Note: This article (written by Eric Reed) first appeared in the Boston Globe in Fall 2020 as part of Harvard Pilgrim and Studio/B’s Aging Strong series, exploring how individuals from athletes to entrepreneurs have navigated the challenges of aging—and the habits that can help others age strong too.
Poor people die younger. There are many sanitized ways to say this, but no matter the words you choose, the results are the same. The highest earners tend to live 20 years longer than the lowest.
This life expectancy gap has increased significantly over the 20th and 21st centuries. For men born in 1930, those in the top fifth of income lived 5.1 years longer than those in the bottom fifth. For those born in the 1960s, that high-income group now lives 12.7 years longer than the low-income group, according to the Congressional Research Service. The same holds true for women, where the inequality gap in life expectancy has grown by nearly 10 years in recent decades.
Yet life expectancy is not the only measure of aging. While lower earners tend to live shorter lives they also tend to live with more health issues that make it difficult to thrive in middle age and on. This complicated web of socioeconomic status and health is the “vitality gap.”
Income inequality drives lifelong issues
Health is about more than just access to the doctor when someone gets sick. It’s connected to an individual’s ability to take care of themselves over the course of their lifetime.
“Our health outcomes aren’t just related to medical care, not by a long shot,” says Jeanne Madden, a professor of population health at Northeastern University and the department of population medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute. “A lot of it is so behavioral … and is fed by access to good food and exercise and not being stressed out all the time. I mean you can go ahead and tell people that they should exercise more, but that’s not something you can do necessarily if you don’t have the means to do those things because you’re scrambling from job to job or you’re taking care of things at home.”
As Madden points out, U.S. policy ensures that children and the elderly have better access to health care than other adults. Programs such as Medicare and Medicaid allow enrollees to seek out treatment when they get sick, but leave low-income Americans without proactive care during the critical years between childhood and old age when many health issues take hold. These costs add up. According to research led by Madden, medical costs alone are a major driver of personal deprivation.
Between 7% and 10% of [Medicare] enrollees (the poor and the elderly) cut their spending on basic needs in order to afford needed medication.
In research conducted on the Medicare population, she found that between 7% and 10% of enrollees (the poor and the elderly) cut their spending on basic needs in order to afford needed medication. This shows up in households that forgo spending on food, transportation, or the utilities to stay warm in the winter.
These choices don’t just go away. Children born into struggling families are more likely to develop chronic issues that will follow them throughout their life, such as asthma or diabetes.
As they grow through their teens, the stresses of poverty are associated with powerful mental health concerns that can even shape the physical development of an adolescent’s brain.
Adults are no more immune to these issues. Chronic lifestyle diseases, from cardiac and diabetic issues to lung problems and joint pain, are all associated with poverty. The stress of long working hours and constant scarcity creates physical wear on the human brain, a toxic buildup of hormones that are linked to mental health issues such as depression. These hormones can also affect fetal development in pregnant women.
In a 2019 study, the Urban Institute found that the issues associated with poverty and inequality cement long-term physical and mental health problems among older adults as well. They wrote:
The evidence suggests that low-income older adults and older adults of color are more likely to live in neighborhoods with economic, social, and physical conditions that are detrimental to their health … Residents of economically disadvantaged neighborhoods—regardless of their own income level—are more likely to suffer from chronic diseases, mobility issues, cognitive impairment, and accelerated biological aging than those living in more economically prosperous neighborhoods.
Wealthier people also have the wherewithal to make healthier choices over the course of their lives. They have the ability to seek better work when a job is harming them, or to eat fresher, more nutrient-rich food. They can seek preventative care to make sure they stay healthy, and non-urgent treatment for chronic issues. They simply have the ability to stay healthier longer, an option which poverty typically denies.
There is no one answer, just many smaller ones
These issues are driven by factors ranging from personal health care over decades to social environment and even air pollution. They echo Madden’s findings that the vitality gap is not the result of a single issue (such as access to care) but the result of a host of problems associated with poverty and inequality.
This reality defies isolated treatment. There is no silver bullet for a problem that builds up over lifetimes in countless greater and smaller ways.
Instead, policy solutions to the vitality gap must match the scope of the problem. It is necessary but not sufficient to cure food insecurity, just as it is essential to ensure that low-income Americans can afford to see a doctor for preventative care.
Giving everyone access to long and healthy lives requires creating lifelong opportunities for people to take care of themselves. That is the scale on which policy-oriented solutions to the vitality gap must operate.
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