More on life expectancy

In the health care debate you are likely to be confronted with the statistic that Americans only live an average of 78.06 years, which places us at either #45 or 30 in the world depending on how you do the rankings, behind places like Greece, Jordan and Puerto Rico. Life expectancy, however, is a poor metric for evaluating the efficacy of a country's health care system for reasons I have mentioned here and here.

I found some further evidence of this today, with a study released three years ago concluding that the U.S. has what it terms "eight Americas" in terms of life expectancy. They are:

• 1. 10.4 million Asians with a per capita income of $21,566 and an average life expectancy of 85.
  
• 2. 3.6 million whites in Minnesota, the Dakotas, Iowa, Montana and Nebraska, with a income of $17,758 and an average life expectancy of 79 .
• 3. 214 million middle Americans, with a per capita income of $24,640 and an average life expectancy of 78.
• 4. 16.6 million whites in Appalachia and the Mississippi Valley with an income of $16,390 and a life expectancy of 75.
• 5. 1 million Western Native Americans with a per capita income of $10,029 and life expectancy of 73.
• 6. 23.4 million black middle Americans with a per capita income of $15,412 and a life expectancy of 73.
• 7. 5.8 million southern low-income blacks with a per capita income of $10,463 and a life expectancy of 71.
• 8. 7.5 million high-risk urban blacks, living in counties with a homicide risk that tops the 95th percentile of U.S. counties, with a per capita income of $14,800 and a life expectancy of 71.

The difference between the first and eighth groups is an astonishing 14 years. So what explains that gap and what can be done to close it? Is the answer improved access to health care? Doesn't seem like that's the prime culprit:

[Harvard's Christopher] Murray says the "longevity gap" can be reduced by "cheap and effective" measures to lower cancer and heart disease risks; among those measures are eating healthier foods, exercising regularly and taking medications that lower blood pressure and reduce cholesterol.

Two of those three are behavioral, while the third simply requires purchasing medicine (which is now covered by Medicare). Another expert opines on the role of access to health care in determining life expectancy:

Jonathan Skinner of Dartmouth says much of the variation depends on such individual factors as diet, exercise and smoking, not health care. "Yet we spend much of our attention and 16% of our national income on health care," Skinner says. "There's no way that differences in the quality of health care can explain 20-year gaps in life expectancy."

Particularly interesting to me is that Asians, the first group, live 7 years longer than the third group despite having a lower per capita income level. Coincidentally, or perhaps not, the state with the highest life expectancy -- Hawaii -- at 81.7 years has a population that is 57.5 percent Asian, the greatest of any state.