The key to living a long life in the United States isn't to drink plenty of water, eat healthy or zen buddhism (though those things certainly don't hurt) — it's money. According to a study published last month in the British medical journal The Lancet, as the income gap between the rich and poor widened in the last four decades, so too has the survival gap. On average, the wealthiest one percent of Americans will live 10-to-15 years longer than the very poorest in society.
And with talks coming from the White House on proposed tax cuts that will likely benefit corporations and the rich, and as Congress goes back and forth on repeal of the Affordable Care Act, these gaps in health and longevity between the haves and the have-nots can only deepen.
The study was one in a series of papers that explored equity and equality of health in the US. (Other factors contributing to the widening health inequity include systemic racism and mass incarceration.) Researchers from the Boston University School of Public Health reviewed literature that looked at trends in survival inequalities over the timespan of 1980 through 2015. In some demographics, they found survival rates stagnated or, in the case of low-income, uneducated white women, even dropped. Poverty, the study notes, has "emerged as an increasingly important risk factor for mortality in American adults."
While the study's authors point to changes in individual risk factors, such as smoking, obesity and substance abuse, as a potential explanation for the widening health gaps, they say these factors don't paint the full picture. "Factors including technological innovation, increased geo- graphical segregation, mass incarceration, reduced economic mobility, and increased exposure to prices might have [also] contributed to a steepening gradient between income and health and to the increasing importance of poverty as a risk factor for poor health," they write.
Because "income is more associated with length of life now than it was 15 years ago … we may be seeing the emergence of a health poverty trap, where essentially people who are poor don't have the same access to the important determinants that allow them to stay healthy," explains Jacob Bor, assistant professor of global health at Boston University and lead author on the study. At the same time, he continues, people who do have poor health often suffer economic consequences and fall into poverty because of medical expenses or loss of productivity.
Bor tells VICE Impact that the answer to decoupling income and health has to do with investments in public health. "One of the big pieces is a Medicare for all type health care system, which would really insure people fully against the cost of care and make sure everyone has coverage. Right now, people who get sick may go bankrupt. Medical costs are responsible for over half of all bills sent to collection, which is just insane to think about."
"We need a health care system that works for Americans," he continues, "and the current proposals by the Republicans to repeal and replace Obamacare are really moving in the opposite direction. They're moving in the direction of more cost-sharing and more financial risks being put on the backs of Americans, not less."
Another way to address rising health inequalities is investing in programs and policies that support the health of people regardless of income, Bor says. He points to social programs, such as food stamps, WIC and Headstart, which have been shown to substantially improve health outcomes. Another good place to start, he adds, is addressing environmental issues such as lead contamination in water.
"In this country, we need to do a better job guaranteeing that everyone, regardless of income, has access to a long life and a healthy life," Bor says. "Right now, we're not doing that and we're increasingly not doing that."
When asked what the average American can do to address these health inequalities, Bor's answer is simple: "The average American can vote. They can vote for politicians who pledge to address the health needs of all Americans, not just the ones who can pay for it."
The good news is, New York and California are both considering single-payer health insurance systems for its residents. Although the idea of universal health care, which is largely supported by the medical community, may seem ambitious, many proponents say it'd ultimately offer more coverage and cost less.
As one California lawmaker told the Mercury News, "Look, now more than ever is the time to talk about universal health care."