“I’ve been rich and I’ve been poor. Rich is better.” So said Sophie Tucker, long ago. It’s still true. A recent study in JAMA demonstrated that if life expectancy was extrapolated from age 40, American males in the top 1% of income would live 15 years longer than the bottom 1%; among women the life expectancy difference was 10 years. The wide variation in lifespan shocked many, leading to headlines around the world. Yet the really shocking results of the study were quite different.
How Was It Done?
IRS and Social Security records – a total of more than 1.4 billion people years over the period 1999 to 2014, the kind of data set Google could be proud of. The education was then sliced and diced according to many variables, including education and locality. Here it is comparable with recent US locality data, where each American county was compared on basic health data. The health differences were as big or bigger than what showed up looking at income alone.
How Much Better Do the Rich Do in Lifespan?
A lot better, though it varies a lot by location. For example, in the top 5%, survival has gone up about 3 years for both men and women in this century alone. Extrapolate that out, and it comes to 20 years increased survival per century – approximately what was seen over the last century. To put this in perspective, if all cancer deaths were prevented and only other forms of death remained, the average person would survive an extra 3.2 years. In other words, among the wealthy lifespan has increased as much in the last 15 years as if cancer was abolished.
Is This Due to Better Medical Care?
In a word, no. Though it’s hard to prove from this study alone, correlations between access to medical care, getting onto Medicare at 65, and “better quality” primary care measures, did not show any consistent relationship between medical care and mortality. That’s also consistent with many other studies: what keeps people alive is not the “quality” and certainly not the expense of medical care, but how people live. Public health trumps medical care over and over again when it comes to populations lasting longer.
What Seems to Matter to Survival?
The stuff everyone talks about – smoking, physical activity, education. Correlation studies don’t tell you a lot about causality. What is clear is, not only does higher income get you to live in environments where water and air quality are better, but “healthy” behaviors are more prevalent in the people you’ll see around you. Humans are social animals. We do what those around us do. Conversely, sick people have a much, much harder time getting into the top 1% of income. Being physically and mentally healthy makes it easier to reach high incomes; high incomes allow people to live in environments where it’s easier to stay healthy.
Is Income Level Destiny?
Far from it. About half the differences between the lowest and highest groups disappeared depending on where people lived. More interestingly, comparing New York, San Francisco, Dallas and Detroit, there was a six year difference in life expectancy for the lowest 20% by income, with only a year’s difference among the top 20%. If you’re poor and live in New York or San Frincisco, you have a much better shot at living longer than Detroit or Dallas.
What Did Correlate with Greater Life Expectancy for People in Lower Income Levels?
Not what our presidential candidates might have expected. The strongest correlate between greater life expectancy and low income came with the fraction of immigrants residing within a locality – more immigrants being associated with longer lives (correlation coefficient of .72.) So much for building walls. Other major factors indicating greater lifespan for people with lower incomes were median home values; local government per capita expenditures; population density; and fraction of college graduates.
Correlation is not causality. But the more money people made the longer they lived. If they did not have much money, lifespan increased apace in places with more social services, more educated populations, and economies that were more vibrant.
No, getting rich tomorrow won’t necessarily make you live longer. But basic public health measures like sanitation, nutrition, education and vaccination matter a great deal to all populations. So does lifestyle. How you move, how you eat, how you rest markedly improve the chance of living long.
Last, medical care can certainly improve lives, especially for populations which lack it. Yet the best results in terms of survival occur through lifestyle.
Lifespan length is not the only measure of health. It’s easier and clearer to measure than mental, social and spiritual health tend to be. Yet all these forms of health matter. And paying attention to social support, community cohesion, and the overall mental outlook of a population matter in lot – even when it comes to how long you’ll live.