Disparity in Life Spans of the Rich and the Poor, by Sabrina Tavernise for the New York Times, published February 12, 2016.

Looking at the extreme ends of the income spectrum, economists at the Brookings Institution found that for men born in 1920, there was a six-year difference in life expectancy between the top 10 percent of earners and the bottom 10 percent. For men born in 1950, that difference had more than doubled, to 14 years.

For women, the gap grew to 13 years, from 4.7 years.

“This may be the next frontier of the inequality discussion,” said Peter Orszag, a former Obama administration official now at Citigroup, who was among the first to highlight the pattern.

The article cites the following as potential causation for disparity:

  • Smoking;
  • Obesity;
  • and “the prescription drug epidemic.”

According to the study, “Limited access to health care accounts for surprisingly few premature deaths in America.”

These are the only factors explored by the Brookings Institution in their study.

I’ve got a long (and incomplete) list of factors they might want to explore as reasons for the “economic and social equities ‘that high-tech medicine cannot fix.'” (Elizabeth H. Bradley, a professor of public health at Yale.)

  • The poor are more likely to be less-educated. This can result in different life choices about diet (not necessarily obesity), safer sex, acceptance of mental health conditions, and health management skills (including but not limited to CPR, maintaining prescriptions, following up with doctors, etc.).
  • The poor are more likely to face environmental health challenges. They are more likely to live near toxic sites, to be exposed to lead, to live in food deserts, to lack convenient and affordable transportation to services which are nearly always located outside of their neighborhoods (pharmacies, clinics, doctor offices, hospitals, grocery stories, child care, employment, etc.).
  • The poor are more likely to lack the ability to access health care. Their access is often theoretical. Find time to take off from their hourly-paid job which usually does not provide health insurance; find time to make calls to doctors to set up appointments and followups and get test results when their job does not allow them to be on the phone when they are on the clock; find childcare for time spent with health appointments; find transportation that is affordable and within a convenient time frame to access health care; find a primary care physician who does not require a several day (or longer) wait to be seen, regardless of severity of issue; find a clinic, urgent care, or emergency room that isn’t over-crowded, under-staffed, and has a manageable wait time; find doctors who will take their complaints seriously.
  • For the poor who are not on Medicaid, the problem is financial. How can all the co-pays, co-insurances, premiums, and deductibles be paid when financial ends barely or don’t meet every month before health expenses are taken into consideration.
  • The poor are less likely to be able to afford or have access to dental care. This can lead to gum disease, which can cause heart disease. Infected teeth can be lethal.
  • The poor are less likely to be have access to cutting edge medicine, both due to location of the provided services and due to cutting edge medicine rarely being covered by insurance (including Medicaid).
  • The poor are more likely to drive unsafe vehicles.
  • The poor are more likely to be depressed, have higher ACE scores, and attempt suicide.
  • The poor are more likely to have poor children who will not be able to afford to care for their parents or send their parents to private care facilities. The poor are more likely to end up in state-run facilities, where mortality rates are higher and longevity shorter.
  • The poor are more likely to remain poor, generation after generation, giving birth to more poor. This is not a question of eugenics but a societal fact. We, as a society, are not lifting people out of poverty — we’re holding them there.
  • Then there are all the intersecting issues of race, gender, sexuality, employment, family structure, so many etceteras. These all play multiple factors in one’s health care.

But you know what? I’m exhausted and depressed from just fleetingly thinking of all of this. I need a nap.

Do better, Brookings Institution. I can pull up citations for everything I listed above. Don’t just say “well, smoking and obesity and we don’t know what else.” What else is well known. Don’t ignore it.