Or rather, some of today’s older Americans feel that way. The study also found that most of the gains in self-perceptions of health after age 64 have occurred among whites and among people with high incomes and high educational backgrounds.
That finding is troubling, for it underscores the growing health divide in the United States between the rich and the poor.
“The widening health disparities is particularly striking because older Americans have access to health care [through Medicare],” said Matthew Davis, the study’s lead author and a health services researcher at the University of Michigan, in a released statement. “Policies have to extend beyond just getting people access to health care to get at what’s driving disparities. The lack of improvement in health among all groups could imply that public health initiatives are leaving some people behind.”
The study was published online Monday in JAMA Internal Medicine.
For the study, Davis and his colleagues analyzed data from 55,000 older adults who participated in the Medical Expenditure Panel Survey, which has people answer questions about their health twice a year. One of the questions asks participants to rate their health as “excellent,” “very good,” “good,” “fair” or “poor.”
The analysis revealed that the share of adults aged 65 and older who reported being in either “excellent” or “very good” health increased from 42.4 percent in 2000 to 48.2 percent in 2014.
That meant that up to 8.4 million more people in that age group said they were in good health in 2014 than did so 14 years earlier.
But the analysis also uncovered some striking disparities based on race, income and education. Between 2000 and 2014, the number of older people reporting good health rose by 21 percent among whites, but dropped by 17 percent among blacks. It also increased by 23 percent among high-income households, but fell by 12 percent among households at or below the level of poverty. And it increased by 10 percent among older people with graduate degrees, but decreased by 2 percent among those whose education stopped at high school or earlier.
A telling measure
Why focus on self-reports of health?
“It turns out that a single question about health [“In general, would you say that your health is excellent, very good, good, fair or poor?”] is actually very accurate at estimating an individual’s likelihood of dying,” explain Davis and one of his study co-authors, Dr. Kenneth Langa, a professor of medicine and health policy at the University of Michigan, in an article they wrote for The Conversation.
“By focusing on good health rather than poor health, we can think of health as an asset much like wealth, where the goal is to be at higher levels,” they add. “We found that, by taking this new approach, health disparities among seniors became strikingly clear.”
Of course, relying on self-reports is also a limitation of the study because people are not always accurate in assessing their own health (or health-related behaviors). Another limitation is that older people’s perceptions of what constitutes “excellent” health may have changed since 2000.
‘Two different Americas’
Still, the findings call attention to what will be on of the most important public health challenges for the country in the coming years: how to care for its aging population. Write Davis and Langa:
By 2050, the population of older adults is expected to nearly double. Older adults’ health will have a significant impact on the national economy, as they will use more health care resources and may stay in the workforce longer.
Furthermore, the growing divide in health suggests that there are at least two different Americas. Depending on where an individual sits on the socioeconomic spectrum, he might expect a different length and quality of life.
Differences in life expectancy are particularly important as policymakers consider potentially raising retirement age for Social Security or the eligibility age for Medicare. In light of this disparity, such efforts to make federal programs financially sustainable would pay out less in the long run to lower income groups.
Indicators point to greater improvements in the length and quality of life among the most privileged groups in the U.S. This raises important questions regarding how we might design better health systems so that all members of society can benefit.
FMI: You’ll find an abstract of the study on the JAMA Internal Medicine website. The full study is, unfortunately, behind a paywall. You can read Davis and Langa’s article about the study at The Conversation.