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Waiting for an exam at a roving free health care clinic in Tennessee. (AP File)

What's behind lowered life expectancies for some American women?

ASK THIS | June 28, 2011

A new report finds women are dying younger in hundreds of counties. The journalist whose in-depth reporting has focused attention on the issue suggests questions local reporters should be asking about how that could possibly be?

By Mike Alberti

Last week, I reported on the Remapping Debate website about a new study by the Institute for Health Metrics and Evaluation at the University of Washington that shows that, between 1987 and 2007, life expectancy actuallyfell for women in hundreds of counties in the United States, a startling departure from previous trends.

While the overall life expectancy in the U.S. rose modestly in the same period, large parts of the South, Southern Midwest and Appalachia saw declines for women, sometimes as large as two years. The regions where life expectancy has fallen are the ones that have long reported worse health outcomes than the rest of the nation: the Mississippi Delta, parts of West Virginia and Kentucky, rural areas in Missouri, Oklahoma, Alabama and Arkansas. These are places plagued by a combination of poverty, lack of access to health care and nutritious food, and unhealthy habits.

But how is it possible that things are getting even worse in these counties? And especially for women? There are some obvious possible reasons: obesity rates have increased in those areas and smoking rates have decreased more slowly than in most parts of the country. Public health experts also point to a worsening of economic conditions and cutbacks in social services as possible causes.

But public health officials where life expectancy has fallen sometimes turn out to be unaware of what's going on in front of their eyes. So reporters looking for answers may have to do their own research. Here are some questions local reporters might consider asking.

Q. How do local indicators compare to state and national levels in terms of both unhealthy behavior and socioeconomic environment? Some helpful websites to check include the county-level health statistics compiled by the University of Wisconsin, It’s important to remember that unhealthy behaviors like smoking and poor diet are not divorced from socioeconomic indicators like income, insurance status, employment and educational attainment.

Q. In many counties, life expectancy rose for men while dropping for women. How do state and local officials explain this disparity?

Q. Are there any county or state policies that are aimed at targeting women’s health?

Q. Have there been significant changes in the social services provided to residents during the last two decades? Medicaid eligibility levels vary regionally and in many cases have gradually been raised, thereby restricting access. Some states and counties spend far more on public health programs than others.

Q. In 1998, nearly all states began receiving annual payments from the tobacco industry in the Tobacco Master Settlement Agreement to compensate the states for the medical costs of treating people with smoking-related illnesses. Many states use those funds to sponsor anti-smoking campaigns and to provide public education on the dangers of smoking. But others simply incorporate the funding into the state budget and do not use it for tobacco-use prevention programs. How does your state government use its settlement funding? How effective have those policies been, and how do they compare to other states? A helpful resource is compiled here by the Campaign for Tobacco Free Kids.

Q. Some counties subsidize supermarkets in small towns where they would not otherwise be able to maintain a presence. What programs are in place to provide healthy food to rural areas?

Q. Has the federal government, specifically the Centers for Disease Control, identified problems specific to a county or region? Has the CDC issued any guidelines, recommendations, or grants to local or state governments that specifically target those issues? If not, why not?

Q. If so, how have those efforts been coordinated by local officials, and how effective have they been? How does your regional branch of the CDC understand its role in reducing health disparities and improving outcomes at the local level? You can find local programs run by the CDC here.

Q. If public health funding has been cut in recent years, how do officials justify those cuts in light of declining public health outcomes?

Q. Other, less obvious factors may also be at play, such as health and safety regulations regarding housing and the workplace. Public school health curricula vary as well. Is there a statewide mandate for the number of hours middle school and high school students have to spend in physical education classes per year? If so, how does it compare to neighboring states? Have school districts banned some kinds of unhealthy food from cafeterias and provided healthier alternatives? Is there a standard and mandated health curriculum? If not, why haven’t local and state officials felt the need to put such measures in place?

Click here for Remapping Debate’s full story.

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