The life expectancy gap between rich and poor Americans has quintupled in the last 40 years. The culprits, according to recent studies, are smoking and prescription painkillers. Premature deaths from both causes are preventable, which should put the pressure on policymakers to support — and fund — programs and policies that help Americans stop smoking and overcome substance use disorders.
In 1970, a 60-year-old man in the top half of the earnings brackets could expect to live 1.2 years longer than a 60-year-old man in the bottom half, The New York Times reported recently based on Social Security data. By 2001, the gap had grown to 5.8 years.
At the extremes of income, the difference is even starker. For men born in the 1920s, those in the top 10 percent in terms of mid-career earnings lived five years longer, on average, than men in the bottom 10 percent. The gap grew to 12 years for men born in 1940, according to an analysis by the Brookings Institution.
The concept of a life expectancy gap based on income has been around for decades, but researchers have only recently confirmed that it is growing. Others have been looking for the causes. Obesity and lack of access to health care have been ruled out as large contributors. There is strong evidence, however, that smoking and drug addiction are major factors.
A 2008 Gallup survey found that the smoking rate among adults who made between $6,000 and $12,000 a year was nearly three times higher than for those earning more than $90,000 a year. A larger percentage of men smoke than women. The trends are similar in Maine, where 20 percent of adults smoked in 2012, the same as the national average.
Education also plays an important role. In 2012, the smoking rate among white men with a high school diploma or less was 35 percent. Less than 9 percent of men with a college degree smoked, according to data from the Minnesota Population Center and State Health Access Data Assistance Center. The trend was similar among women. The smoking rate for both groups has dropped over time as the adverse health consequences of smoking have become better known and publicized, but the decline among those with a college education was much steeper than it was for those without.
The death rate attributable to smoking also tracks education levels. Those with college degrees are about half as likely to die from smoking as those with a high school diploma or less.
Two Princeton economists reported last year that death rates among poor white men in America were rising. This was the only group with increasing death rates, which the husband and wife team Angus Deaton and Anne Case attributed to a rise in suicides and substance use, including heroin and alcohol.
In Maine last year, 272 people died of drug overdoses, according to the Office of the Attorney General. That’s nearly a third more than in 2014. Fifty-eight percent of these deaths were due to heroin and/or fentanyl, and 41 percent were attributed to prescription opioids.
Men account for two thirds of these deaths. The average age was 42. Among those who died of heroin and fentanyl overdoses, 29 percent were between 25 and 44; 37 percent were over 45 and about 1 percent were between 18 and 24.
Combatting these trends should begin in childhood, and it requires a holistic approach, says Dora Mills, former director of the Maine Center for Disease Control and Prevention and now the vice president for clinical affairs at the University of New England. Such an approach is both general and specific in nature. Children need adequate housing and food and access to education so they are more likely to resist drugs and cigarettes. Children and adults also need to know the full risks of drug use and smoking. More specifically, health care providers need to identify those who are at risk for dependency. If they become addicted, effective treatment must be available.
Individually, these preventable deaths are tragedies for families and communities. Collectively, they decrease Maine’s vitality — which should be a compelling reason to drive policymakers to focus on solutions rooted in treatment and prevention.