Health and class

The United States does not collect health data by class.*

However, the recently released report from the County Health Rankings and Roadmaps project (which for the first time this year include a measure of county-level inequality, depicted in the map above), conducted by the University of Wisconsin Population Health Institute, does give us some sense of the relationship between class and health outcomes in the United States.

Here are some of the key findings:

• Rates of children in poverty are more than twice as high in the unhealthiest counties in each state as they are in the healthiest counties. (The top performing counties in the United States, the 10 percent with the lowest rates of child poverty, have child poverty rates of less than 13 percent. The worst performing counties, the 10 percent with the highest rates of child poverty, have child poverty rates of at least 38 percent.)
• Across the nation, rates of unemployment are 1.5 times as high in the least healthy counties of each state as they are in the healthiest counties. (The top performing counties in the United States have unemployment rates of 4.1 percent or lower. The worst performing counties for unemployment have unemployment rates of 10.7 percent or higher.)
• The top performing counties in the United States have income inequality ratios of less than 3.7, while the worst performing counties have income inequality ratios of 5.4 or higher. (Within counties in the United States, the average—median—income inequality ratio of the 80th to the 20th percentile is 4.4. The income-inequality ratio in U.S. counties ranges from 2.6 to 9.6.)

Thus, as Margot Sanger-Katz explains,

The researchers measured inequality by comparing the number of people in a given place who earned above the 80th percentile in the county with the number of people earning less than the 20th percentile. Then they measured life expectancy using a custom measurement they developed — it counts the “potential life years lost” in each community by measuring all those who died before the age of 75, and the age at which they died. So someone who died at age 70 would have five years of potential life lost. Then they adjusted the numbers according to how old people were in the county, so counties with more old people wouldn’t look sicker than counties that were younger. The study looked at only the average life span and not that of higher-income versus lower-income residents.

For every one-point increase in the ratio between high and low earners in a county, there were about five years lost for every 1,000 people. That’s about the same difference they observed when a community’s smoking rate increased by 4 percent or its obesity rate rose by 3 percent. Researchers said that inequality effect persisted even when they compared communities of similar average income and racial composition.

The question we all need to ask then is, how many potential life years have been lost to the grotesque levels of inequality (and the conditions and consequences of growing inequality, such as poverty and unemployment) we have seen emerging in recent decades in the United States?

 

*In contrast to other countries, such as the United Kingdom (which has issued a series of reports over the years on the relationship between health and class, including the Acheson Report, fully titled the Independent Inquiry into Inequalities in Health Report, in 1998).