Tuesday, September 12, 2006


Plutocrats Reap Health Care Benefits

Since there is no such thing as universal health care in America, there are major disparities in life expectancies between different economic and ethnic groups. This is the way the system wants it, one might suggest. The wealthier live longer and the poor die younger. Whites live longer than African-Americans and Indians. Rich white people live much longer than poor non-whites. That’s because the wealthy have established a system that benefits them and they like it that way.

Can it be changed? Maybe if we could change the way we elect our “representatives” (as it is they are bought and paid for by the well-off) we could actually elect politicians who care about people.

The plutes are happy with the way things are.

Wide Gaps Found In Mortality Rates Among U.S. Groups

By David Brown
Washington Post Staff Writer
Tuesday, September 12, 2006; A01

A black man living in a high-crime American city can expect to live 21 fewer years than a woman of Asian descent in the United States. The man's life expectancy, in fact, is closer to that of people living in West Africa than it is to the average white American.

Inhabitants of what a new report calls "Black Middle America" -- African Americans who live outside inner cities and the rural South -- also have a life expectancy five years shorter than those in "Middle America," which encompasses the vast majority of urban and suburban whites.

Even between groups that appear quite similar there are wide differences in the risk of early death. A farmer from a Great Plains state such as North Dakota is likely to live four years longer than a farmer living in Appalachia or the Mississippi Valley.

Those are among the observations of the study, which examines death in the United States through an unusual lens that refracts the population into eight demographic groups, or "Eight Americas."

The differences in life expectancy across that spectrum are as wide as the difference between Iceland and Uzbekistan. The study, based on 2001 data, reveals a United States that is pocked by places where millions of adults face a risk of premature death like that in Angola, Mexico, Nigeria and other parts of the developing world. Furthermore, those differences -- the most obvious sign of the health disparities that have captured the attention of policymakers -- have not changed in two decades.

"I think it's pretty fair to say we're failing," said Christopher J.L. Murray, a researcher at the Harvard School of Public Health. "The score card on the macro level has been failure."

One of the reasons for the persistence of the disparities, Murray says, is that the biggest difference in mortality is seen among people in middle age. That part of the population has not been a major focus of new investment in government health programs in the past two decades.

Instead, children and the elderly -- among whom the disparities are less severe -- have been the principal targets of new and innovative health spending. Those include free vaccines for poor children, the state and federal governments' Children's Health Insurance Program (CHIP), and the drug benefit (Part D) recently added to the Medicare program.

A decade ago, Murray and his colleagues looked at life expectancy county by county. In this study, they began with 2,000 geographical units -- counties or groups of counties. They then divided them into eight groupings based on ethnicity, race and income. Some were broad geographical areas, while others were essentially demographic archipelagos stretching across the nation.

The Eight Americas were: Asians, scattered throughout the country; rural whites in the Northern Plains and the Dakotas; white Middle America, consisting of 214 million people not assigned to other categories; low-income whites in Appalachia and the Mississippi Valley; Western Indians (the smallest group, with 1 million people); black Middle America; low-income rural Southern blacks; and high-risk urban blacks -- those living in places where a person has a 1 percent or greater risk of being killed between 15 and 74 years of age.

The study, by Majid Ezzati, also of Harvard, along with Murray and five other researchers, is published in the Public Library of Science's online journal, PLoS Medicine. It includes a list of the counties with the highest and lowest life expectancies in the nation.

Montgomery County is tied for first (81.3 years), with Fairfax County not far behind at 80.9. Baltimore City is next to last (68.6). The District, at 72 years, is also among the 50 jurisdictions with the shortest life expectancies.

As previous studies have shown, Asians have by far the longest life expectancy -- 87.4 years for women and 82.1 for men. Black urban men have the shortest (66.7), followed by Southern rural black men, at 67.7. Indian men in the West are next, at 69.4.

Curiously, Asian women in the United States -- many of whom are second-generation and have spent their whole lives here -- have a life expectancy that is three years longer than Japanese women, who, as a national group, are the longest-living in the world. Previous research suggests that Asians lose their "survival advantage" after they are in the United States for a long time and have adopted an American diet and habits, but the new study suggests that is not happening with Asian women.

Among the more interesting comparisons, however, are those among whites.

Northern Plains whites have a per capita income below that of Middle America whites (about $18,000 vs. $25,000), and essentially the same percentage who are high school graduates (83 vs. 84). But they live longer -- 79 years vs. 77.9 years.

The comparison is even more dramatic with the Appalachian and Mississippi Valley group. The latter has a per capita income only $1,400 less than the Northern Plains group, but a markedly lower high school graduation rate, at 72 percent.

The gap in life expectancy between those groups in 2001 was 4.2 years for men and 3.8 years for women. This is not far off the overall gap of 6.4 years between black men and white men, and the 4.6-year gap between white women and black women.

The paper did not examine the causes of death between the groups. But the researchers note that high mortality in urban black men persists even when homicide and AIDS are removed. Heart attack, stroke, diabetes, cirrhosis and fatal injuries are the major causes of reduced life expectancy in that group.

The huge strides in cutting infant mortality in the past 50 years are clearly evident in the findings. The risk of dying between birth and age 4 is extremely similar among all Eight Americas -- much more similar than at any other age.

While black inner-city men have a mortality risk similar to that of West Africans, that is true only once they reach their forties. West Africans have a risk of dying in childhood more than 10 times that of even the most disadvantaged African Americans.

Interestingly, there was less variation among the Eight Americas in the rate of health insurance coverage and the frequency of routine medical appointments than there was in life expectancy. That finding suggests that access to care does not explain most of the differences in mortality.

Others in the field found the study informative and not surprising -- and also somewhat frustrating.

"The magnitude of the life expectancy disparity is most striking and is perhaps a bit larger than I might have guessed," said Mitchell Wong of the University of California at Los Angeles, who has studied how various diseases contribute to disparities in mortality. "However, it is not surprising that by combining race and geography, disparities are even larger."

Richard Cooper, chairman of preventive medicine at Loyola University School of Medicine, said that "the problem with these sorts of analyses is that they don't tell you anything very illuminating about the underlying social process" that leads to differences in life expectancy.
© 2006 The Washington Post Company

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