Longevity: Is your community more like Albania or like Sweden?

Jun 15, 2011

If you live in certain counties in Washington, your life probably won’t be much longer than someone's in Albania or Mexico. On the other hand, the healthiest counties have life expectancies similar to Switzerland and Sweden.

This comes from new research showing life expectancy in many American communities is failing to keep up with the rest of the world. And the growing health gap is affecting women more than men.

Consider this tale of two communities:

Twenty years ago, if you lived in the Aberdeen area (Grays Harbor County) or if you lived on Whidbey Island (Island County), your life expectancy was nearly the same … about 79 years for women, and 73-75 for men.  Fast forward to today, and the men of Island County have added six years to their lives and the women there have added four years. But in Grays Harbor County, women have not increased at all, and men only slightly.

The result is a big gap, in two semi-rural counties, just a few hours drive apart.  As the lead author of the study, Chris Murray, puts it:

"There are a large number of counties in the US where it's not a question of keeping up, life expectancy is actually dropping. It's pretty shocking."

Murray is director of Seattle’s Institute for Health Metrics and Evaluation.   The current study, titled Falling Behind, in the journal Population Health Metrics, is one of the most thorough looks yet at the health of counties across America. They found about a quarter of all counties have stagnating or declining life expectancy -- which is one way of tracking overall health. Overall, the U.S. is failing to keep pace with other wealthy nations.

Murray says the U.S. could and should be doing better.

Trends that stand out:

  • Southeastern states, and counties in the Ozarks, are doing much worse than the national average.
  • Most states, including Washington, have counties that are among the healthiest in the world.
  • Every state has huge disparities.
  • Across the country, women are failing to add years to their lives, while men are making progress.

"There's this really surprising stagnation, or even decline, in terms of female life expectancy," says Murray. He thinks women are dying prematurely because of three main causes:

  • smoking,
  • obesity,
  • and high blood pressure.

Smoking is at the top of the list, because women were increasing their smoking rates through the 1970's and 80's, catching up with men. That means, by now, the health effects of that habit are showing up as premature deaths.

If you love this kind of data, check out the interactive maps.

There’s debate over the role of poverty. 

Murray notes that some poor counties are making progress while some wealthy counties are stagnating. To him, that means other factors are causing people in places like Grays Harbor County to die early, while places like Chelan County in eastern Washington are making huge strides. He thinks access to primary care is a big factor, because undiagnosed and untreated blood pressure and cholesterol are huge parts of the declining lifespans in America.

Other experts say the conditions that lead to early death – such as smoking and obesity – are more common among poor people. And there have been numerous studies over the years showing a strong correlation between income and education and better health status.

For example, King County ranks overall as one of America’s healthier counties (#58 for men, #76 for women out of more than 3,000 counties).  But David Fleming, director of Public Health Seattle & King County, says that ranking hides the fact that poor neighborhoods have higher rates of diseases:

"Within King County there are extensive disparities between our poor communities and more affluent communities -- on the same scale as disparities we see across the country," in terms of their overal health.

Adding more nuance: Immigration

Why would Chelan County, and the Wenatchee area, be doing nearly as well as King County, and better than most of the rest of Washington? 

Barry Kling, administrator of the Chelan-Douglas Public Health District, suspects one hidden reason is the immigrant paradox – that first-generation immigrants, even if they’re poor farm-workers, tend to be healthy:

"There's a selection of hardy people. You don’t get people who are barely making it every day going thousands of miles to a new place, to start a new life. So, I think there’s a self-selection as to who comes here."

There have been studies documenting this, in the past. Chelan County is home to many of the state's fruit orchards and has a lot of immigrant farm-workers.

The children of immigrants don’t do as well. As they adapt to our diet and lifestyle, they have the same problems with diabetes, cholesterol and blood pressure that have spread across the rest of America.