WE DID NOT RECONSTRUCT HARD ENOUGH:
Where You Live in the U.S. Affects How Long You Live (Amy Olson, 12/10/21, Dartmouth)
The team’s initial thought was that the differences in mortality rates across the country might be explained by deaths of despair—suicide, alcohol poisoning and drug overdoses such as from opioids. However, this was not the case. Deaths of despair only accounted for one-sixth of all midlife deaths.They then looked at whether geographic differences in mortality rates could be explained by differences in education, such as if a person had a college degree, and whether states with more college graduates had better mortality than states with fewer college graduates. Education was not the root of the problem, as health inequality was still present after education at the state-level was accounted for, the researchers found.
The researchers also investigated how state-level income impacted the increased divergence in mortality rates. “Our findings show that over the past three decades, mortality rates have improved in states with initially high incomes in 1990 while the rates in low-income states have lagged behind,” says co-author Ellen Meara, an adjunct professor at The Dartmouth Institute and a professor of health economics and policy at the Harvard T.H. Chan School of Public Health. “In 2019, high-income states experienced the biggest drop in mortality rates relative to 1968 or 1990, whereas, the low-income states barely budged at all.”
It wasn’t income that drove the great geographic divergence in mortality, the researchers say. Instead, it appears to be the long-term benefits of public health and social policies that were enacted by higher-income states in the 1980s and 1990s, particularly relating to children and adolescents, as they started paying off at midlife in the 2000s and 2010s.
“Investments in public health—higher taxes on cigarettes, expansion of the earned income tax credit for families, and expansion of Medicaid to pregnant mothers in high-income states—are the most likely candidates for why some states gained and others didn’t,” says Skinner.
Meara says, “our results demonstrate how regional investments in health capital over the lifecycle, including policies aimed at adopting good health behaviors, can provide long-term benefits for residents, significantly increasing life expectancy.”
