Change in life expectancy for women in U.S. counties from 1987 to 2007



Go here for a larger version of the map. Red areas indicate counties where life expectancy has decreased. (Source: Institute for Health Metrics and Evaluation at the University of Washington)

That right there is an astounding map. Since basically forever, life expectancy in the U.S. has increased with each passing generation. But a new study found that while that trend has held steady nationally over the last two decades, for women in 313 U.S. counties, life expectancy has actually declined during that time.

That–like so many other health disparities in the U.S.–should be a national embarrassment. According to the study, the U.S. now ranks 37th in the world in average life expectancy. Since 2000, more than 80% of U.S. counties fell in standing against the “international frontier” (which is the average of the 10 nations with the best life expectancies). The researchers describe this as the “biggest decline in life expectancy since the Spanish flu epidemic of 1918.” Except there’s no deadly virus to blame it on–it’s just your regular, run-of-the-mill American inequality.

Unsurprisingly, the numbers show significant racial and economic disparities. In some counties, life expectancy for black men and women is nearly 50 years behind the international frontier. But it’s the regional and gender disparities that are perhaps most striking. As the map above shows, the decline in life expectancy for women is heavily concentrated in the Southeast, the Southern Midwest, and Appalachia.

Remapping Debate talked to several public health officials from those areas to get a better idea of what’s happening at the local level. Some of them found the decline expected, others found it “puzzling,” and all had some explanations to offer–such as poor access to health services in rural areas, budget cuts to local health departments, lack of availability of healthy food and green spaces, and crushing poverty. Teasing apart the possible factors–not to mention investing in the public health programs needed to address them–is, of course, a whole other challenge.

But it’s a challenge that is long past time to take up. It’s not news that the U.S. has horrendous health disparities–it’s just that, unlike other wealthy nations, we don’t seem particularly bothered by it. David Kindig, a professor of population health sciences, hopes this may finally be a call to action:

We’ve known about the disparities in the health care system for a long time, but we’ve tolerated them because, on the whole, we were getting better. Until recently, we didn’t know that a lot of the country was actually getting worse.

That is such a typically American sentiment. We’ve “tolerated” health disparities that have long left marginalized groups lagging behind simply because “on the whole” health outcomes are improving. Just like we tolerate unbelievable, immoral, ever-increasing levels of economic inequality, as long as “on the whole” our GDP keeps growing.

We’ve seriously gotta stop averaging away these deep injustices. It shouldn’t take the reversal of a decades-long demographic trend to get us to quit tolerating this shit–but I hope it finally does.