The poor in some cities — big ones like New York and Los Angeles, and also quite a few smaller ones like Birmingham, Ala. — live nearly as long as their middle-class neighbors or have seen rising life expectancy in the 21st century. But in some other parts of the country, adults with the lowest incomes die on average as young as people in much poorer nations like Rwanda, and their life spans are getting shorter.
In those differences, documented in sweeping new research, lies an optimistic message: The right mix of steps to improve habits and public health could help people live longer, regardless of how much money they make.
One conclusion from this work, published on Monday in The Journal of the American Medical Association, is that the gap in life spans between rich and poor widened from 2001 to 2014. The top 1 percent in income among American men live 15 years longer than the poorest 1 percent; for women, the gap is 10 years. These rich Americans have gained three years of longevity just in this century. They live longer almost without regard to where they live. Poor Americans had very little gain as a whole, with big differences among different places.
And it's not just race that plays a part, either. Again the paper finds evidence that white Americans are suffering from shorter life expectancies if they are poor. Money buys options, and being well-educated and prosperous leads to a longer life regardless of race.
Life expectancy for the poor is lowest in a large swath that cuts through the middle of the country, and it appears in pockets in the rest of the country, in places like Nevada. David M. Cutler, a Harvard economist and an author of the paper, calls it the “drug overdose belt,” because the area matches in part a map of where the nation’s opioid epidemic is concentrated.
The new findings dovetail with a much-discussed paper by Anne Case and Angus Deaton published last year. That research showed rising death rates among middle-age white Americans, especially those with low education. It also showed a sharp increase in drug and alcohol poisonings, suicides and accidents in the first years of this century. Research from the Brookings Institution published in February also found a growing gap in life span between the rich and the poor.
“There is some deeper distress going on among white middle-aged Americans that may continue to propel these mortality rates higher,” Mr. Deaton, a Princeton economist who wrote an editorial critiquing the new paper by Mr. Chetty and his colleagues, said in an interview. “If so, these people at the bottom will live even less long than they’re calculating.”
The places in America with the worst overall life expectancy aren't Detroit or the Appalachians or Chicago, like the media would have us expect. Rather, it's the Texas-New Mexico border area (Midland-Odessa, Lubbock, and especially Pecos) and southwestern Indiana (Terra Haute and Vincennes) where your average life expectancy is 5-7 years less than New York City or San Francisco.
But if you're poor, that gets even worse no matter where you are.
Something to think about. If you're poor, avoid the Ohio/Kentucky/Indiana tri-state. Hell, being poor in the Midwest is worse than being poor in the South. That should tell you something.