Gop in Life ExPectanqtWidens for the Nation

By RoBERT PEARWASHINGTON _ New gov_

3rnment research has found.'large and growing,, disparitiesln llle expectancy for richer andpJl-orer Americans, parallelingtne. growth of income inequalit!in the last two decades.

Life expectancy for the nationas a whole has increased, the re-searchers said, but affluent peo-ple have _experienced g."ut..galns,

- and this, in turn, hascaused a widening gap.__ One of the researchers, GopalK. Singh, a demographer at iheDepartment of Health and Hu_man Services, said ,,the growinginequalities in life expectancy,,mrrrored trends in infant mortil_rty and in death from heart dis-

1 ease and certain cancers.

After 20 years, the lowest so-cioeconomic group lagged fur-ther behind the most affluent, Dr.Singh said, noting that "life ex-pectancy was higher for the mostaffluent in 1980 than for the mostdeprived group in 2000."

"If you look at the extremes rn2000," Dr. Singh said, "men in themost deprived counties had l0years' shorter life expectancythan women in the most affluentcounties (71.5 years versus 81.3years)." The difference betweenpoor black men and affluentwhite women was more than 14years (66.9 years vs.81.l years).

The Democratic candidates forpresident, Senators Hillary Rod-ham Clinton of New York andBarack Obama of lllinois, havechampioned legislation to reducesuch disparities, as have someRepublicans, like Senator ThadCochran of Mississippi.

Peter R. Orszag, director of theCongressional Budget Office,said: "We have heard a lot aboutgrowing income inequality. Therehas been much less attentionpaid to growing inequality in lifeexpectancy, which is really quitedramatic."

Life expectancy is the averagenumber of years of life remainingfor people who have attained agiven age.

While researchers do not agreeon an explanation for the wid-ening gap, they have suggestedmany reasons, including these:

qDoctors can detect and treatmany forms of cancer and heartdisease because of advances inmedical science and technology.People who are,affluent and bet-ter educated are more likely totake advantage of these discov-eries.

9Smoking has declined morerapidly among people with great-er education and income.

{Lower-income people aremore likely to live in unsafeneighborhoods, to engage inrisky or unhealthy behavior andto eat unhealthy food.

t{Lower-income people are lesslikely to have health insurance,so they are less likely to receivecheckups, screenings, diagnostic

Thomas P. Miller, a healtheconomist at the American En-terprise Institute, agreed.

"People with more educationtend to have a longer time hori-zon," Mr. Miller said. "They aremore likely to look at the long-term consequences of theirhealth behavior. They are moreassertive in seeking out treat-ments and more likely to adhereto treatment advice from physi-cians."

A recent study by Ellen R.Meara, a health economist atHarvard Medical School, foundthat in the 1980s and 1990s, "vir-

tually all gains in life expectancyoccurred among highly educatedgroups."

Tfends in smoking explain alarge part of the widening gap,she said in an article this monthin the journal Health Affairs.

Under federal law, officialsmust publish an annual reporttracking health disparities. In thefifth annual report, issued thismonth, the Bush administrationsaid, "Over all, disparities inquality and access for minoritygroups and poor populationshave not been reduced" since thefirst report, in 2003.

The rate of new AIDS cases isstill 10 times as high amongblacks as among whites, it said,and the proportion of black chil-dren hospitalized for asthma isalmost four times the rate forwhite children.

The Centers for Disease Con-trol and Prevention reported lastmonth that heart attack survi-vors with higher levels of educa-tion and income were much morelikely to receive cardiac rehabili-tation care, which lowers the riskof future heart problems. Like-wise, it said, the odds of receivingtests for colon cancer increasewith a person's education and in-come.

]-I]E, NE,W YORKTIME,S NATIONAL SUNDAY MARCH 23'2OO8

. The gaps have been increasingdespite efforts by the feOerat govlernment to reduce them. One ofll9 t9p goals of ,,Healthy people2010," an official statement of na-tional health objectives rssued inruuu, ls to ,.eliminate

health dis-parities - among different seg-

ments of the population,,' includ_tng higher- and lower_incomeg.rgups and people of different ra_cral and ethnic background.- Dr. Singh said last week thatfederal officials had found ,,wid_ening socioeconomic inequalitiesIn l lte expectancy,'at birth and atevery age level.

__He and another researcher,Mohammad Siahpush, a profes_sor at the University of Nebraskarvlefical Center in Omaha, devel_oped an index to measure socraland economic conditions ln evervcounty, using census data on edu-

li!i"", income, poverty. housingand other factors. Counties wer6then.classif ied into l0 groups ofequal populat ion size.

, Jn.1980-82, Dr. Singh said, peo_

pre.ln the most aff luent gioupcould expect to live Z.S yearilonger than people in the mostoeprived group (75.9 versus 73years). By 1998,2000, the differ_ence in life expectancy had in_creased to 4.5 years (79.2 versusr4.t years), anC it continues togrow, he said.

tests, prescription drugs and oth-er types of care.

Even among people who haveinsurance, many studies havedocumented racial. disparities.

In a recent report, the Depart-ment of Veterans Affairs foundthat black patients "tend to re-ceive less aggressive medicalcare than whites" at its hospitalsand clinics, in part because doc-t:ors provide them with less in-formation and see them as "less

appropriate candidates" for sometypes of surgery.

Some health economists con-tend that the disparities betweenrich and poor inevitably widen asdoctors make gains in treatingthe major causes of death.

Nancy Krieger, a professor atthe Harvard School of PublicHealth, rejected that idea. Profes-sor Krieger investigated changesin the rate of premature mortality(dying before the age of 65) andinfant death from 1960 to 2002.She found that inequities shrankfrom 1966 to 1980, but then wid-ened.

"The recent trend of growingdisparities in health status is notinevitable," she said. "From 1966to 1980, socioeconomic disparitiesdeclined in tandem with a declinein mortality rates."

The creation of Medicaid andMedicare, community health cen-ters, the "war on poverty" andthe Civil Rights Act of 1964 allprobably contributed to the earli-er narrowing of health dispar-ities, Professor Krieger said.

Robert E. Moffit, director of theCenter for Health Policy Studiesat the conservative HeritageFoundation, said one reason forthe growing disparities might be"a very significant gap in health

Resufts of a healthstudy mirror thegrowth in theinequality of income.

literacy" - what people knowabout diet, exer.cise and healthylifestyles. Middle-class and up-per-income people have greateraccess to the huge amounts ofhealth infornration or.r the Inter-net. Mr. Moffit said.