Life Expectancy Gap Illustrates Disparities

Dr. George Sigounas told a standing room-only audience at 5600 last week that HRSA is deeply involved in addressing racial and ethnic health disparities -- noting that two-thirds of health center patients are minorities. The agency affords care to one in three impoverished people in America, including half those living with HIV/AIDS.
Dr. George Sigounas told a standing room-only audience last week that HRSA is deeply involved in addressing racial and ethnic health disparities -- noting that two-thirds of health center patients are minorities. The agency affords care to one in three impoverished people in America, including half those living with HIV/AIDS.

 

In Kansas City, two neighborhoods have recently drawn the attention of public health researchers. They're little more than three miles apart. One is called Blue Hills. The other is Armour Hills. In Blue Hills, people die an average of 14 years earlier.

In certain wards of New Orleans, the average life expectancy for a black newborn is 25 years shorter than it is for a white infant.

And despite relatively close proximity to world-class medical facilities in the D.C. region, a recent study by Virginia Commonwealth University found that rural residents little more than an hour west of the city have a life expectancy up to 18 years shorter.

In some cities and regions, the gap can differ by decades from one neighborhood to the next, said Dr. George A. Mensah of the National Institutes of Health in an April 24 multi-agency observance of National Minority Health Month attended by leaders from throughout HHS.

 

From left, Michelle Allender of HRSA's Office of Health Equity and Cara James, director of the Office of Minority Health at the Centers for Medicare and Medicaid Services, jointly hosted the gathering at 5600; Deputy Administrators Brian LeClair and Diana Espinosa listened in with HRSA health scientist Gopal Singh, co-author of the agency's exhaustive 2017 Report on Health Equity and a leading department authority on health disparities.
From left, Michelle Allender of HRSA's Office of Health Equity and Cara James, Director of the Office of Minority Health at the Centers for Medicare and Medicaid Services, jointly hosted the gathering; Deputy Administrators Brian LeClair and Diana Espinosa listened in with HRSA health scientist Gopal Singh, co-author of the agency's exhaustive 2017 Report on Health Equity and a leading department authority on health disparities.

 

"I'd like to make one very simple point," Mensah said, "that the social determinants of health" – a person's immediate surroundings, their access to primary care, education, healthy food, clean water, jobs, transportation and safe housing – "are the root cause of the major diseases that kill us."

Left untreated, small problems can become fatal: "Of the major causes of death in our country … the risk factors themselves of these major killers are all rooted in the social determinants of health."

The U.S. Centers For Disease Control and Prevention, for example, have called the 70 percent decline in deaths from heart disease and stroke during the last 50 years a seminal achievement of the 20th century. But gross inequities in exposure to environmental toxins, poor diet and health care shortages continue to beset minority and rural populations alike, Mensah noted.

In some cases, health disparities by race and ethnicity are widening. Rates of obesity, hypertension and diabetes are increasing nationally, but they're rising more dramatically in minority populations. "What is unique about the United States," said HRSA health scientist Gopal Singh, "is that disparities continue to grow over time" – including rates of death from all causes, and cardiovascular disease and cancer in particular. And African-American infants continue to die at higher rates than white babies.

 

Dr. Hugh Mighty, Dean, Howard University College of Medicine; Dr. George A. Mensah, Dir., Center for Translation Research & Implementation Science at the National Heart, Lung and Blood Institute; Roxanne Elliott, Policy Dir., Community Health Services, FirstHealth of The Carolinas, which has launched a school-based walking and hiking program called "Daily Mile" in 13 elementary schools in two high-poverty counties to combat childhood obesity and improve learning. The program is so popular that it has expanded to after-school hours and weekends.
Dr. Hugh Mighty, Dean, Howard University College of Medicine; Dr. George A. Mensah, Dir., Center for Translation Research & Implementation Science at the National Heart, Lung and Blood Institute; Roxanne Elliott, Policy Dir., Community Health Services, FirstHealth of The Carolinas, which has launched a school-based walking and hiking program called "Daily Mile" in 13 elementary schools in two high-poverty counties to combat childhood obesity and improve learning. The program is so popular that it has expanded to after-school hours and weekends.

 

Said Dr. Hugh Mighty of the Howard University College of Medicine: "I define (the social determinants) as systems of living needing systems of care ... residents in Arlington County, Va. have a median income of nearly $106,000 a year, with an average life expectancy of 86 years. If you fast-forward that to the District of Columbia, what we find is that median income is about $70,000 per year, and life expectancy is only about 78 years." 

Despite the proximity of high-quality care, poor D.C. residents are also pressed by a wave of suburban in-migration that has increased the cost of basic necessities across the board, while pushing them into cheaper housing and neighborhoods lacking basic services.  

"It's not because we have poorer control of high blood pressure or cholesterol," said Mensah.

In Kansas City, Mo., 84 percent of Armour Hills residents are white, and about 70 percent have a college degree. Median household income hovers around $103,000. The unemployment rate is under five percent. A typical single-family dwelling starts at around $350,000. On average, people here live to 83 years old.

Blue Hills, 3.3 miles away,  is 86 percent African American; fewer than half of residents have a college degree; household income stands at $30,500; and joblessness is endemic. A house here costs about $30,000. On average, people die before they reach 70.

A lack of basic social services to prevent more expensive health interventions later in life is a pervasive and persistent problem nationwide, Mensah said: In the U.S., one dollar goes to preventive social services for every dollar spent on health care. In France, the ratio is 2.5 to 1. Germany, 4-to-1.

"There's a real need to find ways to support the social services that can help increase the yield of our medical interventions," Mensah said.

Date Last Reviewed:  April 2019