Lynn Bailey

Being rich or having attended college are the best indicators of a person's good health or poor health—and of how long that person might expect to live.

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The best predictors of a person’s health and longevity aren’t his cholesterol level or body mass index or blood pressure, but his income and education level. It isn’t the availability of open heart surgery or MRI scanners, nor the number of hospital beds in the community. Instead, being rich or having attended college are the best indicators of a person’s good health or poor health – and of how long that person might expect to live.

For the past 20 years, Americans’ life expectancy has increased. (Life expectancy is the number of additional years an individual can expect to live at a given age.) A male born in the United States in 2004 can expect to live 75.2 years, more than 10 years longer than a male born in 1950. A female born in the United States in 2004 can expect to live 80.4 years, some 9 years longer than a female born in 1950.

That’s the good news, but now for the bad news: There is a growing gap in life expectancy between people with low and high incomes and between those with more or less education. While the gap in life expectancy between men and women has narrowed a little, life expectancy in terms of income or educational attainment is widening.

These differences are well documented. Individuals with higher lifetime earnings and more education have lower mortality rates than individuals with lower earnings or less education. Indeed, the more affluent among us can expect to live 4.5 years longer than the poor. Life expectancy for the most affluent in 1980 was higher than for the poor in 2000.

The gap in life expectancy parallels our growing income inequality. Since 1980 in most states, the gap between the highest-income households and the poorest households has grown significantly. The gap is also significant between the richest households and those in the middle. This contrasts dramatically from the 1950s-to-1970s era.

In South Carolina, the richest 20 percent of families have average incomes 6.7 times as large as the poorest 20 percent of families. This ratio was just 5.6 times in the late 1990s. The very richest (the top 5 percent) have average incomes 10.8 times as large as the poorest 20 percent. In South Carolina between the late 1990s and the mid-2000s, the average incomes for the poorest 20 percent decreased by 12.3 percent, or $371 a year. During this same period, average incomes for the middle fifth and the richest fifth didn’t change significantly.1

The reasons for the growing gap in life expectancy aren’t well understood. It could be that poor health causes lower earnings, or it could be that low income results in poor health. Some possible contributing factors explaining these life expectancy differences include smoking, obesity, self-management of chronic diseases, lifestyles, and access/use of health care. How does South Carolina stack up on these factors?

Smoking: In South Carolina, 48 percent of the population with less than a high school education smoke, while only 21 percent of the population with some college smoke. Forty-one percent of the population with a household income of less than $15,000 smoke, while only 26 percent of the population with household incomes over $50,000 smoke.²

Obesity: In South Carolina, 35 percent of the population with less than a high school education are obese, while only 21 percent of the population with a college education are obese. Forty-one percent of the population with household incomes less than $15,000 are obese, while just 23 percent of the population with household incomes greater than $50,000 are obese.³

Self-management of chronic diseases: Research demonstrates that adherence to medical treatment is closely tied to a patient’s educational attainment.

Healthy lifestyles: Research indicates that low income and low educational attainment are increasingly tied to poor diet and lack of physical activity.

Access and use of health care: In South Carolina, 28 percent of people with less than a high school diploma are uninsured, while only 6.2 percent of college graduates are without insurance. Thirty-two percent of people with a household income of less than $15,000 are uninsured, while just 5 percent of people with household incomes over $50,000 lack insurance.⁴ The uninsured avoid seeking health care services and are diagnosed later in the disease process when there are fewer treatment options. According to the Institute of Medicine, being uninsured is the 8^th- leading cause of preventable death in the United States.

The United Healthcare Foundation ranks South Carolina as the 42^nd -healthiest state.⁵ If South Carolina’s civic and business leaders want to improve our health rankings, we need to focus resources on improving household earnings and promoting higher education.

Health and long life are integrally linked to economic development. Economic development and health improvement go hand in hand. The wealthier and better educated we are, the healthier we are.

It’s as simple as that. ¨

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1  The Center on Budget and Policy Priorities and Economic Policy Institute, "Pulling Apart: A State-by-State Analysis of Income Trends" (April 2008) at www.cbpp.org/4-9-008sfp.pdf.

² SC DHEC, Behavioral Risk Factor Surveillance System, www.scdhec.gov/hs/epidata/brfsc2006.

³ Ibid.

⁴ Ibid.

⁵ United Health Care Foundation, America’s Health Rankings 2007, A Call to Action, at www.unitedhealthfoundation.org/media2007/shrmediakit/ahr2007.pdf.