Miamians don’t live as long as the robust residents of Colorado ski country, but can expect to live 14 years longer, on average, than Native Americans living on reservations in the Dakotas, according to a new study on growing inequality in the health and longevity of Americans.
The county-by-county examination of life expectancy in the U.S. revealed that Miami-Dade County ranked nearly two years above the national average at 80.9 years, with Palm Beach at 81.24, Broward at 80.25 and Monroe at 78.85. Collier County, which includes the Naples area, had the longest life expectancy in Florida at 83.43 years. Union County, the state’s smallest and site of a maximum security prison that houses some Death Row inmates, had the lowest at 67.57 years.
Oglala Lakota County in South Dakota, home to the Pine Ridge reservation, had the lowest life expectancy in the country in 2014, the year the study measured, at 66.8 years, comparable to countries like Sudan (67.5), India (67.2) and Iraq (67.4).
Clusters of poor, rural counties with low life expectancy were identified in Kentucky, West Virginia, Mississippi and Alabama.
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High in the Rocky Mountains, home to affluent Breckenridge, Aspen and Vail, Summit County topped the list at 86.8 years, followed by Pitkin (86.5) and Eagle (85.9) — better than Iceland (83.3) and Japan (83.2). Lesotho (47.1), the Central African Republic (49.6), Swaziland (51.8) and Afghanistan (53.8) had the lowest life expectancies in the world.
Babies born today in 13 U.S. counties have shorter expected life spans than their parents did, and the 20.1-year gap between counties with the highest and lowest expectancies is larger than it was in 1980, according to the study published last week in JAMA Internal Medicine.
“Two things that really shocked us: The disparities in life expectancy are increasing, and the overall rate of increase in life expectancy in the U.S. is much lower than in countries of equal economic might,” said Dr. Ali Mokdad, an author of the study by the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. “We spend more on health care than any other country; in fact we spend $3 trillion, which is more than half of what the rest of the world spends on health care. We debate health care more than any other country. Yet in many ways we’re going backwards.
“It’s like talking about recipes and cooking all day long and then at dinnertime it’s a miserable meal that nobody wants to eat.”
Who is surviving longer in a country obsessed with extending life? Risk factors such as obesity, lack of exercise, smoking, hypertension and diabetes explained 74 percent of the variation in longevity. Socioeconomic factors such as poverty, income, education, unemployment and race were related to 60 percent of the disparity, and access to and quality of health care accounted for 27 percent.
“The inequality in health care in the United States is unacceptable,” said Dr. Christopher Murray, director of the institute. “Every American, regardless of where they live or their background, deserves to live a long and healthy life. If we allow trends to continue, the gap will only widen between counties.”
Miami fared well compared to metro areas Washington, D.C. (76.86), Dallas (78.29), and Chicago (78.67) but was behind Los Angeles (81.36), San Francisco (81.97) and New York (81.86).
“In Miami, you guys are above average, but we all need to move to Colorado. Or Japan,” Mokdad said. “Miami, with its money, knowledge, access to health care and quality of health care, could do better, just as we here in Seattle could do better.”
The U.S. spent $9,237 per person on health care in 2014, while Australia spent $4,032 and Japan spent $3,816, the study found.
“Your environment has to support you in healthy habits, and there are food deserts in the U.S., there are places where it’s not safe to walk around the block, where health care is not very accessible,” Mokdad said. “Why do we allow this to happen in a country where we have solutions but don’t invest in them? It is a sad situation.”
U.S. life expectancy of 79.10 years was comparable to that of Turkey (79.2), Saudi Arabia (79.5), Peru (79.5), the Czech Republic (78.8) and Cuba (78.2) but below Canada (81.7) and the nations of Western Europe and Scandinavia. By gender, Japanese women live the longest, an average of 86.3 years.
In the U.S., the 10 counties with the largest increases in life expectancy in the last 25 years were four counties in Alaska, San Francisco, the District of Columbia, New York and Kings County, N.Y., Sumter County, Florida, and Loudoun County, Virginia.
The 10 counties with the largest decreases included eight in eastern Kentucky, Kiowa County, Oklahoma, and Perry County, Alabama.
The study found that geographic inequality in the risk of death decreased among children and adolescents, but increased among older adults.
The institute publishes interactive maps with data on counties and countries.