Where You Live Could Kill You Faster

SSM Population Health

SSM Population Health  Age-standardized annual probability of death among U.S.-born women aged 45–89 years.

New Orleans    Many of us live where we live, where work has brought us, or where family keeps us. Maybe we live where we have come to love the land or the local culture? Maybe we live where we managed to hang on to a house or bought a small piece in a patch where we thought we might want to spend lots of time someday or some summer when it was too hot, or winter when it was too cool. None of us probably include in the equation that by living one place or another we could literally be bringing reality to the expression, “I’m dying to live there!”

Sadly, studies are now emerging that go to the heart of why life expectancy has been lagging, particularly for American women, although American men are not gaining much time these days either. Looking at extensive population data, researchers are finding that discounting all other factors including wealth, employment, and marital status, where women live could mean life and death. Since where you live could also impact on issues like whether or not your state has favorable maternity and parental leave policies, this hits women particularly hard, and could take years off their lives. Social and economic scores were critical because advancing inequity where you live also is not just an issue of justice, but life itself.

In studies being published in SSM Population Health and reported by the New York Times, the residential life lottery ranks the states with the best scores as Hawaii, Nebraska, New Hampshire, North Dakota, South Dakota, and Vermont. Good news for them, but bad news for many of the rest of us, since other than Hawaii almost nobody lives in the other states on that list, and even fewer want to move there for goodness sakes. Other than Hawaii, these are also just about lily white states, which quickly brings us to the states with the worst scores and you can hear the sounds of “Dixie” playing in the background: Alabama, Florida, Louisiana, Mississippi, and New York. Huge income inequality accounts for New York being part of the New South. For women, the list was not much different. The best were Hawaii, Nebraska, North and South Dakota, and Minnesota made this list as well. Women hit hard luck in a different array of states though which included Nevada, Tennessee, Virginia, West Virginia, and Wyoming.

All of this is in spite of the creation of Medicaid and Medicare over the last 50 years, and even more recently the Affordable Care Act. Looking at the states in-and-out of Medicaid expansion didn’t solve the problem. In the worst list, only New York had expanded coverage until Louisiana just came onto the list. In the best, South Dakota and Nebraska rank high, but haven’t expanded while Nevada and West Virginia drag down even though they have.

All of which means there is no quick fix to this. It’s not a matter of just figuring out where the best hospital in your community might be. It’s got to be the pretty much the whole package of social and economic improvements to lengthen lives of both men and women.

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