Kevin Sack devoted his front-page Sunday Week in Review piece, "The Short End O f the Longer Life ," to two recent government reports showing what he finds to be disturbing trends in life expectancy in the United States.
No, it's not on the decline. But one study found that "the life expectancy gap is growing between rich and poor," while the other found "statistically significant declines" in life expectancy for women (not men) in a minority of American counties, many clustered in the Appalachia region. And guess who's cited in the third paragraph as an expert on such matters? Failed presidential candidate John Edwards and his left-wing view of "Two Americas."
The Times painted thefindings in crusade-like terms, similar to President Kennedy putting the spotlight on the poor and hungry in rural Appalachia. The paper's propaganda push came complete with a half-page black and white photo of a little girl in Kentucky standing before a portrait of her great-grandmother, reminiscent of Walker Evans' photos in Let Us Now Praise Famous Men."
A caption referred to the photo as an "Appalachian vignette." The online text box for the photo made the story's case in overheated terms:
Vanessa, with a portrait of her great-grandmother in Lost Creek, Ky. Rising longevity, once considered an American birthright, is not a given anymore, especially for women.
But only if you smoke and overheat, the paper failed to add. For the figures in the actual study belie the liberal assumption that the culprit is deprivation, pointing instead to smoking, high blood pressure, and obesity, none of which have an obvious link to impoverishment, and in the case of overeating, quite the opposite. (If the risk factors had been malnutrition, pellagra and rickets they'd have a case.) These are rich country's diseases.
Sack continued in his Sunday story:
Throughout the 20th century, it was an American birthright that each generation would live longer than the last. Year after year, almost without exception, the anticipated life span of the average American rose inexorably, to 78 years in 2005 from 61 years in 1933, when comprehensive data first became available.
But new research shows that those reassuring nationwide gains mask a darker and more complex reality. A pair of reports out this month affirm that the rising tide of American health is not lifting all boats, and that there are widening gaps in life expectancy based on the interwoven variables of income, race, sex, education and geography.
In a silly political stunt, Sack claimed the findings validated former Democratic presidential candidate (and wealthy trial lawyer) John Edwards' left-wing ranting about "two Americas," even bringing in the failed candidate to explain how he was right all along.
The new research adds weight to the political construct popularized by former Senator John Edwards of North Carolina, that there are two Americas (if not more), measured not only by wealth but also by health, and that the poles are growing farther apart.
The most startling evidence came last week in a government-sponsored study by Harvard researchers who found that life expectancy actually declined in a substantial number of counties from 1983 to 1999, particularly for women. Most of the counties with declines are in the Deep South, along the Mississippi River, and in Appalachia, as well as in the southern Plains and Texas.
The study, published in the journal PLoS Medicine, concluded that the progress made in reducing deaths from cardiovascular disease, thanks to new drugs, procedures and prevention, began to level off in those years. Those gains, as they shrank, were outpaced by rising mortality from lung cancer, chronic obstructive pulmonary disease and diabetes. Smoking, which peaked for women later than for men, is thought to be a major contributor, along with obesity and hypertension.
"Some people are actually sinking," said Majid Ezzati, one of the report's authors. "The line of excuse that we can live with inequality as long as no one is getting worse is just no longer there."
Finally, we get to see the figures. They aren't overwhelming:
The researchers found statistically significant declines for women in 180 of the 3,141 counties in the United States and in 11 counties for men. In an additional 783 counties for women and 48 for men, there were declines that did not reach the threshold of statistical significance.
Of particular concern is that the gap in life expectancy between top and bottom counties expanded by two years for men and by about 10 months for women. In the worst-performing counties, all in southwestern Virginia, the drop in life expectancy over the 16-year period was nearly six years for women and two and a half years for men. In the counties showing the greatest improvement, many in the desert West, life expectancy rose nearly five years for women, and nearly seven years for men.
The first of the two reports, released two weeks ago by the Congressional Budget Office, declared that the life expectancy gap is growing between rich and poor and between those with the highest and lowest educational attainment, even as it is narrowing between men and women and between blacks and whites.
But why precisely did life expectancy slump among women in a small minority of counties? The answer doesn't match up well with the Times' "Two America's" push, but to smoking and obesity (not poor country's diseases):
Pointing to the effects of smoking, obesity and chronic disease, the budget analysts wrote that "in recent decades, socioeconomic status has become an even more important indicator of life expectancy, whether measured at birth or at age 65." Among the implications, they wrote, is that Social Security payroll taxes will become less progressive as the wealthy increase their longevity advantage over the poor.
Peter R. Orszag, the budget office's director, said that the decline in life expectancy among some Americans was "remarkable in an advanced industrial nation" and that he believed the growing gap related to income inequality. "We've had sluggish income growth at the bottom and rapid income growth at the top for the last three decades," he said.
Mr. Edwards said in an interview that the new findings on disparities demonstrate both the reach and consequences of income inequality. "The wealth and income disparity effectively infiltrates all parts of people's lives," he said.
What remains to be determined by the increasingly dynamic field of research into health disparities is precisely how income interacts with factors like race, gender and education to give some people better odds of living longer.
Sack didn't refer to personal responsibility until deep inside the story:
And yet, this month's Harvard study showed that counties with declining or stagnant life expectancy were poorer than those with improving numbers. Recent cancer studies have found that the uninsured are more likely to fail to get a diagnosis until late stages of the disease. Research also shows that many of the behaviors that drive mortality - unhealthy diet, smoking, poor management of chronic disease - are more common among low-income Americans.