Research on the life-expectancy gap between America’s rich and poor finds Las Vegas among the worst; with unhealthy lifestyles and healthcare access to blame

Las Vegas: a place to get rich, but where the poor die younger

Santiago Garcia knows that 46 is far too young to be having major heart problems.

He recently sat atop an exam table at a clinic that offers free health care for uninsured residents and spoke about a hard fact of his life: Las Vegas is killing him.

Garcia is among the ranks of the city’s working poor. For 25 years, the Mexican immigrant has lived as a low-wage construction worker, slapping stucco on houses. Dressed in scuffed boots and paint-flecked pants, he’s still an elegant man. With his gray hair and clipped mustache, he resembles the beer pitchman who calls himself the most interesting man in the world.

Overworked, Garcia often labors 16 hours a day and makes less than $15,000 a year.

“I can feel my body wearing out under the sun,” he said in Spanish during a visit to the clinic. “I’m getting weaker. My health is leaving me.”

Garcia has plenty of company: a sweeping new health study released this week by the Journal of the American Medical Association suggests that the gap between life expectancy for the rich and poor has widened between 2001 and 2014, such that the richest men are living 15 years longer than the poorest; for women, the richest live 10 years longer.

The study also ranked scores of American cities where the working poor die at the youngest ages. Las Vegas ranked near the bottom of life expectancy for both men and women.

In Clark County, Nevada, the study shows, life expectancy for a poor 40-year-old man is 77.6, worse than most counties in the US for the working poor. Poor women in the region lived to an average of 82, a year lower than the nation average.

Facebook Twitter Pinterest Santiago Garcia during a consultation with Robert Sheriff at Ruffin Family Clinic. Photograph: Josh Hawkins/The Guardian

Such results don’t surprise health care professionals in the place known as Sin City.

In this gambling mecca, where tourists flock in droves to act out and relax, human vice comes out to play. People puff on too many cigarettes, their second-hand smoke affecting the health of minimum wage workers around them. Residents, especially poor ones, also drink more, exercise less, and bear the stress of living in an economy that in recent years has endured a major financial hit.

Without state taxes, Nevada often has little or no money for social service programs. To make matters worse, the state suffers from a severe shortage of doctors that results in long waits – even for many wealthier residents.

In some ways, many health professionals here say privately, the poor almost don’t have a fighting chance for a long substantive life.

“We are one of the nation’s unhealthiest states,” said Dr Joseph Iser, the chief health officer for the southern Nevada health district. “The reasons are many, including high levels of alcohol and drug use, and cigarette smoking.”

The city’s spread-out geography doesn’t help. Many areas of Las Vegas are located in so-called food deserts, where healthy food and produce are hard to find.

“If you are poor and don’t have your own transportation, it’s hard to find healthy food unless you live on a bus line,” Iser said. “In addition, we don’t have as may safe venues to walk and exercise. And with high summer temperatures, both are harder to do.”

There is another, even more ominous reason for the low life expectancy among the area’s poor: Las Vegas exists in an area known as the drug overdose belt, where a higher rate of death coincides with high use of opioids.

“We are in the opioid belt big time; we’re right there,” said Dr Florence Jameson, who founded and now heads Volunteers in Medicine of Southern Nevada, a nonprofit group that operates two free clinics that provide medical care for the uninsured in Clark County.

If you are poor and don’t have your own transportation, it’s hard to find healthy food unless you live on a bus line Dr Joseph Iser

On a recent day, Jameson, a free-spirited woman who wears her long black hair in a ponytail, made her rounds at the Ruffin Family Clinic, located in a working-class neighborhood just north of downtown Las Vegas. The $2.4m, 12,000 sq ft facility has 10 examination rooms in addition to counseling offices, procedure rooms, optometry and dental clinics, pharmacy, radiology center and laboratory.

Staffed by 450 medical and non-medical volunteers, the Ruffin Family Clinic this year expects to see 6,500 patients “who fall though the cracks,” those ineligible for Medicaid but too poor to afford private or government-subsidized insurance plans.

In Nevada, experts say, the need for medical assistance for the poor, seems unending. “We’re usually 50th out of 50 states in many medical categories,” Jameson said.

In one room, Dr Rebecca Edgeworth, the Ruffin Clinic medical director, checks the heart of Pam Lim, a 57-year-old woman from Malaysia without health insurance. Recent years have been difficult for her husband’s real estate business.

“I have some swelling in my neck,” she tells Edgeworth. “I had fish for dinner the other night. I think that’s where it started.”

For Lim, such visits are critical.

“Low-income people are less likely to get proper health screening,” Edgeworth said. “They’re not getting timely pap smears, mammograms and cholesterol checks; all the normal things that people with health insurance take for granted.”

The 48-year-old Edgeworth is a Las Vegas native who takes the area’s lack of health care for the poor personally. “It hurts my heart to see what is happening here,” she said.

The ongoing doctor shortage doesn’t help. Presently, Nevada has only two medical schools. But two more are scheduled to open next year, a move that will provide hundreds of new resident doctors, new front-line troops Edgeworth hopes can address the state’s worsening mental health crisis that includes suicides and drug overdoses.

“For many people, Las Vegas represents a place to hit it rich,” she said. “But many get here and discover that it’s not all gambling and showgirls. They develop bad habits. They smoke and drink. And as we all know, untreated substance abuse and underlying mental heath problems lead to bad outcomes.”

Many poor face the stress of providing for a family on low wages. “If you are under the constant pressure as a provider,” Edgeworth said, “your own health often becomes a low priority.”

Facebook Twitter Pinterest Dr Rebecca Edgeworth checks on Pam Lim, a 57-year-old woman from Malaysia. Photograph: Josh Hawkins/The Guardian

In Las Vegas, a home foreclosure rate that led the nation during the recent US economic crisis has added to the burden. One result is high rates of smoking.

Several times a year, the clinic sponsors weeks-long smoking cessation clinics, some in Spanish, before which Edgeworth and others make hundreds of calls to ensure attendance. “Smoking is a powerful addiction; you don’t just rip the cigarette out of someone’s mouth,” she said. “You don’t behave like a mother. You tell patients you want to be their health partner.”

In years of practice, Jameson has realized that doctors cannot help improve the lives of the poor without addressing such underlying issues as substandard housing, depression and drug addiction. “If you can’t deal with that,” she said, “everything else falls flat.”

The Ruffin Clinic has launched a new program stressing social and behavioral health intervention. “Patients can discuss shelter issues, lack of food, paying utility bills and be assessed for services,” said Amy Schmidt, a social worker who runs the program.

Even after his doctor visit, Santiago Garcia knows full well his health will remain a battle. He often goes months without work, enduring a level of stress that could one day kill him.

But like many working poor, he remains philosophical.

“I know I’ll never be here,” he says, reaching over his head. “”But I am happy where I am.”