economics | April 12, 2016

For U.S. Poor, Geography Determines Longevity: Raj Chetty’s Health Inequality Study

Geography and life expectancy are linked—at least for America’s poorest people. A major new study released by The Health Inequality Project—led by Lavin speaker Raj Chetty, who acted as Corresponding Author and Principal Investigator—shows that where poor people live has a profound impact on how long they live. And while clearly distressing, the study also offers an opportunity to address health inequality with more precision, given the role geography plays in longevity. “You want to think about this problem at a more local level than you might have before,” Chetty tells The New York Times.

It’s long been known that poor Americans live shorter lives than the wealthy. But this new research, garnering a well-deserved flurry of press coverage, has discovered a number of important correlations between geography, income, and longevity. Not only has the gap in lifespan between richest and poorest Americans grown between 2001 and 2014—the top one percent of male earners live, on average, a staggering 15 years longer than the bottom one percent (for women, the difference is 10 years)—but poor people have much to gain depending on what part of the country they call home.

In certain areas, the poor “live nearly as long as their middle-class neighbors,” reports The New York Times. But in others, low-income residents live shorter lives—much shorter. “To give you a sense of the magnitude,” Raj Chetty tells NPR, “men in the bottom 1 percent have life expectancy comparable to the average life expectancy in Pakistan or Sudan.”


Another way to conceive of this gulf is to compare cities. Poor people in San Francisco, for example, live an average of three years longer than those in Detroit. As The Washington Post illustrates, this difference matches the degree to which national averages would rise if cancer were wiped out. And if we “think about [the] new data as if the poor in Detroit get cancer and the poor in San Francisco don’t,” then we can see, with brutal clarity, how important these findings are.

The research allows a clearer picture of wealth distribution to emerge, as well. The middle of the country and the “drug overdose belt” (NYT) of the south and south-west are hardest hit. Among the top 100 largest metropolitan areas in the U.S., low-income men and women live the longest in places like New York City, Miami, San Jose, Los Angeles, Santa Barbara, Newark, and San Diego. They live the shortest lives in cities like Detroit, Tulsa, Indianapolis, Gary, Ind., and Las Vegas.

While certainly troubling, the study also shows that how much you earn and how long you live aren’t rigidly fixed. After all, regardless of income, people are living longer in particular cities—and that means there may be practices and policies to implement at the local level to help the most vulnerable people. 

While naturally reluctant to offer premature conclusions, Chetty does suggest that “the story is not just one at the national level.” And while medical coverage is important, it’s not the whole story. Speaking with Judy Woodruff of PBS, Chatty argues that “better health behaviors”—involving lifestyle, diet, exercise, work, sleep, stress, and more—are vital contributing factors in cities with smaller lifespan gaps. “One potential hypothesis is that these types of cities invest a lot in public health. They’re often the first cities to enact things like smoking bans or bans on trans fats, which could end up improving the health of not just the rich, but also the poor.”

Vaccinations, public health spending, education, and various public health initiatives to “establish a culture of health” (NYT) could motivate local initiatives to address this regional inequality. Ultimately, and based on this sweeping data, policymakers can begin to work more fruitfully toward instilling health and wellbeing across the country by investing economic and social opportunities in a local context. 

“There is a great deal of inequality in life expectancy in America,” Chetty informs PBS, “but it’s not inevitable.”

Raj Chetty speaks on the economics of inequality in America. To book Raj Chetty as the keynote speaker of your next event, contact The Lavin Agency speakers bureau.