means bringing together elected leaders, private-sector institutions and employers, and faith-based and civic groups to craft long-term, in-depth solutions that respect and respond to the needs of local communities.
Health insurance and high-quality health care are important, but to address what’s really ailing Americans, we have to address broader issues.
Illustration via Petrified Collection/Getty Images