America's diminishing quantity of life

In large swaths of the nation, life expectancy has stopped increasing and even declined slightly over the decade that ended in 2007, particularly among women. This historic reversal of a long-time trend toward longer life expectancies in the world's richest nation is virtually unique in the developed world and appears largely due to the growing inequality of American society.

To be sure, this week's report by researchers at Washington University's Institute for Health Metrics and Evaluation found that many American communities — especially those in wealthy enclaves along both coasts and in South Florida — were home to some of the longest-lived citizens in the world, comparable to people in Switzerland and Japan. In such places, it was not uncommon for people to live healthy and productive lives well into their 80s and beyond.

But in less affluent communities, such as those in rural areas of Appalachia and the Deep South, or in the low-income neighborhoods of cities including Baltimore, the picture was far different. Residents there often have life expectancies shorter than people in some Third World countries, along with comparable rates of infant and child mortality. In parts of Baltimore, for instance, the life expectancy for men was less than 66.7 years.

Moreover, the differences in life expectancy along class lines show up even between affluent and poor neighborhoods in the same city. The average life expectancy of a person in Baltimore's affluent Roland Park, for example, was some 20 years longer than that for a resident ofHollins Market.

The report comes at a time when the Republican candidates for president are all gleefully denouncing the national health care reform law passed last year that was designed to reduce health inequalities and to remake a system that spends more than any other nation while producing worse results. Even First Lady Michelle Obama's efforts to convince people to eat healthier foods and exercise regularly — obesity is a major driver of the nation's poor health outcomes — has come in for criticism as paternalistic government meddling, or worse.

Yet while politicians can rail against the government telling us what to eat — and score political points on the campaign-trail with complaints that "Obamacare" is destroying the best health care system in the world — the fact is that every year millions of Americans die prematurely from preventable illnesses because they can't get access to health services they can afford.

Last year, a study by the Baltimore City Health Department found that poorly educated, low-income city residents were twice as likely to die prematurely as their well-educated, affluent neighbors. We spend millions on treating illnesses but a relative pittance for the kind of preventive care aimed at keeping people healthy.

We can change these trends. Baltimore, a city that has had a series of activist and ambitious health commissioners in recent years, still lags the national averages in life expectancy, but it is catching up, thanks in large part to a focus on reducing infant mortality and violence and the adoption of policies designed to reduce health disparities. The city has a long way to go, but it is under no illusions about that fact and it is making aggressive efforts to enlist community groups, businesses, hospitals, churches and every other segment of society in the effort.

The recently enacted health care reform law will extend health care benefits to millions of Americans who previously were shut out of the system. But simply expanding insurance coverage won't be enough if it doesn't give health-care providers incentives to improve the quality of services for the most disadvantaged citizens and make it easier for Americans to get preventive care.

The aim should be not only to provide universal access to care but also to teach people to use the health services that are available to them earlier and more effectively. We know what it would take for the United States to catch up to the rest of the developed world in its health outcomes, and it doesn't depend solely on expensive miracle drugs or high-tech therapies.

Rather, it just requires us to acknowledge that the way we do things isn't inherently the best, that there are more efficient ways we could spend our health-care dollars, that more health care isn't necessarily better health care, and that we have developed a culture of unhealthy habits such as smoking, over-eating and an aversion to exercise that are is much a threat to our long-term health and well-being as any catastrophic illness that lands us in the hospital.

Most of all, it requires that we treat the problem as if our lives depended on it, because they do.

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