50 years of US economic change linked to poorer health, shorter lives for less-educated Americans

Fifty years of economic change have taken a heavy toll on some Americans, especially those with less education who not only have been left behind but are sicker and living shorter lives, according to new research.

The study published in Epidemiology and led by Arline Geronimus, professor at the University of Michigan School of Public Health and a member of the National Academy of Medicine, examined local communities and the effects of macroeconomic restructuring on growing educational inequities in health and lifespan.

Geronimus and colleagues found that long-term economic decline impacted life expectancy, particularly among adults with lower levels of education. 

Using data from 1990 to 2017, the study showed that Americans living in economically stagnant areas were more likely to suffer from more stress and much greater levels of chronic illness and live 1-2 fewer years between ages 25 and 84 compared to people in more prosperous areas of the country.

"These findings suggest that structural economic changes over the past half-century have had profound, long-term effects on health—especially for less-educated workers," the study authors wrote.

Geronimus said the study "supports the overarching notion that macroeconomic restructuring impacted life expectancy inequitably for less vs. more educated adults among both white and Black American men and women, contributing to higher death rates and extra years of life lost for the least educated living in geographic areas where economic opportunities were most adversely affected by macroeconomic restructuring."

Geronimus and the research team looked at how economic changes affected different parts of the U.S. to see if those shifts helped widen the gap in life expectancy by education—and which life-threatening health conditions were responsible.
Their research found that job loss, reduced security and other negative effects of the changing economy, including globalization and technological advancement, increased the stress people already feel from trying to succeed.

"The ability of less-educated workers to make ends meet, avoid food insecurity or access needed health care has been consistently challenged since 1980," Geronimus said. "In the face of prolonged economic hardship and social exclusion, less-educated workers engage in high-effort adaptive coping. 

"For example, working several low-paying jobs, reflecting the belief that their economic uncertainty can be overcome with effort and tenacity. In the face of strong societal headwinds, this tenacious coping can cumulatively result in wear and tear, or weathering of critical body systems, increasing the risk of cardiometabolic diseases and cancers." 

Adult life expectancy has stagnated in this group over the last half-century beginning well before the COVID-19 pandemic, Geronimus said. The stagnation coincided with deteriorating economic prospects for the least educated adults as jobs were lost to globalization and technological change. 

Contrary to popular narratives, the study also found that increased deaths from suicide or substance abuse were not the main drivers of the life expectancy gap. Instead, the divergence was largely due to higher mortality from cancer, cardiovascular and metabolic diseases, and other internal conditions associated with chronic stress.

"It is important to recognize that such findings do not diminish the importance and devastation of the opioid epidemic in 21st century America or our need to address it," Geronimus said. "Only that other factors such as targeted marketing and overprescription of opioids in the first decades of the epidemic and the increasing supply and broad accessibility of fentanyl, a highly deadly synthetic opioid, in the most recent decade are the primary explanations for the opioid epidemic and resulting deaths."

The researchers said that reducing chronic disease deaths will require societal action to level the playing field for all workers, not simply encouraging changes to their individual health behavior. And they encourage economic and health policy makers to be attuned to the adverse health impacts of large structural changes to the economy for the sake of the health of less-educated workers.

Co-authors of the study include: Timothy Waidmann and Vincent Pancini of the Urban Institute, John Bound of U-M and the National Bureau of Economic Research, and Meifeng Yang of U-M.

Study: Long-term Economic Distress and Growing Educational Inequity in Life Expectancy (DOI: 10.1097/EDE.0000000000001843)