In the actual reality of the real-world, how long people tend to survive varies by county right here in the good ol' US of A. No head-hunting tribes of remote island cannibals required.
A report published recently in the Public Library of Science looks at life expectancy by county in the US over the past several decades. While life expectancy has gone up on average, it has stagnated, or even declined, in dozens and dozens of counties, mostly in economically challenged parts of the country, including the deep South and Appalachia.
The falling life expectancy in some counties, by a little over a year on average, is associated with a short list of prominent health threats: smoking-related lung diseases, obesity, and high blood pressure. These, in turn, can be linked to behaviors that, in theory, individuals can control: tobacco use, diet, and physical activity.
But it would be a mistake to blame the losers of survival roulette for their own misfortunes. While we do all control daily choices that dictate what we do with our feet, our forks, and our fingers, those choices are made in the context of the lives we lead, and the places we reside.
Some environments make being healthy the path of least resistance; other environments make it nearly impossible. It is far-fetched indeed to suggest that people are living shorter lives in some counties because they have less will power on average than either people living in other counties, or residents of their own county one generation ago!
Ultimately, life expectancy will stop rising for all of us, either due to the relentless effects of uncontrolled health threats such as obesity and diabetes, or simply because we reach the natural limits of the human life span. But when life expectancy is rising for some and falling for others, it's not testimony to human limitations, but to failures in social policies and questionable priorities. We are allowing the gap between haves and have-nots to widen, and the breadth of that expanse is measured, starkly, in average years of life.
In response to my public comments along these lines, I’ve received some interesting correspondence. One person in particular reprimanded me for suggesting we should stray into a bottomless pit of subsidies for education, healthcare, jobs, etc., to rectify disparities.
But I am suggesting no such thing. Believe it or not, left-leaning, public health type though I may be, I don’t want to send all of my income to taxes any more than you do! I do not think the resolution of disparities that encompass everything from job opportunities to life span lies with handouts. I think it lies with better informed policies.
One word we are almost certain not to hear from any of the presidential candidates is "rationing," because the word seems taboo in our society. That is both too bad, and downright silly. Resources of any kind--money, healthcare, ears of corn--are either limitless, or limited. If limited, at some point you run out. Between here and there is rationing.
If we ration resources such as tax revenue, social services, and healthcare in a haphazard manner, the return on investment is apt to be poor. That certainly seems to be the case when the country that spends more on healthcare than any other on the globe witnesses falling life span in 200 of its counties.
Rationing is inevitable, but rationing rationally is anything but. If we don’t look deep to see why some of us are living longer and some are living shorter lives as the decades come and go, we will never ask the right questions, let alone get the right answers.
Should we spend on emergency care what we might have spent on preventive care? Would money spent on the treatment of disease have been better spent on education or job training? Unless we ask the right questions, we are destined to ration limited resources irrationally, as we do now.
Perhaps some of the rhetoric in the presidential campaign about social inequities will resonate with greater urgency as the implications of this report are contemplated. When the length, as well as quality, of life Americans may expect to enjoy varies considerably by county, survival is anything but a "remote" concern. It's a concern of the first order, right here at home.
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