Is everyone really living longer?

By Trudy Lieberman, Rural Health News Service People are living longer. Or are they? That's an important question as policymakers debate whether to raise the eligibility age from 65 to 67 for receiving Medicare benefits. Those supporting the change argue that the age for receiving full Social Security benefits is already 67 for those born after 1959, so why not do the same for Medicare? People are living longer anyway, and besides, the shift would save Medicare billions of dollars. While in general Americans are living longer and healthier lives thanks in part to medical advances, those gains are not distributed equally in the population. Politicians and advocates who don't support raising the eligibility age believe such a move could actually encourage some people to put off getting care and would force them to pay on their own for treatment Medicare now covers. It's important to look under the hood when we hear talk about people living longer. For awhile now researchers have found that the biggest gains in longevity have been among the most educated, and for several generations, it was expected that children would live longer than their parents. But new research published in the policy journal Health Affairs last summer indicates that life spans for some of the least educated Americans is actually going down, particularly for white women. White women without a high school diploma lost five years of life expectancy, on average, between 1990 and 2008, the study showed. By 2008, life expectancy for black women with the same education level had surpassed that of white women. For white men it was a similar story. Those without a high school diploma lost three years of life. Longevity for black and Hispanic men with the same education level went up, but black people as a whole still do not live as long as whites. What's going on here? The data have stumped researchers looking for a simple explanation. "The gaps in longevity are widening and we don't know why," says Sherry Glied, a professor of public health at Columbia University's Mailman School of Public Health. Glied told me high rates of smoking among less educated white women may explain part of the trend but not all of it. "There's some belief that some of this may have to do with health insurance. There's clearly an enormous need for it before someone reaches Medicare age," she said. It's during those years before they are eligible for Medicare that these women may experience health burdens and need care they cannot pay for. Glied says helping people avoid or give up unhealthy behaviors may be part of the answer. The Robert Wood Johnson Foundation, a philanthropic organization interested in health, has funded a project that ranks every county in the U.S. identifying factors that make a community healthy. Much of what influences health and longevity and ultimately the public purse occurs outside the doctor's office. The foundation's County Health Rankings & Roadmaps project (http://www.countyhealthrankings.or/roadmaps) shows what's happening in your community with the idea of spurring communities to improve the health of their residents. I looked at the rankings for Nebraska to see how the counties stacked up with one another when it came to health outcomes and health behaviors. I compared Cedar County in the northeast corner of the state with Kimball County in the southwest corner of the Panhandle. Cedar ranks No. 1 in health outcomes in Nebraska, with only 9 percent of the population in fair or poor health and a premature death rate much lower than the national benchmark and the statewide average. In the category examining health factors, Cedar ranked No. 10. Only 14 percent of adults in the county smoked. The numbers tell a much different story for Kimball County, which ranked No. 79, at the bottom for health outcomes and number 70 for health factors. (Some counties were not ranked.) In Kimball County, the premature death rate was double the state average and the national benchmark while 19 percent of the population was in fair or poor health, and 29 percent smoked. Clearly, debates about raising the Medicare age are entwined with the decline in longevity for some and with unhealthy behaviors that vary widely among and within states. Those interrelationships make Washington policy discussions complicated, but they also make the outcomes and decisions even more important to ordinary people than they may seem. If you want to check out how your county ranks, go to the County Health Rankings & Roadmaps website