Americans -- particularly American women -- are collectively falling behind the world's healthiest countries in life expectancy, according to a new study that analyzed the vital statistics of thousands of U.S. counties.
In more than 80 percent of the nation's counties, people are dying years earlier than in countries like Japan, Israel, Great Britain and Canada. The situation is worst in the Deep South, where some impoverished counties are 50 years behind the world longevity curve, and in locales with high populations of Native Americans, the authors say.
"While people in Japan, Canada, and other nations are enjoying significant gains in life expectancy every year, most counties within the United States are falling behind," the authors reported in this University of Washington story.
Alaska mirrors the national trend. Life expectancy for women in the northernmost U.S. state had fallen 18 years behind the 10 countries in the world with the highest longevity rates, according to the data. So an Alaskan woman born in 2007 could expect to live only as long as women from the healthiest countries were already living in 1989.
And it gets worse: Alaska women were only eight years behind this international standard in 1987.
"Despite the fact that the U.S. spends more per capita than any other nation on health, eight out of every 10 counties are not keeping pace in terms of health outcomes," said lead author Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington. "That's a staggering statistic."
Alaskans are falling behind in the longevity race
The study -- Falling behind: life expectancy in US counties from 2000 to 2007 in an international context -- has gotten wide news coverage, adding to the ferocious debate over the future of the country's health care reform. By the most basic measure -- life expectancy at birth -- the United States produces a mediocre performance, according to the World Health Organization.
"The U.S. simply isn't keeping up with the rest of the developed world in life expectancy," Marissa Cevallos said in a Los Angeles Times health blog last week. "And women in particular are backsliding, a trend attributed in part to obesity and smoking. But the devil is in the details."
As of 2007, American life expectancy was ranked 37th in the world -- men could expect to live 75.6 years, and women 80.8 years respectively, according to the study. (For a different take on this statistic, the World Health Organization estimated Americans had a combined life expectancy of 79 as of 2009 -- 31st in the world, between Denmark and Portugal. Canada, by comparison, was ranked 12th.)
Sound OK? Not quite.
"National life expectancy in the U.S. in 2007 was lower than the international frontier by 3.2 years (13 years behind) for men and 3.2 years (16 years behind) for women," the authors wrote.
"The U.S. picture, with its remarkable combination of poor health outcomes despite the highest levels of health spending per capita, is even more stark and disturbing when examined at the local level," added Murray and his three co-authors.
Geographically, the lowest life expectancies for both sexes were in counties in Appalachia and the Deep South, extending across northern Texas. Counties with the highest life expectancies tended to be in the northern Plains and along the Pacific coast and the Eastern Seaboard. In addition to these broad geographic patterns, there are more isolated counties with low life expectancies in a number of western counties with large Native American populations. Clusters of counties with high life expectancies for males and females are seen in Colorado, Minnesota, Utah, California, Washington, and Florida.
In Alaska, men had a life expectancy of 74.5 years in 2000 -- 11 years behind the international standard. By 2007, men could expect to live another 1.2 years, which put Alaskan male longevity 12 years behind. Women collectively had a life expectancy in Alaska of 80.5 years in 2007, according to the data.
Women fared worse when compared to their longest lived sisters overseas (and those living across the border to the east.)
The 2000 life expectancy of Alaska women was 79.6 years -- 16 years behind the international standard. Alaskan women born in 2007 could expect to live 1.1 years longer, but that advance was 18 years behind the other top performing countries.
No breakdown comparing rural vs. urban Alaska
For Alaskan details, you've got to scoot the map toward lower right hand corner.
Unfortunately, all of Alaska was clustered into a single group, so you can't compare life expectancies among different parts of the state, or against other U.S. counties. Of course, the state's population is smaller than 17 U.S. cities and 85 U.S. counties, according to census data.
"Alaska is unique in our study," spokesman William Heisel explained to Alaska Dispatch in an email. "Alaska counties have changed boundaries a number of times over the 20 year period we were looking at, so the only way we could adequately calculate life expectancy for a consistent geographic area was by merging all of the counties together across the time period. That means we basically have one life expectancy for the whole state.
"That's imprecise, for certain, and one of the major limitations of the study. We hope to find methods that will allow us to adjust for boundary changes and other shifts in the future."
Still, scoot to the map to show Alaska, then double-click on any Alaska borough or census area. A little box will appear on the screen containing the averaged statewide data. You can then compare how Alaskan life expectancies have morphed over the 20 years between 1987 and 2007 by using the arrow in the upper right hand corner of the box.
Alaska women fall behind sisters in the healthiest countries
The details are disconcerting.
For instance, Alaska males had a life expectancy of 71.6 in 1987 — giving Alaskan men the same lifespan that males in the top 10 performing countries enjoyed in 1975. By 2007, Alaskan male life expectancy had risen to 75.9, but still remained 12 years behind the international standard — below life expectancies seen in Belgium, Costa Rica, Finland and Kuwait, but above life expectancies seen in Korea, Chili and Denmark.
Alaska women, as usual, outlive their men in raw terms. In 1987, the state's females collectively enjoyed a life expectancy of 78.4 years, a level only eight years behind the international standard.
But zip forward through the years, and an alarming trend appears. While the life expectancy of Alaska women slowly rises in nominal terms, reaching 80.5 by 2007, the pace of improvement is paltry. Among the top performing countries, women enjoyed similar lifespans to Alaska women by 1989.
In a sense, this relative decline puts the collective life expectancy of Alaska women on par with the Third World, ahead of countries like French Guiana, Kuwait and Uruguay.
Contact Doug O'Harra at doug(at)alaskadispatch.com.