The amount of money a person makes might determine how long that person will live, according to new research published recently in the Journal of the American Medical Association. The study, which analyzed demographic information from the tax records of all Americans between 2001 and 2014, found that the rich in America are living significantly longer than the poor, and that the difference in life expectancy is increasing over time.

As a whole, the top 25 percent of earners (those in households making more than $85,000 per year) live 7 years longer than those in the bottom 25 percent ($25,000 or less per year). Moreover, between 2001 and 2014, the longevity of the richest Americans increased by 2.5 years, while those at the bottom of the income distribution gained only a few months of life. In some places, the poorest Americans even had shortened life spans.

Maine, specifically, leads the country with some of the longest life spans among its wealthiest citizens. A 40-year-old man in Portland, making more than $85,000 annually, can expect to live to be 87 years of age, and a woman in the same income bracket to 89. However, the state’s longevity gap is larger than average, with men and women in the bottom 25 percent of income living only to 79 and 81 years, respectively.

This study didn’t explore the specific causes of this disparity, but previous research has shown that a person’s level of income is correlated to a number of healthy behaviors. For instance, those who earn less money tend to exhibit higher rates of obesity and tobacco use, report increased levels of stress, and are less likely to participate in health maintenance programs — factors which put together can lead to poorer health. This study did uncover another surprising factor though — for the poor, where you live has a dramatic effect on your health.

Across the country, wealthy individuals enjoy similarly long lifespans. However, there is wide variation among the poorest Americans, with expected longevity ranging anywhere between 77 and 82 years. That data is discouraging, but the study provided a glimmer of hope. While it is clear that some cities and counties are providing only meagre health care for their poorest citizens, others are excelling. Putting it another way, many municipalities have found innovative ways to improve the health of their richest and poorest citizens alike, and should serve as models for the rest of the country.

Maine provides some leadership. In 2011, a survey identified several counties nationwide that achieved significantly better health outcomes than would be expected by their socioeconomic status. Franklin County, one of Maine’s poorest, topped the list. To explore why, researchers from Maine published a study in JAMA that analyzed health trends in Franklin County between 1970 and 2010.

Franklin County, they reported, received a federal grant as part of President Lyndon Johnson’s War on Poverty in the late 1960s. This money was used to hire primary care physicians, build clinics and to fund the Franklin Area Health Plan, an organization that provided coordinated health care to 3,200 of the county’s poorest citizens at little or no cost.

Those initiatives dramatically expanded access to health care, but medical providers pushed even further. Physicians and nurses identified cardiovascular disease as the county’s most pressing health concern and teamed up with community members to implement several public health initiatives. Together, they screened people at churches, schools and work places and intervened to reduce cardiovascular risk factors such as high blood pressure, cholesterol, tobacco use and diabetes.

Those interventions had a dramatic impact. Hospital admissions in the county declined and by 1979, Franklin County achieved the lowest mortality rate in Maine.

Since then, spurred on by societal health trends and high-priced medical technology, mortality rates have fallen to record lows statewide and have, on the whole, caught up to Franklin County. However, as the study in JAMA shows, those gains have been appreciated predominantly by those at the top of the income distribution.

The Affordable Care Act (Obamacare) contains several provisions aimed at reducing health disparities across the country. It provides expanded health care access for low income individuals and calls for funding to support public health interventions, similar to those in Franklin County.

The historical experience of Franklin County suggests that such a ground-up approach can work, but that it requires the concerted effort of health care providers, payers and community members alike.

Though it may take years for the benefits of novel public health interventions to pay off, Maine should, once again, take the lead.

Michael Milligan is a third-year medical student at Harvard University in Massachusetts.


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