Monday, March 11, 2013

Differential Life Expectancy of the Rich and Poor is Half Chosen, Half Structural

The Washington Post has an interesting article by Michael Fletcher on how raising the Social Security benefit age would affect poor people much more than rich people.  The catchiest fact:

the life expectancy of male workers retiring at 65 had risen six years in the top half of the income distribution but only 1.3 years in the bottom half over the previous three decades.

However, deep in the article they also note that the behavior of the poor and the rich among the old are quite different.  Comparing a poor Florida county with an adjacent rich one (Putnam vs. St. Johns), Fletcher notes:

Adults also smoke at nearly double the rate they do in St. Johns, and they are far more likely to be obese and far less likely to be physically active.

He quotes doctors who say that the difference in life expectancy shows differences in health insurance and health care availability. Yet it is clear that a big part of the difference is due to self-chosen behavior, by both the rich and poor populations.

The centrist position here is that both factors are relevant. 

But I think at this point we can say that the many bad effects of smoking, at least, are the smokers' own dumb fault, and not primarily to be addressed by health insurance and having more doctors.  And in coming years I think we will reach the same conclusion about most causes of obesity and lack of exercise.

4 comments:

MMMSecret said...

"...that the many bad effects of smoking, at least, are the smokers' own dumb fault, and not primarily to be addressed by health insurance and having more doctors. And in coming years I think we will reach the same conclusion about most causes of obesity and lack of exercise."

During the Vietnam era, cigarettes were handed out with every meal that the military served. I suspect this got far more "poor" hooked than "rich." I suspect that there are other socio-economic factors that drove the smoking rates higher among the poor, although I haven't researched it. (education and availability of both professional assistance and social support/pressure in quitting smoking come to mind).

Similarly today, eating well isn't always as affordable as eating poorly- particularly to someone working several jobs to make ends meet. It certainly takes more intellegence and education to navigate all the diet and health "advice" available out there. Not to mention that today's working poor have fewer hours to dedicate to exercise and less money to spend at the gym.

True, you can say that their smoking/obesity is "their own dumb fault", but I suspect that even these things that appear controllable to those of us in ivory towers are a lot more complicated that they seem at first blush.

It's true that health insuance and doctors aren't going to solve all these problems. But access to sound medical advice about smoking and diet is a start. And access to responsible weight management and smoking cessation programs through health insurance (both of which are provided by the insurance I recieve at work) would likely go a very long way.

gruntled said...

I distinguish smoking and obesity, because the social consensus, and social pressure, against smoking have been solid for a long time - more than a generation. Likewise, there are many socially supported ways to quit, difficult though that task is. And we have, in that time, cut smoking rates in half. One of the reasons that smoking now correlates with lower class is because smoking is one of the causes of downward mobility, not just a correlate of who starts.

MMMSecret said...

"One of the reasons that smoking now correlates with lower class is because smoking is one of the causes of downward mobility, not just a correlate of who starts."

Fair Point.

Aric Clark said...

This strikes me as an example of Fundamental Attribution Error. There are all sorts of environmental reasons why poorer people would be more likely to smoke or be obese. Not to oversimplify and say it is solely environment, but I definitely don't think we can single these causes of illness out and say they're down to individual choice.