Income inequality and provision of public services a matter of life and death

A new study published in the Journal of the American Medical Association offers further evidence of the effects of income inequality on health and well-being.  Using data from the Social Security Administration and the Internal Revenue Service, a team of economists tracked the life expectancy of US residents from 2001 through 2014, and found that, of adults over 40, the bottom 1% of earners had a life expectancy almost 15 years shorter for men and 10 years shorter for women, than those in the top 1%.  This gap also widened between 2001 and 2014.; While life expectancies barely increased for those in the bottom 5% over the past fifteen years, for those in the to 5% of earners, life expectancy increased by 2-3 years.

What makes this study particularly interesting is the use of so many data points (1.4 billion), and the team’s ability to look at variations across regions at both the bottom and top of the income scale.  They found that life expectancies, especially for the poor, can vary considerably depending on where one lives.  For example, those who are poor in Manhattan live much longer than those who live in rural Mississippi.

By examining social characteristics in different parts of the country, the researchers were able to calculate the effect of various characteristics on life expectancy for the bottom 25% of earners (those in households earning less than $28,000 per year).[1]

These correlations revealed that state and local government choices can have a big effect on quality and longevity of life for the poor, and that life expectancy is tied to other measures of well-being.   Apart from obvious health-related factors like tobacco use, obesity prevalence, and exercise rates, the strongest indicators for an area with increased life expectancy among low-income households included:

Population density. Towns and cities are generally able to provide better public services, from transportation and public recreation facilities to clean drinking water and garbage removal, than rural areas.

Government spending. Legislators at the state and local level can direct funds not only at the infrastructure programs listed above, but also toward health education campaigns, safety-net services like Medicaid and Supplemental Nutritional Assistance Program (SNAP, aka “Food Stamps”), and public safety programs like police and emergency services.

Education levels.  Areas with a higher proportion of the population holding college degrees had higher life expectancies among low-income individuals. The federal Centers for Disease Control did find that those holding degrees tend to live longer than those who don’t have post-secondary education, but this latest report shows a correlation by proximity. Low-income individuals are unlikely to hold degrees themselves, but still live longer when their neighbors do.

Presence of immigrants.  This may not be a cause, of a community’s overall well-being.  Safer, more prosperous, and healthier communities are more likely to attract immigrants.  It is also thought that immigrants tend to live longer than native-born Americans, for reasons that are unclear.

Life expectancies for low-income Mainers are generally above the national average, [2] but those living in the rural north of the state or Down East have shorter expectancies than the rest of the state.  There are also some large variations between the poorest and richest Mainers’ life expectancies.  Wealthy men in Androscoggin, Cumberland, Penobscot, and Somerset Counties live ten years longer, on average, than their poor counterparts.

  Life Expectancy, Women Life Expectancy, Men
County Bottom 25% Top 25% Difference Bottom 25% Top 25% Difference
Androscoggin 82.7 88.9 6.2 76.9 86.9 9.9
Aroostook 82.7 89.9 7.2 77.4 86.9 9.4
Cumberland 83.2 88.4 5.2 77.7 87.7 10.0
Franklin 81.8 86.3 4.6 79.0 86.8 7.8
Hancock 84.3 89.1 4.8 79.8 87.5 7.7
Kennebec 82.7 88.7 6.0 77.1 84.2 7.2
Knox 84.3 87.5 3.2 78.0 84.4 6.4
Lincoln 84.4 88.7 4.2 78.7 86.2 7.5
Oxford 84.4 90.9 6.4 77.5 85.6 8.0
Penobscot 83.1 87.8 4.6 76.6 86.5 9.9
Sagadahoc 82.4 88.2 5.8 77.9 86.9 9.0
Somerset 83.1 88.5 5.4 77.8 87.9 10.1
Waldo 83.7 87.4 3.7 78.0 85.0 7.0
Washington 82.8 84.3 1.5 77.8 83.6 5.8
York 83.1 88.9 5.8 78.3 86.4 8.1


Maine’s lawmakers should sit up and take notice.  Income inequality is not an abstract concern; for tens of thousands of Mainers, it’s a matter of life and death.  The ability of state and local governments to provide public services can add years onto an individual’s life.

Source: MECEP analysis of dataNote: The population of Piscataquis County is too small to produce reliable data for this study.  “Bottom 25%” and “top 25%” are defined nationally, i.e. households earning below $28,000 and above $100,000 respectively.



[1] Life expectancies for the top 25% of earners (those above $100,000 a year) remained relatively consistent across areas.

[2] That Maine’s poor live longer than those in other parts of the country appears to be due to its outdoors culture – the rate of exercise is one of the few indicators that is better in each of Maine’s counties than the national average.