Studies Find Disparity in Life Expectancy Widening Between Wealthy and Poor Americans


Key Points

  • The life expectancy gap between wealthy and poor Americans is among the highest in the developed countries, with the richest 1% living 10 to 15 years longer than the poorest 1%.
  • Many in the United States forgo medical care because of cost, with 39% of low-income Americans reporting not seeing a doctor because they could not afford it, compared with 7% of people in Canada and 1% of people in the United Kingdom.
  • In 2015, health-care inequalities in the United States remain, with 25.2% of poor Americans uninsured compared with 7.6% of wealthier Americans.

To better understand the conditions and mechanisms driving health disparities in the United States, The Lancet partnered with physicians and public health researchers from the City University of New York, Harvard Medical School, Cornell University, Yale School of Medicine, and the New York City Department of Health and Mental Hygiene, among other institutions, to produce a five-part series called America: Equity and Equality in Health. The report also features a commentary by former presidential candidate Senator Bernie Sanders (D-VT).

The series focuses on four areas producing a disparity in life expectancy, which has been widening between the wealthiest and poorest Americans since the 1970s and now stands at 10.1 years for women and 14.6 years for men. The four areas include current inequalities in the U.S. health-care system, structural racism, mass incarceration, and economic inequality.

Study Conclusions

The study “Inequality and Health-Care System in the USA” by Samuel L. Dickman, MD; David U. Himmelstein, MD; and Steffie Woolhandler, MD, MPH, finds:

  • Economic inequality in the United States has been increasing and is now among the highest in developed countries.
  • Both overall spending and government health-care spending are higher in the United States than in other countries, yet inadequate insurance coverage, high cost-sharing by patients, and geographic barriers restrict access to care for many Americans.
  • To achieve health-care equality, a nonmarket-financing scheme that treats health care as a human right is essential.

The study “The Affordable Care Act: Implications for Health-Care Equity” by Adam Gaffney, MD; and Danny McCormick, MD, MPH, finds:

  • The Affordable Care Act (ACA) has nearly halved the share of Americans without health insurance coverage. Disadvantaged groups, including the poor, African Americans, and Hispanics, saw gains, although stark health-care inequalities remain.
  • Despite the ACA, financial barriers to care persist and might be worsening. High cost-sharing in the form of copayments, deductibles, and co-insurance obstructs access to care and frequently leads to financial distress or even ruin.
  • By providing comprehensive coverage to all Americans without cost-sharing, single-payer health-care reform could reduce health-care inequalities.

The study “Structural Racism and Health Inequities in the USA: Evidence and Interventions,” by Zinzi D. Bailey, ScD; Nancy Krieger, PhD; Madina Agénor, ScD; Jasmine Graves, MPH; Natalia Linos, ScD; and Mary T. Bassett, MD, finds:

  • Racial/ethnic health inequities in the United States are well documented, but controversies over explanations of these inequities persist.
  • One example of structural racism is the ongoing residential segregation of African Americans, which is associated with adverse birth outcomes, increased exposure to air pollutants, decreased longevity, increased risk of chronic disease, and increased rates of homicide and other crime. Residential segregation also systematically shapes health-care access, utilization, and quality at the neighborhood, health-care system, provider, and individual levels.
  • A focus on structural racism offers a concrete, feasible, and promising approach toward advancing health equity and improving population health. Without a vision of health equity and the commitment to tackle structural racism, health inequities will persist.

The study “Mass Incarceration, Public Health, and Widening Inequality in the USA” by Christopher Wildeman, MD; and Emily A. Wang, MD, finds:

  • Incarceration in the United States is common and concentrated in the black community.
  • Mass incarceration contributes to racial health disparities in the United States across a range of outcomes because of its direct and indirect consequences for health as well as the disproportionate concentration of incarceration among black communities.
  • Because the United States incarcerates many more of its citizens than other developed democracies, mass incarceration might have contributed to the country’s lagging performance on health indicators, such as life expectancy.

The study “Population Health in an Era of Rising Income Inequality: USA, 1980–2015” by Jacob Bor, ScD, SM; Gregory H. Cohen, MPhil; and Sandro Galea, MD, PhD, finds:

  • Gaps in mortality and life expectancy according to income and education have widened from 1980 to 2014.
  • Growth in health inequalities has been most pronounced in the bottom half of the income distribution. Since 2001, the poorest 5% of Americans experienced close to zero gains in survival. At the same time, middle-income and high-income Americans have gained more than 2 years in additional life expectancy.
  • Rising health inequalities should be addressed to avoid the emergence of a 21st century health-poverty trap.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.