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How Cities Can Help Improve the Health of Their Low-Income Citizens

Across America, poor folks tend to live shorter lives than rich ones, but towns and cities can reduce the gap.

By Francie Diep


New York City. (Photo: Aurelien Guichard/Flickr)

All across America, the rich tend to live years longer than the poor. But that gap can’t simply be attributed to income; it’s also geography.

American cities vary widely in the life expectancies of their wealthiest and poorest denizens, according to a large analysis published Sunday in the Journal of the American Medical Association. In New York City, for example, those who earn the top one percent of incomes are expected to live, on average, six years longer than New Yorkers in the bottom 10 percent. In Little Rock, Arkansas, the gap between the life expectancies of the richest and poorest is 11 years.

These differences in geography hint that American cities can improve their health inequities, by using their own, local resources and passing local laws. In the new analysis, those American towns where the poor lived longest tended to have governments that spent more per person.

So what kind of laws might work? Pacific Standard identified a few:

  • The new paper found a strong correlation between the percentage of a city’s low-income smokers and its life expectancy for the poor. Laws restricting tobacco advertising and banning smoking in public places have already helped slash smoking rates in the United States and across the globe. Certain advertising campaigns and programs subsidizing the cost of quitting smoking also have good track records of lowering smoking rates.
  • There was a weaker correlation between life expectancy and the percentage of a city’s low-income, obese population. Many obesity researchers think city policies, such as building parks and pedestrian-friendly neighborhoods, are key to helping folks maintain ideal weights. “What psychological research is showing us is that people who are really effective at meeting their goals and living healthy lives — they don’t do it through willpower,” says University of Southern California psychologist Wendy Wood. “They do it through setting up environments that allow them to form healthy habits.”
  • Many poorer Americans live shorter lives in what Harvard University economist David Cutler refers to as the “drug overdose belt.” That’s the swath of the central U.S. where more folks tend to struggle most with opioid abuse and addiction. Cities such as Santa Barbara, California, are trying innovative new programs to deal with the epidemic. Whether they’ll work remains to be seen.

In an increasingly unequal America, this latest analysis is a reminder that local, hyper-specific policy changes can work to make everyone healthier.