Only a few miles separate the Baltimore neighborhoods of Roland Park and Upton Druid Heights. But residents of the two areas can measure the distance between them in years—twenty years, to be exact. That’s the difference in life expectancy between Roland Park, where people live to be 83 on average, and Upton Druid Heights, where they can expect to die at 63.
Underlying these gaps in life expectancy are vast economic disparities. Roland Park is an affluent neighborhood with an unemployment rate of 3.4 percent, and a median household income above $90,000. More than 17 percent of people in Upton Druid Heights are unemployed, and the median household income is just $13,388.
It’s no secret that this sort of economic inequality is increasing nationwide; the disparity between America’s richest and poorest is the widest it’s been since the Roaring Twenties. Less discussed are the gaps in life expectancy that have widened over the past twenty-five years between America’s counties, cities and neighborhoods. While the country as a whole has gotten richer and healthier, the poor have gotten poorer, the middle class has shrunk and Americans without high school diplomas have seen their life expectancy slide back to what it was in the 1950s. Economic inequalities manifest not in numbers, but in sick and dying bodies.
On Wednesday, Senator Bernie Sanders convened a hearing before the Primary Health and Aging subcommittee to examine the connections between material and physiological well-being, and the policy implications. With Congress fixed on historic reforms to the healthcare delivery system, the doctors and public health professionals who testified this morning made it clear that policies outside of the healthcare domain are equally vital for keeping people healthy—namely, those that target poverty and inequality.
“The lower people’s income, the earlier they die and the sicker they live,” testified Dr. Steven Woolf, who directs the Center on Society and Health at Virginia Commonwealth University. In America, people in the top 5 percent of the income gradient live about nine years longer than those in the bottom 10 percent. It isn’t just access to care that poor Americans lack: first, they are more likely to get sick. Poor Americans are at greater risk for virtually every major cause of death, including cancer, heart disease and diabetes. As Woolf put it, “Economic policy is not just economic policy—it’s health policy.”
Tracing health disparities back to their socioeconomic roots adds context to growing calls for pro-worker policies like raising the minimum wage and providing paid sick leave. Lisa Berkman, director of Harvard’s Center for Population and Development Studies, presented a range of evidence indicating that policies supporting men and women in the labor force—particularly low-wage and female workers—lead to better health for themselves and their families.
The experts also identified education as a “key lever” for improving health outcomes, as education is closely linked with economic mobility and in turn, health. The mortality risk has risen for less educated women in recent years, while diabetes death rates are three times higher among Americans without a high school diploma than those who graduated. With 22 percent of American children living in poverty, several witnesses pointed to the expansion of early childhood education as policy that would have a profound effect on the nation’s health.