In the United States, rural residents do not live as long as their urban counterparts. This disparity has been widening for decades. Around 1970, urban life expectancy was 70.9 years, compared with 70.5 in rural areas, but by 2005–2009, the difference was greater (78.8 versus 76.8 years). In our research recently published in the IJE, we found that the gap in life expectancy would be even wider today if declines in cardiovascular disease (CVD) mortality had not dramatically slowed around 2010.
Smoking, alcohol misuse and behaviours that result in obesity (such as an unhealthy diet and insufficient physical activity) have strong negative effects on individual health. Because these health behaviours are very common among people in Europe, smoking, alcohol and obesity also largely influence mortality rates and life expectancy in Europe.
However, the impact of these three lifestyle factors on life expectancy is likely changing over time. Smoking, obesity and alcohol misuse, like true epidemics, tend to first become more common in a population, followed (eventually) by a decline in their prevalence and associated mortality.
Elias Nosrati, Michael Ash, Michael Marmot, Martin McKee and Lawrence P King
Health inequalities are on the rise in the United States: the gap in life expectancy between those at the top and the bottom of the income spectrum has increased rapidly since the dawn of the century, to the point where the lives of the poor are cut short by up to a decade and a half compared with those of the wealthy. Moreover, while the rich tend to live longer everywhere, life expectancy among the poor varies significantly by geographical region.
In our article recently published in the IJE, we show that these patterns of health are the product of powerful political and economic forces. Over the past few decades, neoliberal politics, the decline of unions and economic globalisation have resulted in rapid industrial restructuring and economic dislocation in the US. Organised labour has been eroded in the industrial heartland, and manufacturing operations have been shifted to the non-unionised south and to foreign countries.
Daniel H Simon, Andrea M Tilstra and Ryan K Masters
Rising mortality among young and middle-aged White Americans has alarmed researchers, public health professionals and the broader public. These concerns were amplified by a 2015 study in which the authors attributed rising mortality rates among White Americans to increases in deaths from chronic liver disease, suicide and drug overdoses. The authors argued that increased mortality from these causes of death is likely a result of the “same underlying epidemic” that is affecting a “lost generation” of Americans. The underlying epidemic was said to be “deaths of despair”, originating from rising distress, economic insecurity and chronic pain.