The Health Divide: U.S. life expectancy gap shows ‘alarming’ inequities, Medicaid cuts on the table
(Photo via Getty Images)
The country’s variation in life expectancies grew wider during the COVID-19 pandemic, report the authors of a new study published in The Lancet.
“Life expectancy in the USA varies by more than 20 years depending on an individual’s race and ethnicity and where they live,” states the report, which divvied up the country into “10 Americas” based on geography, race, income and other characteristics.
The life expectancy gap, a key measure of a population’s overall health, increased from 12.6 years in 2000 to 20.4 years in 2021.
The disparity is influenced by factors such as someone’s race and ethnicity as well as geographic location. For example, in 2021, Asian Americans had the longest expected lifespan at birth, or about 84 years. That’s more than two decades longer than American Indian/Alaska Native people living in the American West, who had the lowest life expectancy of just 63.6 years.
Smoking rates drop but disparities persist
The United States has made substantial progress when it comes to reducing smoking rates as well as secondhand smoke exposure, according to a report released last week from the U.S. Surgeon General.
Since 1965, smoking has declined more than 70%, but that drop hasn’t been shared evenly among all U.S. residents. Numerous disparities persist, including by race and ethnicity, income, education, sexual orientation and gender identity, occupation, and behavioral health status.
Among the key findings: Cigarette smoking is higher among American Indian and Alaska Native people than any other racial and ethnic group — one in four AIAN adults reportedly smoked cigarettes in 2020. And, smoking among men and women living in poverty is twice as common compared to people not living in poverty.
The report also found smoking is higher among adults with lower education; those who identify as gay, lesbian or bisexual; those that live in rural areas; people who work in manual labor and service jobs; people who live in the Midwest and South; and those living with a mental health condition or substance use disorder.
Researchers identify geographic disparities in obesity
A new study in The Lancet estimated obesity rates throughout the United States and found significant geographic disparities in this important health measure.
For example, researchers found that about 52% of adolescent males living in Texas were overweight or obese in 2021. That’s compared to Colorado, where about 40% fell into that category. For female adolescents, the highest rates came in Mississippi, where roughly 63% in this age group were overweight or obese. Among adults, the overweight-obesity rate was highest in North Dakota for men, at nearly 81%, and Mississippi for women — at about 80%.
Over the past several decades, the country’s overweight and obesity epidemic has resulted in a significant health burden, the authors noted. The prevalence in obesity has outpaced the increase in people considered overweight, especially among adolescents, the report found. While researchers predicted that many southern states will continue to have a high prevalence of obesity, they forecast the highest percent changes will come in states like Utah for adolescents and Colorado for adults.
Doulas can advance health equity, but they need to be reimbursed
Doulas can help to reduce the country’s troubling health inequities. But most expecting families can’t shoulder the cost of this care on their own, writes Holly Horan, an assistant professor at the University of Alabama and a birth and postpartum doula, in the American Journal of Public Health this month. The lack of insurance reimbursement means doulas are often less available to at-risk populations. That’s why Medicaid reimbursement is critical in improving access to them, Horan explains.
Medicaid offers reimbursement for this service in 13 states and Washington, D.C. Nearly all states are working on initiatives to expand doula access, either through reimbursements or public health programs. A growing body of research has shown the value of doulas, she wrote, pointing to a study published in the same journal this month that found doulas improved maternal health outcomes among Medicaid enrollees.
Disparities pervasive in specialty care
As the COVID-19 pandemic highlighted vast inequities in how people experience and receive health care, medical specialties turned to their own fields to evaluate their roles in the problem.
One example: The field of orthopedics has identified disparities in everything from outpatient visits to post-surgery outcomes, write the authors of a review recently published in the Current Reviews in Musculoskeletal Medicine. The most common disparities stemmed from race and type of insurance.
Previous work has highlighted how hard it can be for people with Medicaid insurance to access orthopedic care — a 2022 surveyfound an average acceptance rate for new patients of just 53%. Secret-shopper phone calls have turned up even lower figures, with one effort finding just 18% of practices offered availability for Medicaid patients after excluding safety net hospitals and institutions, another study found.
Early window key for tackling long-term health inequities
Even before birth, social factors can influence a baby’s brain health and development. Rapid brain development from the in-utero period through early childhood is critical to long-term brain health, write the authors of a new literature review.
This early childhood timeframe also coincides with a period during which pregnant people and families have more frequent interactions with the medical system – providing a key window for health providers to address health disparities. For example, health systems could address nutrition and folic acid deficiency as well as pre-gestational hypertension before the baby is born, which are connected to preterm birth and low-birth rate. This time is also critical in connecting people to primary care to manage chronic conditions, and share info on services such as substance use counseling.
“These critical periods confer both vulnerability to harmful exposures and opportunity to benefit from positive environments, with lasting effects,” the authors write in the review, published in November’s Seminars in Fetal and Neonatal Medicine.
Medicaid cuts on the table
As President-elect Donald Trump and his team mull ways to pay for extending the 2017 tax cuts, early federal programs such as Medicaid and food stamps are in the crosshairs, The Washington Post reports.
These discussions, which the Post reported based on conversations with seven people familiar with the talks, point to renewed interest in adding work requirements for Medicaid as well as spending caps for the federal-state program, which provides health insurance to low-income people.
(Check out last week’s Center for Health Journalism webinar for more on potential cuts to Medicaid under a Trump administration.)
More broadly, Republicans have criticized soaring federal Medicaid spending following the Affordable Care Act expansion. Even so, Republicans point to the high political cost of such moves, which could impact at least 70 million low-income Americans, the article notes.
Such cuts could also have a disproportionate impact on disadvantaged communities. “As a major source of health coverage for people of color, Medicaid programs are an important potential mechanism to address racial health disparities,” a report from the Kaiser Family Foundation stated earlier this year.
What we are reading:
- “It took years for my Black son to be diagnosed with cystic fibrosis. Then it happened to my family again” by Rena Barrow, STAT
- “How UnitedHealth’s Playbook for Limiting Mental Health Coverage Puts Countless Americans’ Treatment at Risk” by Annie Waldman, Pro Publica
- “U.S. towns plunge into debates about fluoride in water,” by Mike Stobbe, Associated Press
- “Dr. Oz picked to lead Centers for Medicare and Medicaid Services. What does it do?” by Ken Alltucker, USA Today
- “The stunning success of vaccines in America, in one chart,”by Dylan Scott, Vox