Saturday, May 16, 2015

Five Miles and 20 Years of Extended Life

Don Siegel

Thomas Jefferson wrote in our Declaration of Independence:

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the Pursuit of Happiness.

While many have commented on or written about liberty and the pursuit of happiness, not much has been written about life, in that most people understand that our government exists, at least in theory, to protect it’s citizen’s rights, which, in turn, is a surrogate for protecting their lives. Clearly, we have an extensive and expensive aggregate of military forces, police forces, and undercover agencies that do just that. But a new report[1] from the Center on Society and Health at Virginia Commonwealth University (VCU), makes one wonder whether the declaration’s guarantee of life, is really being protected. If everyone has the unalienable right to life, then how do we explain longevity differences in neighborhoods in New York City of 9 years, in Atlanta of 13 years, and in Richmond Virginia of 20 years? While we know that “all men” are really not created equal, longevity differences of these magnitudes suggest systemic factors that clash with one’s inalienable right to life. That life expectancy is 63 years in Gilpin, a neighborhood in Richmond, near the state capital of Virginia, and 83 years in Westover Hills, another neighborhood, 5 miles away, should make us all wonder about what is going on.

I am not really asserting that the government is directly responsible for these longevity disparities, but our socio-economic system, and the environments that emerge from them are clearly involved with creating the conditions that make living in a community more or less healthy. The VCU project ties longevity to health, and health to income, asserting that “…the relationship between income and health is a gradient: they are connected step-wise at every level of the economic ladder. Middle-class Americans are healthier than those living in or near poverty, but they are less healthy than the upper class. Even wealthy Americans are less healthy than those Americans with higher incomes.”[2] The following chart, pretty much, shows compelling data of this health gradient for 12 different diseases or illnesses.[3] Clearly, one needn’t be a statistician to conclude that family wealth is highly correlated to health.

Not surprisingly, major risk factors also follow this pattern, with data from 2011 showing that , 

… smoking was reported by one out of four (27.3 percent) adults from families who earn less than $35,000 a year, three times the rate of those from families who earn $100,000 a year or more (9.2 percent). Obesity rates were also higher (31.9 and 21.2 percent, respectively), in part because of lower levels of physical activity and higher levels of caloric consumption. In 2011, the proportion of adults who reported getting recommended levels of aerobic exercise was 36.1 percent for those living in poverty compared with 60.1 percent for those with incomes at least four times higher than the [Federal Poverty Level]. 

The longevity differentials previously cited are simply the natural end point for lives lived very differently. Yet, one cannot help but ask whether in an advanced country, such as the United States, income should be so closely tied to health and longevity?

Who Cares about This?

Although the connections between income, health, and longevity are quite compelling, I often wonder whether we, as an aggregate, really care that two babies born into two families at different ends of the income continuum are destined to have very different lives with regard to their health prospects, their projected longevity, and most probably, the quality of their days. This is in stark contrast to the American Dream Ideology, which asserts that where one starts out in life has little to do with where one winds up, in that talent, hard work, and perseverance are supposed to be the factors that determine our destinies. Unfortunately, these health and longevity data do not support such a Pollyanna view of growing up in America today. Where one starts out in life is clearly connected to how long one might expect to live, and the quality of one’s life.

Clearly, there are research groups scattered about that study this stuff, and many individuals and organizations that are doing good work in attempting to reduce the relationships among family wealth, health, and general well-being, but we have really not taken on this issue in a systemic way, to fulfill our country’s promise of “life” in its promise of : “…life, liberty, and the pursuit of happiness.” Arguably, most people may ascribe to the notion that “…life is not fair”, and be resigned to endemic inequities.  Others, may attribute differential life circumstances to differential capabilities, and people’s unwillingness to pursue longer term personal development at the expense of shorter term satisfaction. While others may simply be indifferent to the plight of folks very different from themselves, who live “on the other side of the tracks.” But, these data are too compelling to ignore. A twenty-years longevity difference between groups of people living five miles apart in a country having great wealth is really difficult to explain in a society that is based on the notion that every individual should have an equal opportunity to thrive.  

What can be done?

Yet, what could be done, if we were really committed to tackling the longevity inequity problem? The answer is clearly not simple, but lies in “connecting dots”, that have been identified as representing separate issues by different interest groups.

First, we need to do a much better job in getting poorer kids educated. While education may be perceived as the route out of poverty, as we see from health data, income is also highly correlated to longevity and well-being. This is a complex relationship, as the connection between education and health may, at first, be perceived to be mediated by health education, which is a factor. But the more powerful connection probably comes from the interaction between income and lifestyle. This is so because the more education one gets, the higher the income that people are projected to have, and the higher one’s income, the more likely they are to be able to live in safe neighborhoods, to gain access to higher quality food, to live in homes not contaminated by lead or asbestos, to have jobs in safe work environments, to be less likely to smoke, to get more exercise, to incur less stress, to obtain higher quality health insurance, and to more easily access doctors, dentists, optometrists, physical therapists, psychologists, and other health providers.  As a profile, it becomes apparent that healthy living is very much a function of the environment in which one lives. In turn, this is largely determined by one’s income, which is connected to one’s occupation, which is tied to one’s education. Consequently, as I argued in my last post, we must do more to provide high quality education in general, but especially to children at the bottom of the income continuum.

Supporting the education of Project Coach participants entails working with them on a day to day basis to make certain that they are engaged in their classes, do homework assignments thoroughly, study effectively for exams, and master coursework. It also means helping students plot future trajectories for post secondary school education. This might entail everything from counseling students on selecting the best middle and high schools to attend, to helping them create a “future self” that includes higher education. Taking college trips, providing opportunities to prepare for the SATs/ACTs, assisting with college applications and financial aid forms, and any other activities that make higher education a natural progression would be in order. It may also entail helping youth explore and prepare for post secondary school employment in vocations not requiring a college degree.

The second approach that Project Coach takes to helping youth fulfill their potential entails community development. Recent research shows that future income, especially for children coming from families in the lower income quartile, is very much a function of where they grow up. In a nutshell this research found that:

For children growing up in families at the 25th percentile of the income distribution, each year of childhood exposure to a one standard deviation (SD) better county increases income in adulthood by 0.5%. Hence, growing up in a one SD better county from birth increases a child’s income by approximately 10%[4].

In dollars and cents terms this would mean that a low income boy growing-up in Hampden County, where Project Coach operates, would make $680 less per year than if he grew up in an “average community” in the study. On the other hand, if such a child grew-up in Tolland County (a county adjacent to Hamden County), he would make $4,850 more in a year than growing up in the “Average County”, or $5,530 more per year than remaining in Hampden County! While the authors do not specifically demonstrate the causal links in this bump in income, they do speculate that it has to do with such things as: less segregation by income and race, lower levels of income inequality, better schools, lower rates of violent crime, and a larger share of two-parent households. With regard to health, a quick analysis shows, as might be expected, that in the cities identified at the beginning of this post which had wide discrepancies in longevity, one finds that for poor kids growing up in Atlanta their average adult income would be depressed by $2,850/year; in New York by $3,730/year (using the Bronx as a locale); or by $3,270/year in Richmond, Virginia. Consequently, the connection between, health, income, and community comes full-circle. Where one lives has an impact on education, income, and health.

Given that mass migrations of poor people to wealthier communities is probably not in the cards, an alternative strategy that Project Coach is pursuing is to help develop the community in which it exists in order for it to become more like those communities where upward mobility and healthy lifestyles are more likely to occur. We have already been part of One Spr1ngfield, which is engaged in antiviolence, clothing, and food security initiatives in the North End. As well, we provide educational and recreational programs during the after school hours and summer vacation period for children in grades 3-5. Project Coach also has an intensive, multi-year, youth development and jobs training program for 50-60 adolescents. Healthy communities also are cohesive communities in that they are made up of people who actually know and care about one another, and who support building and maintaining high quality living conditions. With our contingent of teenagers, we are currently exploring ways for how to diversify their involvement in sports, and deploy some of their vast talents and emerging leadership skills to maintain and expand such community development initiatives. Our emerging plans include engaging a broader array of community members in projects that encompass education, health, recreation, and the environment.

[2] Woolf, S. H et al. How are income and wealth linked to health and longevity?, Center on Society and Health,
[3] J. S., Schiller, J. W. Lucas, and J. A. Peregoy, “Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2011.” Vital and Health Statistics 10, no. 256 (2012): 1–207, tables 1, 4, 8, and 12.
[4] Raj Chetty and Nathaniel Hendren. (2015) The Impacts of Neighborhoods on Intergenerational Mobility: Childhood Exposure Effects and County-Level Estimates.

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