Here in the Twin Cities, we like to brag about our towns’ oft-bestowed best-of statuses: Minneapolis has been named the most bike-friendly city in the U.S., we’ve ranked well for quality of life, and our fair cities even topped a list of lists last year.
But we don’t do as well as some cities when it comes to health equality, according to a new study published online this week in the Journal of the American Medical Association.
The wealthiest five percent of men in the Twin Cities area are estimated to live about 13 years longer than the poorest five percent of men, according to data provided by the study. The wealthiest five percent of women in the Twin Cities might live about 10 years longer than the poorest five percent.
For both genders, those gaps in life expectancies are wider in the Twin Cities than in New York, Los Angeles, San Francisco, Boston, Seattle, Houston and New Orleans, among other cities.
Using tax and mortality data, adjusted for race, the JAMA study’s major takeaways were: Unsurprisingly, Americans with higher incomes are generally expected to live longer; the gap in life expectancy for the rich and poor has grown in the new millennium; and, for the rich, life expectancy doesn’t vary much by locale, but for the poor, location matters.
“It's been widely known for a while now that income and longevity are related,” said Ben Scuderi, a Harvard University Department of Economics researcher and a co-author of the study. “What we’re really bringing to bear in this is more resolution.”
Scuderi was careful to point out that the study doesn’t draw conclusions about what causes longer or shorter lives, but it does look at factors associated with longevity.
Access to health care and income inequality weren’t so much associated with longer or shorter life expectancies. But lifestyle factors, like smoking, obesity and exercise did have significant correlations, Scuderi said.
“The poor live longest in affluent cities with highly educated populations and high levels of local government expenditures, such as New York and San Francisco,” the researchers wrote.
Why not the Twin Cities, where there’s a well-educated population, high exercise rates and relatively large per-capita government spending?
“I think the story you’re picking up on is that the rich and poor across the nation are kind of living in separate worlds of health,” Scuderi said. Some cities just come closer to exceptions to that rule.
The 13 year life expectancy gap for men (roughly the difference between the overall average life expectancies in the U.S. and Rwanda) and 10 year gap for women (about the same difference as being a lifelong smoker or not) in the Twin Cities are really about average, he said.
Another factor that widens the gap in the Twin Cities is that the very rich here have slightly longer than average life expectancies, while the very poor are closer to average.
A system built for the majority
Minnesota Department of Health Commissioner Dr. Edward Ehlinger said he can’t definitively point to an explanation for health inequality in the Twin Cities area, but speculated demographic changes and higher levels of racial segregation here than in other cities might play a role.
“We’ve had a system that was, in socioeconomic factors, really based on a majority white population, where we had a really small minority population,” he said. “But now, as the population of people of color and American Indians grows, our policies are based more on the majority and not on everyone.”
Ehlinger said Minnesota’s relatively good health status overall may divert attention from health disparities.
“I think now, people are recognizing that we need to really focus on those issues if we’re going to be a healthy and prosperous state,” he said.
Ehlinger said increasing incomes for the poor is one of the best ways to reduce health disparities: Research has found that when a person’s household income rises above $35,000, his or her life expectancy increases by more than three years, he said.
Income affects the neighborhoods people live in, their housing, access to food, education and health care, stress levels and transportation.
A study released this week by Wilder Research and the Federal Reserve Bank of Minneapolis found that nearly a third of Minnesotans have low access to healthy food through a full-service grocery store.
“Most people have the belief that if everybody just had good medical care and made good personal choices they’d be healthy. But the data show clinical care is about 10 percent of the determinants of health, and behavior is between 20 and 30 percent,” Ehlinger said. “What really impacts health is the physical, social, economic and cultural environments where people live.”