Life Expectancy for Low Education Groups in the US is Worsening

It is well known that there are significant socioeconomic gradients in mortality and morbidity, and there is a substantial literature on this subject. Nevertheless, there are many people who do not seem to find these trends concerning. Or at least, not concerning enough for society to act upon. Whatever about increasing relative differences, it is quite a different matter to see increases in actual mortality rates. Especially in a country like the US, and especially given the recent substantial increases in (average) life expectancy. This deserves more coverage and should be seen in the context of the similar pattern in real wages for certain groups.

The following NYT Article discusses the issue. The abstract for the article being cited is below.   

http://www.nytimes.com/2012/09/21/us/life-expectancy-for-less-educated-whites-in-us-is-shrinking.html?hp

Differences In Life Expectancy Due To Race And Educational Differences Are Widening, And Many May Not Catch Up

Health Affairs, August 2012, vol. 31 no. 8, 1803-1813

http://content.healthaffairs.org/content/31/8/1803.abstract

    S. Jay Olshansky, Toni Antonucci, Lisa Berkman, Robert H. Binstock, Axel Boersch-Supan, John T. Cacioppo, Bruce A. Carnes, Laura L. Carstensen, Linda P. Fried, Dana P. Goldman, James Jackson, Martin Kohli, John Rother, Yuhui Zheng, John Rowe

Abstract

It has long been known that despite well-documented improvements in longevity for most Americans, alarming disparities persist among racial groups and between the well-educated and those with less education. In this article we update estimates of the impact of race and education on past and present life expectancy, examine trends in disparities from 1990 through 2008, and place observed disparities in the context of a rapidly aging society that is emerging at a time of optimism about the next revolution in longevity. We found that in 2008 US adult men and women with fewer than twelve years of education had life expectancies not much better than those of all adults in the 1950s and 1960s. When race and education are combined, the disparity is even more striking. In 2008 white US men and women with 16 years or more of schooling had life expectancies far greater than black Americans with fewer than 12 years of education—14.2 years more for white men than black men, and 10.3 years more for white women than black women. These gaps have widened over time and have led to at least two “Americas,” if not multiple others, in terms of life expectancy, demarcated by level of education and racial-group membership. The message for policy makers is clear: implement educational enhancements at young, middle, and older ages for people of all races, to reduce the large gap in health and longevity that persists today.

The bright side of life expectancy?

This is a nice graph which illustrates effectively the variation in male life expectancy: how many years a newborn baby boy can currently expect to live.
Actually, no, its a horrible graph because it shows that in many parts of the world, especially sub-Saharan Africa, people don't live much beyond 40, about half what we can expect in rich countries.
For the raw data & the graph for females see here.

Life expectancy and socio-economic status

A useful Irish Times article documents CSO data on how life expectancy varies with socio-economic status and other variables: "Life expectancy is longest among those with the highest social class and the highest level of education. Male professional workers have a life expectancy of 81.4 years, for example, 6.1 years higher than their unskilled counterparts...For women, professional workers have the highest life expectancy, at 86 years, while unskilled workers have the lowest, 81 years."

Quality of Death International Rankings

A new report by the Economist Intelligence Unit has ranked countries according to quality of end of life care. Ranking is based on an index comprising various indicators such as health care spending, life expectancy, access to medication, public awareness and policy environment. The UK comes out on top, Ireland also does relatively well and is ranked 4^th. Some of the key findings:

- Drug availability is the most important practical issue
-State funding of end-of-life care is limited and often prioritises conventional treatment
-More palliative care may mean less health spending

More details here.

Life Expectancy and Economic Growth

Life Expectancy and Economic Growth


Matteo and Sunde
In this paper we investigate the causal effect of life expectancy on economic growth by explicitly accounting for the role of the demographic transition. In addition to focusing on issues of empirical identification, this paper emphasizes the role of the econometric specification. We present a simple theory of the economic and demographic transition where individuals' education and fertility decisions depend on their life expectancy. The theory predicts that before the demographic transition improvements in life expectancy primarily increase population. Improvements in life expectancy do, however, reduce population growth and foster human capital accumulation after the onset of the demographic transition. This implies that the effect of life expectancy on population, human capital and income per capita is not the same before and after the demographic transition. Moreover, a sufficiently high life expectancy is ultimately the trigger of the transition to sustained income growth. We provide evidence supporting these predictions using data on exogenous mortality reductions in the context of the epidemiological revolution.

Early Manifestations of Personality and Adult Health

Another study linking childhood personality to later health this time by Laura Kubzansky and colleagues in this months issue of Health Psychology:

"Children with high attention reported better self-rated health and fewer illnesses as adults; more distress-prone children reported worse self-rated health and more illnesses as adults."

Studies showing personality linkages to mortality (e.g. Friedman et al., 1993) have a strong design as they use an objective outcome measure and avoid many possible confounds in self-report measures. By using self-rated health or illnesses it's always possible that what we're seeing is distress prone people complaining more and rating their health as bad and illnesses as more frequent and severe. Controlling for adult personality and health behaviours helps to specify if early personality is important due to it's link to fundamental biological processes or due to it's influence on a trajectory of personlity and behaviour over the lifespan. I didn't see this in the Kubzansky study. However, it is supported by a series of studies point to childhood distress, neuroticism, instabiliy as risk factors for later illness and premature mortality and to conscientiousness, self-regulation, dependability etc. as protective. The biggest challenge at the moment is to test the potential causal linkages that may exist between personality, life-events and health. Potential pathways are outlined well in an article by Timothy Smith in Perspectives on Psychological Science.

Pollution and Life Expectancy

Following on from a discussion about pollution and life expectancy earlier today, it was a coincidence that I stumbled upon some relevant research. An article in the Tipperary Star cites research by Dr C Arden Pope III from the Department of Economics, Brigham Young University in Provo, Utah, and colleagues from Harvard. Their study matched air pollution in 51 cities with the life expectancy of their inhabitants between 1980 and 2000. It found that people in cities with the biggest shift from polluted to clean air had an average 10 months longer lifespan. The study was published in the New England Journal of Medicine.

Personality and Life Expectancy (Conscientiousness and Non-Cognitive Skills)

Following on from growing evidence that higher levels of conscientiousness are associated with greater health protection, Kern and Friedman (2008) show that conscientious individuals tend to live longer. Associations with longevity were strongest for the achievement (persistent, industrious) and order (organised, disciplined) facets of conscientiousness.

This suggests that there may be links between longevity and what economists refer to as non-cognitive skills. Even more interesting is the approach taken to de-compose (overall) conscientiousness into a range of non-cognitive skills, including persistence, industriousness, organisation and discipline.

The importance of concientiousness is also documented by Terracciano et al (2008). Furthermore, this study shows that the association of personality traits with longevity is largely independent from the influence of smoking and obesity; longevity was associated with being conscientious, emotionally stable, and active (a facet of extraversion).

Low levels of neuroticism and high levels of extraversion are also associated with a lower later-life risk of developing dementia, according to recent research in Neurology (reported in the Leitrim Observer).

Literacy not intelligence moderates the relationships between economic development, income inequality and health

Abstract:Objectives. Kanazawa (2006) presented data allegedly supporting a racist version of evolutionary psychology that claims that the populations of wealthier and more egalitarian societies live longer and stay healthier, not because they are wealthier and more egalitarian, but because they are more intelligent. The objectives of this study are: (i) to determine the relationship between IQ and literacy in Kanazawa's sample of countries and (ii) to reanalyse Kanazawa's dataset using measures of literacy in lieu of national IQ test scores.

Method. Correlation and regression were employed.
Results. National literacy scores across the countries in the sample are highly skewed. In spite of this, the literacy measures are highly correlated with alleged differences in national IQ (r = .83-.86). The measure of literacy together with economic development (GDPpc) and income inequality (Gini coefficient) control at least 59-64% of the variance in national life expectancy at birth.

Conclusions. There is no scientific justification for believing that alleged intelligence differences play any role in explaining international differences in health status. Measures of alleged national IQ scores are highly confounded with differences in literacy. Literacy is a key factor in the health of any community and policies designed to enhance the literacy of a population are expected to lead to significant improvements in health status.

Marks (2007)


The Kanazawa paper 'IQ and the wealth of states' and his paper Mind the gapin intelligence: Re-examining the relationship between inequality and health have been criticised in several papers:

Dickins et al. (2007)

Kanazawa (2006) has put forward an evolutionarily grounded theory which claims that individuals in wealthier and more egalitarian societies live longer and stay healthier not because they are wealthier or more egalitarian but because they are more intelligent (2006: 637). The claim rests on an argument which asserts that general intelligence is a solution to evolutionarily novel problems and that most dangers to health in contemporary society are evolutionarily novel. Kanazawa also claims that this relationship does not hold in sub-Saharan Africa. These claims are based on a cross-national analysis which finds a positive correlation between 'national' IQ scores and mortality data. The implication is that intelligence is the principal factor determining longevity in the rest of the world, regardless of issues such as adequacy of diet and availability of health care. Kanazawa's theoretical claims about the evolution of general intelligence as a domain-specific adaptation are inconsistent with adaptationist analysis: natural selection does not solve general problems. The assumptions that sub-Saharan Africa is more representative of the evolutionary past than is the rest of the world, and that most hazards to health in contemporary society are evolutionarily novel, are implausible. The methods used are inadequate because Kanazawa argues for causation from correlation and fails to consider alternative explanations. The IQ data are flawed for reasons to do with sample size and sampling, extrapolation and inconsistency across measures. Nor are they temporally compatible with the economic and demographic data

From Geoff (2007)
Kanazawa concludes that `wealthier and more egalitarian societies live longer and stay healthier … because they are more intelligent'. The result does not apply to sub-Saharan Africa, but this exception is explained by reference to his theory of evolutionary psychology, `The Savanna Principle'. We reanalyse the data, taking into account non-linearity in the relationship of GDP to life expectancy and find that the results no longer support his conclusions. We also argue that HIV prevalence rates are a more parsimonious explanation for differences between sub-Saharan Africa and elsewhere.