Geography Matters- The Rich Live Longer Living Anywhere but Not Poor People

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By The New York Times

For poor Americans, the place they call home can be a matter of life or death.

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.

But the fact that some places have increased the life span of their poorest residents suggests that improving public health doesn’t require first fixing the broader, multidecade problem of income inequality. Small-scale, local policies to help the poor adopt and maintain healthier habits may succeed in extending their lives, regardless of what happens with trends in income inequality.

“You want to think about this problem at a more local level than you might have before,” said Raj Chetty, a Stanford economist who is the study’s lead author.

“You don’t want to just think about why things are going badly for the poor in America. You want to think specifically about why they’re going poorly in Tulsa and Detroit,” he said, naming two cities with the lowest levels of life expectancy among low-income residents.

The research, in the works for nearly three years and based on a vast trove of records on earnings and deaths, is the most detailed analysis to date of a pattern first identified at least a couple of centuries ago, that more money translates into a longer life.

It could be as simple as this: Wealth buys higher-quality medical care, which allows people to live into old age. But a long line of evidence, including the new work, suggests it’s less obvious than it might seem. The affluent seem to live in healthier ways. They exercise more, smoke less, feel less stress and are less likely to be obese.

It’s not even certain that the cause and effect flows from higher income to greater health; to some degree, it may go the other direction as well, because people who are healthy are better able to hold down a demanding job, and so have higher incomes.

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