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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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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About Health Affairs

Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking content is also found through healthaffairs.org, Health Affairs Today, and Health Affairs Sunday Update.

Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.

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