by Doctor Science
The United States is no longer a First World country, not all the way through.
We're not a First World country because we no longer have one of their most important characteristics: a high and steadily-increasing life expectancy. A study released this week shows that in significant areas of the US life expectancy is no longer increasing, and in a shockingly large part of the country the life expectancy for women is actually decreasing.
For life expectancy to decline in a developed nation is rare. Setbacks on this scale have not been seen in the U.S. since the Spanish influenza epidemic of 1918This is what life expectancy change looks like for a First World country, Sweden:
Graph made by me (with help from Sprog #1), data from Statistics Sweden.
And this is what it looks like in what you might call "the Second World", countries of the former Soviet Bloc:
Taken from a discussion in a "Civilization" forum.
The study, Falling behind: life expectancy in US counties from 2000 to 2007 in an international context, looks at county-level data, so one of the grains of salt to bear in mind is that counties are immensely non-uniform. In particular, to say (as the authors do) that e.g. "between 2000 and 2007, more than 85% of American counties have fallen further behind" the life expectancy standard in the most advanced nations, doesn't actually tell us what percent of the US population they're talking about.
For instance, Georgia has 159 counties for 9.7 million people (a mean of 61,000/county), while New Jersey has 23 counties for 8.8 million (a mean of 382,000/county). Yet the single county of Fulton, GA (Atlanta) has a population of a million, more than one-tenth of the whole state. Playing around with the Washington Post's map of the study's data (warning: may be addictive), you'll see that life expectancies in Fulton grew quite rapidly from 1987-2007: 5.1% for women and 8.4% for men. This is even faster than they grew in Sweden for that same period, 3.5% for women and 6.4% for men.
So when you look at this map of the change in women's life expectancy:
from The LA Times
or work with the interactive tools at the Washington Post or the researcher's site at the University of Washington, you have to bear in mind these maps, as well:
US population density (Census data)
Poverty, Census data
Counties with low LE overall -- "Third World" counties -- are all rural (low-density) and poor. They fall into three basic groups:
From Falling Behind, this map shows how far behind the "international longevity frontier" each US county is. To be "20 years behind" means to have a LE equal to the best international examples from 20 years ago.
1. Black majority or nearly-so counties in the Southeast, in the coastal plain or the Delta of the Mississippi.
2. The epicenter of white Appalachian poverty in the coal-mining counties of eastern Kentucky and western West Virginia.
3. Indian Reservations.
Counties with falling women's LE -- "Second World" counties -- don't overlap with the above as much as I'd expected. They are still rural -- no high-density county has a falling LE -- but they aren't all on the list of poorest counties, though none are rich. Many more than I expected are over 90% White.
The more sophisticated statistical analysis of the study's authors confirms my eyeball estimates: neither race nor income fully explains the pattern here. Although they emphasize the role on a national level of preventable factors such as tobacco use and obesity, that doesn't explain how adjacent counties can have very different outcomes. "It’s not the health care system that’s having the biggest impact on health; it’s the community," they report.
For instance, I looked in detail at various counties in Wisconsin, especially Marathon, where I have many relatives. I was not surprised to find that it has a very high, nearly-Swedish LE, which has been growing steadily. I was very surprised, even shocked, to see that female LE has fallen in nearby Jackson County; I have no idea why. I guarantee that the difference between these counties is *not* that Marathon has a radically lower rate of obesity than Jackson -- the effects of Wisconsin cheese are apparent all over the state.
No, there must be something about the community, about the *local* culture, that can cause such a great difference. But it's also apparent that these local issues are part of some national problem that's affecting much of the rural Midwest and South -- and is moving even many white people out of First World America.
The Prophetess Anna (1631). Also known as "Rembrandt's Mother", though the ages are IMHO quite wrong -- Rembrandt's mother would have been only 60 or so when this was painted, but the model looks at least 80 to me.