Within many cities in the U.S. the gap in life expectancy between communities can be as high as 25-30 years, even if they are only a few miles apart. The communities with the lowest life expectancies are also the ones with the most poverty. These communities don’t provide enough resources and opportunities for people to live healthy lives. In this webpage I provide information around the history of the problem, its current manifestation, and some possible solutions that would address it.
Though statistical data is scarce, this problem began in the Gilded Age where rapid industrialization commenced in America, resulting in wide inequality between socioeconomic classes. The national average life expectancy in 1900 was 46 years for men and 48 years for women. These low rates were due largely to the spread of disease and malnutrition. From 1870-1900, more than 12 million immigrants entered the United States with hopes of a better life. Major cities had trouble meeting the housing and sanitation needs of these new immigrants, and as a result tenement housing developed. Tenements were working class housing that were “closely spaced, lacked ventilation and natural light, and had no hot water for bathing” (Thompson). These conditions fostered the rapid spread of disease which ended up killing one third of the population in the year 1900.
The period between the 1890s and the 1920s, known as the Progressive Era, identified and attempted to address these inequalities through reforms. Activists like Jane Addams recognized these inequalities in housing and worked tirelessly to improve the living conditions, and thus health, in low income communities. Efforts to create social services for low income citizens helped, but the problem of wealth and health inequality still remained.
During the period from 1900-1950, the death rate from diseases decreased by 96%. This decrease is largely attributed to medical advancements like the germ theory which was published in 1861, and the discovery of penicillin in 1928 which sparked the implementation of antibiotics in the mid-1930s. And yet, in the midst of all of these advancements, the death rate from disease of people with annual incomes of less than $1000 ($17,000 today) in 1937, was twice that of the rest of the population.
With the decline in germ-born diseases came the rise of new chronic diseases, such as cardiovascular disease and cancer, which accounted for three quarters of all deaths by the mid-century. In the 1960s and 70s, advanced procedures such as bypass surgery and angioplasty brought down the rate of cardiovascular disease by providing a way to navigate a blocked artery. Also during this period, medical researchers began to develop chemotherapy drugs for the treatment of cancer. As a result, the overall mortality rate decreased, and thus the life expectancy rose to 66 years for men and 71 years for women. And yet, by the 1970s lung cancer mortality rates were significantly higher for people in a lower socioeconomic class. Proximity to pollution and higher rates of smoking could potentially be the root causes of these higher rates.
The average quality of life as seen through national life expectancy data — currently 76 years for men and 81 years for women — improved for Americans in general because of medical advancements and better knowledge surrounding health. However, people in lower socioeconomic classes have generally experienced a higher mortality rate, no matter the disease or era. The lack of access to clean water, medical care, healthy food and proper sanitation all contributed to these high mortality rates.
Current Day Problem in the Bay Area and Beyond
In the U.S. today, where you live impacts your health outcome more than your genetic code. Citizens in low income communities have a lower life expectancy than citizens in higher income communities. This inequality is especially prevalent in the Bay Area as this phenomenon was first discovered in Alameda County by Dr. Anthony Iton. For example, using data from 2010-2015, residents living in the flats of Oakland had an average life expectancy of 72 years whereas those living in the hills had an average life expectancy of 87 years.
The inability to access quality healthcare is often thought of as the main source of the problem; however, most experts estimate that access to health care only contributes about 10-15% to life expectancy. So what accounts for the other 85-90% of the problem?
Education is the most important determinant of health as it influences your job options and thus your income. In 2012, two out of every five adults in poverty in Oakland had less than a high school diploma. Schools in low income communities are many times overcrowded and under resourced. Access to healthy food is also a very important determinant. Convenience stores and fast food restaurants are abundant in low income communities in the Bay Area, and grocery stores and farmers markets are scarce or nonexistent. Affordable housing is extremely difficult to find in the Bay Area. The average price for a home in San Francisco is $1.4 million and the average rent is $3,700 per month. Access to clean and safe parks are extremely important as they serve as a place for people to exercise. Access to social support such as community centers, schools, and churches as well as personal connections provide citizens with safety net networks that help you navigate obstacles when they arise. Environmental factors also play a big role. For example, in Richmond, California, petrochemical companies release large amounts of pollutants every year, and as a result Richmond has “higher rates of hospitalization due to asthma and higher rates of diabetes” (Unnatural Causes).
People who live in low income communities have to juggle a myriad of challenges, as systems around them like transportation, housing, employment, and criminal justice are often not reliable. It is very common for low income citizens to lack a sense of agency as they feel they can’t control the situation they are in. This leads to chronic stress or allostatic load, which “drives health problems like obesity, diabetes, asthma, and heart disease”, and over time “mimics premature aging” (Miyamoto). Constant stress can change your genetics over time, and those modified genetics can even be passed down to your children. These chronic diseases account for 70% of the deaths in America.
It Starts at the Top
The U.S. ranks 49th in the world when it comes to life expectancy; yet, we spent 3.6 trillion, or $11,172 per person, on health care in 2019, which was the most out of any country. The real reason other countries have better health outcomes is because they invest more in social services like education and housing. For example, in 2017, “nations that [were] members of the Organization for Economic Cooperation and Development (OECD) spen[t] [on average] about $1.70 on social services for every $1 on health services; the U.S. spen[t] just 56 cents” (Butler).
Current Efforts Being Made
Non-profit organizations have tried to tackle this problem. Building Healthy Communities was a ten-year plan started by The California Endowment, a private foundation, in 2010 which dedicated 1 billion dollars towards an effort to transform 14 of California’s communities that are most vulnerable to health inequities. Among these were the cities of Oakland and Richmond. Bay Area Regional Health Inequities Initiative (BARHII) is a coalition of 11 of the Bay Area’s public health departments that are trying to address health inequities. They provide trainings and webinars to educate people on the various determinants of health in the Bay Area.
What You Can Do
The first step to solving the inequities in the Bay Area is activism, in which anyone can participate. People in low income communities need to have a voice in order for the problems causing lower life expectancy to be highlighted. Getting people involved in their local government is crucial, as local governments are able to address health inequities in specific neighborhoods.
Activism is extremely powerful and has proven to instigate change in the Bay Area. For example, in 2007 Richmond’s unemployment rate was 18.5%, but it decreased drastically to 3.7% by 2017. This is largely due to the Richmond Equitable Development Initiative that surveyed residents on the “environmental, social, economic, and health issues in Richmond” (Richmond).
Activism can take many forms, even simple deeds like informing your peers that these health inequities exist because of a lack of social services in the U.S. can help. Apply what you have learned about this issue to discussions around health care in the U.S. and how we can utilize taxpayer dollars effectively to provide everyone an opportunity to live a long life.
More dedicated activism can come through volunteer work with organizations like BARHII or Building Healthy Communities, which focus directly on solving healthy inequities in California. If you don’t live in California, work with any organizations that focus on problems like affordable housing, access to healthy food, or access to quality education can help address life expectancy discrepancies. Also support for any bill or legislation that addresses health inequities can have a large impact and facilitate change.
Building Healthy Communities website: https://www.calendow.org/places/
BARHII website: http://barhii.org/
The implementation of policies is necessary when considering solutions to this problem. Connecting the minimum wage to the cost of living at the local level will address some of the immense income inequality that we see in the Bay Area today, and will make housing more affordable and displacement less common. Similarly, policies around land use need to be considered. Communities need dedicated healthy places for low income housing or mixed income housing that are not used for profit. Restrictions on the amount of pollutants that companies release into the atmosphere is essential. New housing should not be developed in close proximity to these plants. Policies to create more government-funded food pharmacies to provide low income patients with healthy produce could immensely change their health outcomes. Also, the government should institute policies that require that public schools serve healthy food and teach students about the causes of health inequities. Schools also need to be held accountable so that their discipline is fair and that they are using their funding to provide students with a safe environment. Improvements to life expectancy in low income communities at the local and state levels in California will prompt the federal government to invest in social services to address health problems where they start: unhealthy neighborhoods.
Here I have linked a website that accurately calculates the average life expectancy in your county based on your zip code. If you feel comfortable, you can type in your address and it will give a more specific life expectancy. (Note: this website does not store your zip code or address)
Answer these questions in the comment section:
- Did your predicted life expectancy surprise and/or disappoint you?
- After reading through my webpage, do you understand why your life expectancy is relatively high or low?
- Do you think the solutions I proposed are tangible?
- Do you have any other feedback for me?