Life expectancy increased in the United States by nine years between 1960 and 2018. While that number has leveled off over the past four years, a number of factors contributed to the boon—including geography.
To better understand the effects of place on life expectancy, Tatyana Deryuginan and David Molitor, both Associate Professors of Finance at Gies College of Business at the University of Illinois at Urbana-Champaign, surveyed the causal mechanisms behind geographical variation across the United States and Europe.
In their paper, “The Causal Effects of Place on Health and Longevity,” published in the Journal of Economic Perspectives, the researchers discovered five interrelated mechanisms that play a role in the geography of life expectancy, which are listed below.
The authors were especially interested in people who move—whether for college, career, retirement, lifestyle change, or better environmental conditions—and how their new residence impacted their health.
As they write in regard to their focus,
When considering how place shapes health, most of the motivation and empirical literature has focused on longevity, arguably because it is easier to measure systematically than other aspects of health. Additionally, life expectancy gains are worth a lot, making longevity a natural first-order concern for researchers and policymakers. We therefore focus most of our discussion on how place of residence affects mortality while recognizing that place could also affect other important dimensions of health.
Bottom line: where you live matters for your health, and the financial conditions of each region play a primary role in life expectancy.
While certain factors that affect health (such as smoking) cut across economic cohorts, other aspects of fitness (like free time devoted to exercise) are intimately tied into finances.
Let’s look at the five mechanisms in more depth.
Income, wealth, employment conditions, and education are all socioeconomic factors the authors cite in playing a role in health and longevity, with a caveat: these mechanisms are less likely to matter to elderly and disabled individuals than young and working-age individuals.
Not that geography doesn’t matter to those first two cohorts. Perhaps counterintuitively, the authors draw a comparison between having more access to hospital beds to worse outcomes—possibly suggesting that the need for more health care facilities means more people in that area require care.
Other aspects fit into this dynamic. Exogenous income shocks and negative wealth shocks (due to the stock market) have been shown to impact physical and mental health, as well as lead to earlier deaths.
Losing your job plays a major role in health outcomes. Interestingly, young workers entering the job market during a recession translates to higher mortality risks later in life as well.
Access to nutrition has also long been considered a driving factor in health outcomes. The authors question the common wisdom of food deserts, however:
Proximity to grocery stores or restaurants with nutritious food may facilitate healthy living, and areas with higher socioeconomic status may attract more such establishments. The empirical evidence on this specific mechanism is mixed. Allcott et al. (2019) find that the nutritional quality of purchased groceries is not affected by moves to neighborhoods with greater availability of healthy groceries, and Hut (2020) finds no relationship between average nutrition quality of purchased groceries in a destination and changes in movers’ nutritional quality for at least two years following the move. But Currie et al. (2010) find that the presence of a fast-food restaurant near a school raises the probability of obesity among the students.
Research from 2018 likewise found that even though more affluent individuals have access to higher-quality foods, they don’t necessarily purchase them. Regardless, it’s hard to argue against access in the first place. And so while affluence doesn’t necessarily equal better choices, leveling off socioeconomic status would certainly help health and longevity, as the authors show in health outcomes in the more affluent Western Europe and American coasts compared to Eastern Europe and the American south.
Humans are undoubtedly influenced by peers—we’re social animals, after all—but do their bad habits influence our behaviors, to the detriment of our health? The authors entertain this exceptionally broad question through a narrow lens: investigating people who move, then examining their new peer groups’ effects on their alcohol and smoking patterns.
Disentangling place versus people provides an added layer of challenge, and the data the authors mine show relatively small impacts when it comes to college students. This ticks up in adults, where moving leads to higher prevalence of uncontrolled hypertension, obesity, diabetes, and depression, all of which square with research on peer effects.
Teasing apart the influence of your peers will always remain a challenge, however. As they write,
Among movers more generally, health habits of both movers and local residents could simultaneously be affected by a variety of living conditions, including local prices and policy, giving rise to the observed correlations.
Health care delivery
Research has consistently shown that America spends an outsized amount of GDP on health care yet doesn’t deliver results nearly as effectively as nations that spend less. The authors of this paper acknowledge the challenges in isolating geography as a driver of longevity on a causal level even though correlational data exist.
That said, because health care access varies geographically across America, access to both insurance and hospitals will impact outcomes, especially in emergency situations. The authors also found that certain insurance plans deliver better outcomes. Of course, the uninsured often don’t seek care due to exorbitant costs, making the identification of health care delivery a challenge to study holistically.
You can’t separate your health from your environment, and so place obviously impacts health and longevity. The authors point out that air pollution and erratic temperature swings impact mortality rates, especially in the elderly. Pollution, they point out, has also negatively affected infant mortality rates.
Beyond this study, we have reams of data on climate change’s effects on health outcomes, and that economic inequality plays an important role in place. For example, one East Harlem street was measured 31 degrees hotter than Central Park West, which is located less than two miles away. The financial and racial factors between these neighborhoods has not escaped notice:
African Americans in the city are twice as likely to die from heat exposure as white New Yorkers, according to the city’s health department.
Cutting across the previous four mechanisms (and so much more), public policy can affect life expectancy in numerous ways. Citing one long-term study that examined 135 different policies across the nation,
The authors find that more liberal policies tend to be associated with improved life expectancy for both men and women and that this relationship is particularly strong for the regulation of private labor, immigration, civil rights, and the environment.
These policies include guardrails around drinking and smoking (such as increased tobacco prices and alcohol taxes), access to social safety nets, and environmental protections.
And so the authors speculate that policies that help people relocate to welfare-improving regions could also positively impact public health overall. Since you can’t separate policy from environment, such moves could help offset the current economic disparities that lead to poorer health and longevity outcomes.
The authors also note the profound impact of family and friends in choosing where to live. Any programs that emerge would need to consider the broader ecosystem that people live within, which is not limited to career opportunities and environmental pollutants. They would also have to consider familial and social ties.
Of course, no one should have to move in order to experience many of the socioeconomic benefits listed above. We just need to rethink public policy and how money flows through different places. As the authors conclude,
Additionally, given scarce social resources, it is worth considering whether policies that target some other existing inequality (perhaps in wealth or income) would be superior to policies that target life expectancy more directly. Indeed, it may be that targeting income or wealth inequality would reduce inequalities not only in life expectancy but also in other non-health dimensions.
We need an economic system that works for everyone. The health of the world, and all of its citizens, depend on it.