Pundits and politicians like to say the United States has the best health care in the world. If so, it’s not showing up in how long we live, a new study suggests.
While life expectancies in some parts of the U.S. match those of the healthiest nations on earth, in vast swaths of this country preschoolers can expect to live no longer than their peers in some of the poorest and most strife-ridden parts of the world.
That holds true in the Kansas City area, where life expectancies in Johnson County match those of Switzerland and Sweden, while those in Wyandotte County are more like what’s found in Libya or Sri Lanka. Jackson County life expectancies compare to those in Mexico and Uruguay, and Clay County’s to those in Cuba.
“What are we getting for our health care dollar if we’re spending more per capita than any other country and we have the life expectancies of countries that are reeling from civil wars or natural disasters?” asked William Heisel of the Institute for Health Metrics and Evaluation. “By many measures, we should have better outcomes.”
The institute, based at the University of Washington, compiled data on every county in the U.S. to calculate life expectancy each year from 1989 through 2009. It also compared county life expectancies to those in other countries.
The average life expectancy for men in the U.S. in 2009 was 76.2 years and for women 81.3 years, the institute found.
But life expectancies varied dramatically. In Marin County, Calif., men could expect to live to a ripe 81.6 years. In two Mississippi counties, male life expectancy was just 66.1 years, about the same as in Pakistan.
Women’s life expectancies ranged from 85.8 years in Collier County, Fla., to 74.1 years in McDowell, W.Va., comparable to that of Algeria.
Overall, life expectancies in the U.S. have increased by 4.6 years for men and 2.7 years for women since 1989. But Heisel said that was “not a great improvement. That’s far behind the countries that are doing the best.”
In hundreds of U.S. counties, life expectancies remained the same or even declined, the study found. That was the trend through most of Oklahoma and Tennessee, and in a third of Georgia counties.
Kansas City area counties all showed improvements in life expectancy. But the differences among them were significant.
Life expectancies were lowest in Wyandotte County. On average, men could expect to live only to 71.6 years, putting them on par with men in Libya, Poland and China. Women live on average 77.9 years, about the same as they do in Sri Lanka, Ecuador and Lithuania.
“We’re well aware of all the negatives around our health. We’re well aware of our issues. We have an older urban community with some pretty stark needs,” said Joe Connor, director of the Wyandotte County Public Health Department. Low educational attainments and income levels were factors, as well as poor access to health care and recreation.
“That all leads to poor community health,” Connor said.
For the past several years, Healthy Communities Wyandotte, a coalition of schools, hospitals, social service organizations and government officials, has been drafting long-range plans for improving education, nutrition and access to health care. The group’s first initiative is a comprehensive plan for adding sidewalks and trails to make it easier to walk to schools and parks.
“It’s not going to happen overnight,” Connor said. “But over time, you will see a huge difference.”
Jackson County’s life expectancies – 73.9 years for men and 79.7 years for women – also were below the overall U.S. rates.
Neighboring Johnson County had the highest life expectancies. Men live on average 79.3 years, the same as in Switzerland, Japan and Australia. Women could expect to live to 82.9 years, as they do in Canada, Finland, Sweden and Norway.
“Certainly socioeconomic factors affect health status,” said Lougene Marsh, director of the Johnson County Department of Health and Environment. “While poverty has grown in Johnson County over the past decade, still on a comparative basis, our rates are not as high as in other counties.”
Marsh also attributed the health of Johnson County residents to the abundance of parks, trails and other recreational opportunities.
In Kansas City, the Health Department calculated life expectancy by ZIP code and found they varied by as much as 16 years. Tucked into the Northland is ZIP code 64158, with a life expectancy of 85 years. East of Prospect Avenue and south of Swope Parkway is ZIP code 64130, with a life expectancy of 69 years. That ZIP code has been plagued by its high murder rate.
Infant mortality rates in Kansas City’s poorest ZIP codes were five times higher than in its wealthiest, according to the Health Department’s data.
High unemployment, low rates of homeownership and low educational attainment all contribute to poor health, Kansas City Health Department director Rex Archer said.
“It’s neighborhood conditions,” Archer said. “These dynamics make a difference. All these combined stressors increase infectious diseases, chronic diseases, intentional and unintentional injuries.”
Although socioeconomic disparities and a lack of health care coverage affect life expectancy, they aren’t the only things in play, said Heisel of the Institute for Health Metrics and Evaluation.
“We see counties with few resources doing well and counties up higher in income doing less well,” he said.
Preventable factors – smoking, poor diet and obesity, and inadequate treatment of high blood pressure and high cholesterol – play an important role. The quality of treatment and follow-up care of people with chronic conditions such as diabetes and hypertension also affects life expectancy.
Heisel pointed to New York City as an area that had made great strides in raising life expectancy. The city’s health department responded aggressively to the AIDS epidemic, has targeted unhealthful foods and has worked to make the city more friendly to pedestrians, he said.
Archer would agree. Missouri’s spending on public health has been declining.
“I think we are at a crisis,” he said. “Can we continue to move things forward or are we slowing down or in a reversal mode? We can turn some (public health problems) around, but we need some seed money.”
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