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Living longer? Not in US

Living longer? Not in US

By Derrick Z. Jackson

Globe Columnist / June 28, 2011

ONE FALSEHOOD must end in the raging debates on Medicare, Medicaid, and health reform. In their denunciation of reform, Republicans from House Speaker John Boehner to Tea Party presidential candidate Michele Bachmann boast we already have the world’s best health system. Last week Representative Scott DesJarlais of Tennessee spiced up the rhetoric by saying reform is “destroying the greatest health care system the world’s ever known.’’

No one doubts we have some of the most advanced medical technologies, research, and facilities. But if you measure systems by life expectancy, the United States, at 37th in the world for both men and women, is not even close to having the best. As Republicans continue to demonize what little reform we have agreed to, life expectancy for American women is dropping as never before in some sections of the nation.

Researchers at the University of Washington’s Institute for Health Metrics and Evaluation this month published a county-by-county analysis of life expectancy. From 1987 to 1997, there were 227 counties where female life expectancy dropped. From 1997 to 2007, the number of counties where women’s life expectancy dropped exploded to 737.

Comparisons with the rest of the developed world are more appalling. Of the nation’s 3,147 counties, nearly two-thirds — 2,054 — fell further behind life expectancies for women in the 10 longest-living countries. This is despite the United States having the world’s highest per-capita health spending.

Christopher Murray, the director of the Institute for Health Metrics and Evaluation, said his research team expected to find regional and racial disparities, but the overall breadth of the backward movement was stunning. He said that several negative trends were hitting American women all at once. “Men were big smokers in the 1950s and have cut back since,’’ Murray said. “Women started later and we are now seeing the damage done by this wave of women smokers. Obesity also hits women harder than men, and this is a huge factor nationwide. With high blood pressure, we know from previous studies that women are not being diagnosed or treated at the same level.’’

Besides the precarious state of women, life expectancy for black men in two-thirds of the nation’s counties is no better than what it was in other rich countries in the 1950s. The geographical inequality of who lives the longest or least in America is so stark that the maps from the University of Washington study almost perfectly mirror the national maps of obesity and diabetes done by the Centers for Disease Control and Prevention. Both maps show the Deep South and Appalachia at the epicenter of the nation’s health collapse. Massachusetts, more aggressive than most states at attempting to deliver health care, fares better than the national average, and even Suffolk County, which has significant pockets of poverty, has life expectancies for black men and women higher than the national average.

The Washington researchers pondered how much better the national health would be if we had a “high-performance’’ system. They determined that if the health risk factors of smoking, high blood pressure, obesity, and diabetes could be brought under control, life expectancy could be improved by five years for men and four for women.

At this point, the nation needs a health-promotion system that considers a range of options. They include regulation of trans-fats and salts in commercial food, higher tobacco and alcohol taxes, greater access to and affordability of healthier foods, environments that encourage exercise, and expanding the number of primary-care physicians.

“A health system push on preventable causes would not be easy, but it is a target that is technically possible and could make a major impact,’’ the study said.

Murray said he hopes the county-by-county data will help health and political leaders better target their policies. What the data should do is end any boasting about the greatness of our health care system. There is nothing to brag about when three times more counties are seeing big drops in life expectancy for women.

Derrick Z. Jackson can be reached at

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