A guest essay by Charlotte Probst
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Tuesday, August 16, 2022 | The Latest Research, Commentary, And News
From Health Affairs
Dear John,
Today's newsletter is written by Charlotte Probst of the University of
Toronto's Centre for Addiction and Mental Health.
Socioeconomic Inequalities In US Life Expectancy
For the past ten years I have been working on socioeconomic inequalities
in alcohol-related health burden, driven by the interest of working
toward a society where all individuals have an equal prospect of a long
and healthy life.
Socioeconomic health inequalities are old stories, but they continue to
astonish me and are increasing in urgency.
In this month's issue of Health Affairs, my colleagues and I published
a study
where we investigated changes in life expectancy since 2000 in the
United States, with a focus on socioeconomic differences in life
expectancy at age eighteen.
We found growing differences in life expectancy from 2000 to 2018.
By 2018, adults who had a high school degree or less could expect to
live nine to twelve years less than their counterparts with a college
degree.
This means that a substantial proportion of the population (more than 35
percent) is missing out on a whole decade of life-a decade in which
one could master a skill, enjoy retirement, or see one's grandchildren
grow up.
A persistent challenge in researching the social determinants of health
and socioeconomic health inequalities is the causal chain, which is near
to impossible to disentangle.
A thicket of multilayered, interacting factors including social factors,
environmental exposures, health behaviors, exposure to stress, and
health care access stands between indicators of socioeconomic status and
mortality risks.
My research is focused on alcohol use.
Our above-mentioned study shows that causes of death that are closely
linked to alcohol use (such as mental and behavioral disorders due to
use of alcohol, alcohol poisoning, liver disease and cirrhosis, motor
vehicle accidents, and suicide) made overall negative contributions to
life expectancy in the US over the past ten years, especially among men
and women with some college education or less.
Furthermore, alcohol-related deaths contributed to increases in the gap
in life expectancy between those with low and high educational
attainment. These findings give important pointers to the broader
societal trends that may be underlying the stagnation and declines in
life expectancy in the US.
For example, in line with Case and Deaton's seminal work on despair
,
heavy alcohol use may be increasing in certain subgroups of the
population to cope with stress, financial peril, eroding social
structures and declining believes in the promise of the American dream.
The findings from our study suggest that a targeted approach focusing on
alcohol use and alcohol-attributable mortality among individuals with
some college education or less may be a promising approach to improving
public health and life expectancy and the inequalities related to it.
To go beyond the analysis of cause-specific mortality and account for
differences in drinking patterns and related health risks between
different subgroups of the population, I am currently leading the
Simulation of Alcohol Control Policies for Health Equity
project.
We are generating a complex simulation model to further investigate the
role alcohol use, socioeconomic status, and race/ethnicity have played
in the developments in US life expectancy since 2000.
By way of identifying feasible strategies, it will inform public health
decisions regarding alcohol control interventions with the aim of
improving life expectancy, while reducing health disparities.
We look forward to synthesizing the findings from this five-year study
in the coming years.
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Elsewhere At Health Affairs
Today in Health Affairs Forefront, Ngozi Erondu and coauthors discuss
some of the lessons learned from the Framework Convention on Tobacco
Control
and identify areas within the agreement that have contributed to
inequities in global health outcomes.
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Mohammed Ali on Health System Fragmentation And Diabetes Outcomes
Listen to Health Affairs Editor-in-Chief Alan Weil interview Mohammed
Ali from Emory University on his research on the fragmented US health
care system, diabetes outcomes, and health equity.
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Daily Digest
Alcohol-Attributable Deaths Help Drive Growing Socioeconomic
Inequalities In US Life Expectancy, 2000-18
Charlotte Probst et al.
Equity And The Pandemic Instrument: Lessons From The Framework
Convention For Tobacco Control
Ngozi Erondu et al.
Mohammed Ali on Health System Fragmentation And Diabetes Outcomes
Mohammed K. Ali and Alan Weil
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