In this series on “Our economy deteriorating,” we’ve been focusing on the factors that can be leading up to “economic collapse” as is being ever-more frequently discussed in the alternative social science and economics literature.
People often ask, “What would that collapse look like? What would its characteristics be?” The further we delve into this question, the more it looks like a matter of how people who are in the middle range of the inequality spectrum would expect a collapse to look like, from their vantage point. However, from the perspective of people trapped at the very bottom ranges of the inequality spectrum or pyramid, it seems like a “privileged question.” Conditions at the bottom of inequality in the peak inequality economy/society look like those of an economy/society which is already in the midst of collapse, or has already collapsed.
That’s what this blog post will get at. Any updates and revisions will appear at bottom of the page.
Is Racism a Fundamental Cause of Inequalities in Health?
Jo C. Phelan and Bruce G. Link
Annual Review of Sociology, Vol. 41 (2015)
We previously proposed that socioeconomic status (SES) is a fundamental cause of health inequalities and, as such, that SES inequalities in health persist over time despite radical changes in the diseases, risks, and interventions that happen to produce them at any given time. Like SES, race in the United States has an enduring connection to health and mortality. Our goals here are to evaluate whether this connection endures because systemic racism is a fundamental cause of health inequalities and, in doing so, to review a wide range of empirical data regarding racial differences in health outcomes, health risks, and health-enhancing resources such as money, knowledge, power, prestige, freedom, and beneficial social connections.
We conclude that racial inequalities in health endure primarily because racism is a fundamental cause of racial differences in SES and because SES is a fundamental cause of health inequalities. In addition to these powerful connections, however, there is evidence that racism, largely via inequalities in power, prestige, freedom, neighborhood context, and health care, also has a fundamental association with health independent of SES.
In searching the scholarly, peer-reviewed literature, we looked up the phrase “life expectancy by U.S. zip code.” This is where the real cost of wealth and income inequality clearly shows, and the cost is in terms of years of life, as well as a person’s general health conditions during their shorter life than the people higher up the wealth scale. Someone suggested this story to me, and I found this the best place to start in this brief review of the literature on inequality of mortality in the United States.
Why Americans Die So Much
U.S. life spans, which have fallen behind those in Europe, are telling us
something important about American society.
by Derek Thompson
The Atlantic, Sept. 12,2021
I’m talking about the past 30 years. Before the 1990s, average life expectancy in the U.S. was not much different than it was in Germany, the United Kingdom, or France. But since the 1990s, American life spans started falling significantly behind those in similarly wealthy European countries.
According to a new working paper released by the National Bureau of Economic Research, Americans now die earlier than their European counterparts, no matter what age you’re looking at. Compared with Europeans, American babies are more likely to die before they turn 5, American teens are more likely to die before they turn 20, and American adults are more likely to die before they turn 65. At every age, living in the United States carries a higher risk of mortality. This is America’s unsung death penalty, and it adds up. Average life expectancy surged above 80 years old in just about every Western European country in the 2010s, including Portugal, Spain, France, Italy, Germany, the U.K., Denmark, and Switzerland. In the U.S., by contrast, the average life span has never exceeded 79—and now it’s just taken a historic tumble.
…“Europe has better life outcomes than the United States across the board, for white and Black people, in high-poverty areas and low-poverty areas,” Hannes Schwandt, a Northwestern University professor who co-wrote the paper, told me. “It’s important that we collect this data, so that people can ask the right questions, but the data alone does not tell us what the cause of this longevity gap is.”
…Europe’s mortality rates are shockingly similar between rich and poor communities. Residents of the poorest parts of France live about as long as people in the rich areas around Paris do. “Health improvements among infants, children, and youth have been disseminated within European countries in a way that includes even the poorest areas,” the paper’s authors write.
.But in the U.S., which has the highest poverty and inequality of just about any country in the Organization for Economic Cooperation and Development, where you live is much more likely to determine when you’ll die. Infants in the U.S. are considerably more likely to die in the poorest counties than in the richest counties, and this is true for both Black and white babies. Black teenagers in the poorest U.S. areas are roughly twice as likely to die before they turn 20, compared with those in the richest U.S. counties. In Europe, by contrast, the mortality rate for teenagers in the richest and poorest areas is exactly the same—12 deaths per 100,000. In America, the problem is not just that poverty is higher; it’s that the effect of poverty on longevity is greater too.
Concludes Derek Thompson:
For decades, U.S. politicians on the right have resisted calls for income redistribution and universal insurance under the theory that inequality was a fair price to pay for freedom. But now we know that the price of inequality is paid in early death—for Americans of all races, ages, and income levels. With or without a pandemic, when it comes to keeping Americans alive, we really are all in this together.
In Thompson’s Atlantic piece he references this study in National Bureau of Economic Research:
Archived here in he blog files–and downloadable to you–The NBER paper notes improvement in the gap between black and white child deaths over the decades from 1990 through 2018. Nonetheless, there were still two black children dying for every white child, in 2018.
The NBER study is archived here on the blog files, and should be downloadable to you here:
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When we zoom in to the Zip Code level, geographically mapping out inequality of differences in life expectancy, we can focus more on inequality as Professor Dorling of Oxford University has done in the United Kingdom, contributing to his book “Peak Inequality: “Britain’s Ticking Time Bomb.”
For example, let’s look at this study —
Life Expectancy at Birth in Milwaukee County: A Zip Code-Level Analysis
J Patient Cent Res Rev. 2017 Fall; 4(4): 213–220.
Published online 2017 Nov 6. doi: 10.17294/2330-0698.1576
By Erica S. LeCounte, MPH and Geoffrey R. Swain, MD, MPH
To calculate life expectancy, death count data and population estimates were entered into an abridged life table using the Chiang methodology. Data were linked with measures from the American Community Survey to examine the relationship between life expectancy and zip code characteristics.
Life expectancy varies greatly across zip codes in Milwaukee County. Overall, there was a 12-year difference in the life expectancy of children born into zip codes with the lowest and highest life expectancy: 53206 (71.3 years) and 53217 (83.2 years). There was a strong positive correlation between life expectancy and median household income (r=0.784, P<0.0001), educational attainment of a bachelor’s degree or higher (r=0.741, P<0.0001) and the socioeconomic index combining education and income (r=0.819, P<0.0001).
Disparities in life expectancy within Milwaukee County are stark and correlate with differences in social and economic factors. To improve health outcomes such as life expectancy, health care practitioners and health care systems must become more involved in activities at the social and policy levels to improve social and economic conditions that would allow their patients to live healthier and longer lives.
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The entire Google Scholar search by the string “Life expectancy varies by U.S. Zip code” can be found here, approx. 15,000 entries from 2017.
Given what we have read so far, we may ask ourselves, “has the response to the Covid-19 pandemic resulted in a big and wide national reform movement to overcome the peak inequality impacting on the standard of living of black, indigenous, and people of color communities as measured quantitatively and qualitatively in the USA?”
This paper published by National Center for Biotechnology Information-National Library of Medicine located on the National Institutes of Health website provides an answer to that question.
National Disparities in COVID-19 Outcomes between Black and White Americans
Michael Poulson, Alaina Geary, Chandler Annesi, Lisa Allee, Kelly Kenzik, Sabrina Sanchez, Jennifer Tseng, Tracey Dechert
National Center for Biotechnology Information
National Library of Medicine
National Institutes of Health website
Here is what these authors found:
Background: There is very limited comprehensive information on disparate outcomes of black and white patients with COVID-19 infection. Reports from cities and states have suggested a discordant impact on black Americans, but no nationwide study has yet been performed. We sought to understand the differential outcomes for black and white Americans infected with COVID-19.
Methods: We obtained case-level data from the Centers for Disease Control and Prevention on 76,442 white and 48,338 non-Hispanic Black patients diagnosed with COVID-19, ages 0 to >80+, outlining information on hospitalization, ICU admission, ventilation, and death outcomes. Multivariate Poisson regressions were used to estimate the association of race, treating white as the reference group, controlling for sex, age group, and the presence of comorbidities.
Results: Black patients were generally younger than white, were more often female, and had larger numbers of comorbidities. Compared to white patients with COVID-19, black patients had 1.4 times the risk of hospitalization (RR 1.42, p < 0.001), and almost twice the risk of requiring ICU care (RR 1.68, p < 0.001) or ventilatory support (RR 1.81, p < 0.001) after adjusting for covariates. Black patients saw a 1.36 times increased risk of death (RR 1.36, p < 0.001) compared to white. Disparities between black and white outcomes increased with advanced age.
Conclusion: Despite the initial descriptions of COVID-19 being a disease that affects all individuals, regardless of station, our data demonstrate the differential racial effects in the United States. This current pandemic reinforces the need to assess the unequal effects of crises on disadvantaged populations to promote population health.
This particular posting on the blog has been drawing together two meta-narratives: The deterioration of the economy of our United States of America, coupled with the “peak inequality” of wealth, income, and the inequality of political-personal power derivative from that peak wealth inequality. We should also recognize that mapping “unequal communities” for example by County or more micro, by zip code data, will reveal that many of the unequal communities now living in a collapsed economy are also majority-white-person communities. This is the uncomfortable truth which national politicians trafficking in white supremacist narratives would prefer not to see the light of day.
- 2. an overarching account or interpretation of events and circumstances that provides a pattern or structure for people’s beliefs and gives meaning to their experiences:
Any readers of the blog who would be interested in contributing future posts on topics such as these, or to take part in a podcast series called “Abolish Inequality Podcast” may contact us here: