Human Limits

Exploring performance and health with Michael J. Joyner, M.D.

Photo of Michael J. Joyner, M.D.

Life Expectancy & Entitlements: Economic Inequality or Behavioral Inequality?

Discussion about the retirement age and reforming Medicare and Social Security spending is likely to be a long term part of the political debate (or is it gridlock) in the U.S.   The well respected Economist magazine based in London suggests that President Obama’s legacy is dependent on getting entitlements under control so that the U.S. can spend money on other things.  The rationale for this is laid out in the graph below that comes from the most recent projections from the non-partisan and independent Government Accountability Office (GAO).  It is the most optimistic scenario in the GAO report.  The point is that we are headed to an unsustainable financial situation if Social Security, Medicare and other health spending, along with interest payments by the Federal Government are not brought under control.  One way to control these costs is to increase the retirement age to reflect the fact that life expectancy has increased dramatically since Social Security and Medicare started.   The primary concern with raising the retirement age is that most of the gains in life expectancy have occurred in better educated people who also tend to have higher or even much higher incomes.  So raising the retirement age is seen “unfair” by some commentators.




Health Behaviors Education and Income

The next three graphics come from a recent CDC report about the state of U.S. heath from 2008-2010.  The first is a table that shows the impact of education and income on smoking rates.   The column on the right is the percent nonsmokers.  Less educated and/or lower income people smoke a lot more than better educated higher income people.




The next two graphs show the impact of education on physical activity and obesity.   There is a similar effect of income on physical activity and obesity and as I noted above education and income are highly correlated.








What is the Real Problem?

I have discussed this topic before and it seems to me that what is unfair is that aggressive steps are not being taken to address these issues in a comprehensive way for all Americans.   A couple of posts ago I showed you what key risk factors alone and in combination did to life expectancy to a cohort from Scotland.  From what I can tell each of the key risk factors above is worth about 3-5 years of life expectancy and the data above suggest that on average well educated/higher income people have about 1-2 fewer risk factors than poorly educated/lower income people and that difference explains most of the difference in life expectancy between groups.   The other key point is that the risk factors above are independent of access to traditional medical care which may not do much to improve the health of low income people with limited access to health care.  There is a lot of denial about all sorts of things in the current political and public policy arenas.  Failure to aggressively address key behavioral risk factors for the population as a whole and especially for less educated/lower income people is a good example of just how pervasive this denial is.


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