Healthier and Healthier

Nice: apparently, northwesterners are living longer than ever!

And it’s not just that elderly patients are eking out a few extra miserable months in the intensive care unit before dying of old age. Nope—death rates are falling at pretty much every stage of life, from infancy, through teenage years and middle age, and into the senior years. The big drops in death over the last decade have been in heart disease, cancer, strokes, and certain infectious diseases like pneumonia. Car crash deaths are down too. Among major causes of death in Washington, only Alzheimers fatalities have consistently trended upwards over the last decade. In BC, diabetes deaths are up slightly as well. But the big killers are all on the downslope.

Falling death rates may come as surprising news, since we’re so used to hearing about the bad news around health: new health risks, rising obesity, skyrocketing health care costs. Yet slowly but surely, bit by bit, we’re doing better at staving off an early demise. And while long life doesn’t automatically mean healthy life, there are still strong statistical links between overall life expectancy and people’s self-rated health, and also with more objective measures of living free of disability. So overall, life expectancy really is a pretty darn good proxy for the health of a population.

Within the Northwest, BC clearly leads the way on longevity. At last count, BC’s life expectancy stood at 82.1 years—a notable (though perhaps temporary) eight-month lifespan increase over the previous year. Holding today’s mortality patterns constant, a BC infant born today could expect to live three years longer than a baby born today in the Northwest states. And as the chart to the right shows, the longevity gap between BC and the states has widened over time: although the Northwest states are getting healthier, BC residents are getting healthier faster. In fact, the province’s performance has been so strong that if BC were an independent nation, its life expectancy would rank among the top five in the world.

Why is BC doing so much better than the US Northwest in helping people live longer, healthier lives? It’s tempting to believe that there’s just one single factor in play—say, Canada’s health care system. But it looks like things are far more complicated than that; the province’s health advantage stems not just from one cause, but many. Universal health insurance gives BC residents a decided boost—roughly one in seven residents of the Northwest states go without health insurance. (See the Kaiser State Health Facts website for the deets.) The province also has lower fatality rates from car crashes and guns. And BC also has lower rates of obesity than the Northwest states, which may stem at least in part from more compact, walkable urban and suburban neighborhoods, which are also a factor in the lower car crash risk in the province. A host of economic and demographic factors, from immigration trends to poverty, undoubtedly play a role too.

One of BC’s less heralded health advantages may be the province’s comparatively low level of income inequality. National and international research finds a fairly consistent link between high income inequality and poor health. A recent book, The Spirit Level, describes this link, along with a number of other connections between economic equality and social wellbeing. (If you don’t have time to read a book, this website summarizes the main points.) Not surprisingly, the equality-wellbeing link has drawn plenty of critics—and perhaps some of the criticism is justified.

Still, to my eye the research on the effects of economic equality on human wellbeing is worth paying attention to. And while BC’s income structure is more equitable than in the US Northwest, the trends are troubling: the share of provincial income captured by the top 1 percent of BC households grew from 6.6 percent in 1982 to 12 percent in 2007. (Data are from a recent study by Dr. Mike Veall. For data on US inequality, see this recent study by Dr. Emmanuel Saez; the Center for Budget and Policy Priorities has state-by-state numbers.) So if BC wants to retain its mantle of North America’s leader in promoting long, healthy lives, it would do well to pay attention to the trends in economic inequality.