Apr 18, 2016 by



Poor New Yorkers tend to live longer than other poor Americans. Credit Nicole Bengiveno/The New York Times

An important new study shows that the poor in some cities, like New York and San Francisco, live longer than those with similar incomes in places like Detroit and Oklahoma City. The findings could help local and state governments figure out what they can do, or do better, to help people live longer and healthier lives.

Researchers long ago found that the rich tend to live longer than the poor. What’s striking about the new research, which was published last week in The Journal of the American Medical Association, is that where people live also makes a big difference. For example, 40-year-old New Yorkers who are in the bottom 25 percent of Americans by income have a life expectancy of 81.8, while 40-year-old Detroit residents in the bottom 25 percent have a life expectancy of 77.7.

There are several possible explanations for these gaps, but the study shows that where local government spending is higher, there is clearly a higher life expectancy for the poor. The cities where the poor fared better had low rates of smoking and obesity, which are leading causes of cancer, heart disease and diabetes. That, too, might be influenced by government actions. Residents in cities like New York and states like California that have banned smoking in bars and restaurants, raised tobacco taxes or restricted artificial trans fats tend to have higher life expectancies.

Poor residents also did better in cities that were more densely populated. The study does not speculate on why that might be, but denser cities, with mass transit systems, may encourage more walking and less door-to-door driving.

The life expectancy of the poor was also higher in cities with more immigrants. That could be because immigrants tend to be healthier than native-born Americans when they arrive. Immigrants may also be more likely to move to cities with better public services.

The study did not find a strong correlation between the percentage of people with health insurance and life expectancy. That contradicts other studies, which have found a link between access to health care and longevity. Questions about this conclusion have been raised in separate editorials in the journal by the Princeton economist Angus Deaton and two public health experts, Dr. Steven Woolf and Dr. Jason Purnell.

Because the study was based on tax and Social Security records from 2001 to 2014, it did not reflect the impact of the Affordable Care Act, the 2010 law that has helped millions of poor Americans get health coverage and pushed insurers and doctors to provide more preventive care. (The health insurance marketplaces authorized by the law opened in October 2013.)

The study did provide strong evidence of the positive effects that state and local public health policies can have on people’s lives. Its authors noted that the life expectancy for the poor increased between 2001 and 2014 in some cities like Birmingham, Ala., where local officials expanded health services, including opening clinics in poor neighborhoods, and imposed restrictions on smoking.

Critics say adopting government policies like smoking bans amounts to setting up a “nanny state.” But the evidence shows that such regulations give people longer and healthier lives.


A version of this editorial appears in print on April 18, 2016, on page A20 of the New York edition with the headline: Geography and Life Expectancy.

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