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How geography changes life expectancy for America’s poorest

America's poorest citizens have shorter lifespans than wealthier Americans, and new research finds that gap is growing. But the study also found that the poor who live in affluent and highly educated cities live longer than those who live in other areas. Judy Woodruff learns more from Raj Chetty of Stanford University.

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  • JUDY WOODRUFF:

    Now: the connections between income, geography, and life expectancy.

    It's a sobering fact that the poorest citizens have shorter life spans than wealthier Americans. But new research published finds that the gap in life expectancy is growing. Since 2000, the wealthiest 5 percent of Americans can now expect to live an additional three years. For the very poorest, there's been almost no change.

    And yet research also found that the poorest who live in affluent and highly educated cities live longer than other poor Americans.

    Raj Chetty is the co-author, and he's an economist at Stanford University.

    Raj Chetty, welcome to the program.

    Why is this gap in life spans getting longer for so many people?

  • RAJ CHETTY, Stanford University:

    Well, Judy, what we're seeing is that there is a really dramatic increase in life spans for the very highest-income Americans throughout the country.

    what's interesting is that, for the low-income Americans, say in the bottom 20 percent, we find that the story is very heterogeneous across places. There are some places like Birmingham, Alabama, where the poor are gaining just as much in life expectancy as the rich, but there are other places like Tampa, Florida, where the poor actually losing in terms of life expectancy, where they live shorter lives today than they did in 2000, at the beginning of this millennium.

    And so in terms of understanding why we're seeing this increasing gap, I think the story is not just one at the national level. It's one that is going to force us to look at the local level to understand why the trend looks so positive in Birmingham, yet so negative in other places like Tampa.

  • JUDY WOODRUFF:

    And are there clues now as to why that is?

  • RAJ CHETTY:

    The places with the highest levels of life expectancy for the poor tend to have better health behaviors, perhaps not surprisingly. These are places with lower levels of obesity, higher rates of exercise, lower levels of smoking.

    They also tend to be cities like New York and San Francisco, more affluent, highly educated, high-cost-of-living cities, where the poor seem to be doing better. Now, we don't know exactly why. 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.

    But that remains to be explored further.

  • JUDY WOODRUFF:

    But it's not — and it's not just the big cities, the New Yorks and the San Franciscos. You said it's a Birmingham. It's the medium-sized cities as well.

  • RAJ CHETTY:

    That's right.

    It's really remarkable how diverse the patterns are around the country. There is no systematic bloc of cities where you find clear gains. The general patterns are affluent, educated cities, but it includes places like Cincinnati, Ohio, where we're seeing very positive trends, Birmingham, Alabama.

    In general, levels of life expectancy are highest on the coasts for low-income people, California and the Northeast, and they tend to be the lowest in Nevada and then the geographic belt running through the middle of the country, including states like Oklahoma and Detroit, Michigan, and so forth.

  • JUDY WOODRUFF:

    And what did you find with regard to gender, in terms of women at both ends of the income scale, and men?

  • RAJ CHETTY:

    We find large gaps in life expectancy in the U.S. as a whole between the highest- and lowest-income Americans for both men and women.

    For men, being in the top 1 percent of the income distribution gives you a life that's about 15 years longer, on average, than men in the bottom 1 percent of the income distribution. For women, the gap is 10 years, still large but not quite as large.

    And what's interesting, Judy, about the gender difference is that it's well known that women tend to live longer than men on average, but we find that that's much more true at low-income levels. Among low-income families, women live about six or seven years longer than men. At the highest income levels, women live only about one year longer than men.

  • JUDY WOODRUFF:

    And just quickly, what questions does this lead you to? What do you want to know next in order to understand this better?

  • RAJ CHETTY:

    Well, what this research shows us is that there is a great deal of inequality in life expectancy in America, but it's not inevitable.

    There are some places in America where gaps in health outcomes and life expectancy are much smaller, and what I think that shows us is that we can learn from those places, places like New York and San Francisco, and places like on a positive trajectory like Birmingham and Cincinnati, learn what those places are doing right, and hopefully translate those lessons to other areas to reduce inequality and help outcomes more broadly.

    The question going forward is, what exactly is the recipe to do that? And our hope is that these data that we have put out in this study will be useful in helping researchers and policy-makers figure that out.

  • JUDY WOODRUFF:

    Raj Chetty, economics professor at Stanford University, thank you.

  • RAJ CHETTY:

    Thank you.

  • JUDY WOODRUFF:

    And you can hear more from Raj Chetty about the long-term implications of disparities, both racial and economic, by watching a recent interview he did on our Web site. It's part of our ongoing series Race Matters. That's at PBS.org/NewsHour.

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