WAR ON WOMEN: A SECOND FRONT?
by CAJUNJOE
Worsening Health Outcomes for Poor Women (especially in states refusing to expand Medicaid under Obamacare)
Joe Bruns
The American Prospect, Monica Potts memorably tells the story of Crystal Wilson, of Cave City, Arkansas, who died this past May two months shy of her thirty-ninth birthday. Ms. Potts paints an intimate portrait of Crystal to personalize a demographic mystery posed in the title of her piece: What’s Killing Poor White Women?
Demographers have long been intrigued by the differences in mortality rates of segments of the population. Women live longer than men and whites live longer than blacks, even as those gaps are narrowing. But ever since such statistics have been recorded, with very few exceptions such as the 1918 flu epidemic, the trend among all major segments of the population has been upward.
That is until health statisticians began noticing a new trend in American longevity: there was a wide disparity between male and female longevity growth rates when looked at county-by-county. In fact, according to a study in Health Affairs, (Kindig and Cheng 2013) female mortality rose in 42.8% of US counties between 1992 and 2006. By way of comparison, male mortality rates increased in only 3.4% of US counties.
Change In Female Mortality Rates from 1992-96 to 2002-06
Furthermore many of those counties where female longevity fell lay in an arc, from West Virginia, through the states of the old Confederacy to Texas, along with the rural mid-west and counties with Native American reservations. While more recent data show that the downward county-by-county trend has leveled off, there is no dispute that female longevity is significantly disadvantaged in the poor/rural South.
In fact, a woman living in Montgomery County, Maryland has a life expectancy twelve years longer than one living in McDowell, West Virginia.”
The twenty US counties with the worst female longevity are all in the states of the old Confederacy with the exception of two in West Virginia. Among the possible contributing causes are obesity, smoking, and poor nutrition leading to diabetes and heart conditions, as well as limited access to quality health care. What is even more striking, though, is that the loss of longevity is particularly seen among white women.
It also turns out that there is a significant correlation between high school education and longevity among all groups. In a paper written in August, 2012, lead researcher S. Jay Olshansky found “that in 2008, US adult men and women with fewer than twelve years of education had life expectancies not much better than those of all adults in the 1950s and 1960s.” These effects appear to have a compounding effect on white women. Olshansky found a five-year drop in life expectancy among white women high-school dropouts compared to a three-year drop for white men.
Crystal Wilson fit into a pattern. At the time of her death, Crystal weighed over 200 pounds, and had been diagnosed with diabetes, but was ‘waiting to get medicine’ for it. Her primary source of income was her husband’s disability check. She met her husband, Possum, while she was in high school. He was 28; Crystal was 16. They married and Crystal dropped out of school.
Forbes Magazine, among others, regularly comes out with articles claiming that poverty in the United States is not so bad, that it is more a matter of bad choices or even bad luck, and at any rate, they are not as poor as those in other countries.
But it is also a fact that while the United States spends more per capita on health care than any other industrialized nation, we are slipping badly in outcomes. According to a major study in the Journal of the American Medical Association, the United States ranks 26th out of 34 OECD countries in ‘healthy life expectancy.’ And we are losing ground to other industrialized countries.
Despite a level of health expenditures that would have seemed unthinkable a generation ago, the health of the U.S. population has improved only gradually and has fallen behind the pace of progress in many other wealthy nations,” writes Harvey V. Fineberg, M.D., Ph.D., of the Institute of Medicine, Washington, D.C
So, how is this interesting from a public policy perspective? It’s worth looking at two additional graphics.The first depicts health insurance coverage by state.
The second map shows where states are with regard to Medicaid expansion.
To me, while obviously not identical, the patterns on these two maps are striking in their similarity to the first map showing where women had shortening life expectancies. America may have “the best healthcare system in the world,” as Sen. Jeff Sessions (R-AL) said, but if so, like wealth, it is unequally distributed.
If I were a politician from a county or state with worsening health outcomes for poor women I don’t know how I would explain to my constituents, or even myself, a failure to support the expansion of Medicaid under the Affordable Care Act, or the rejection of the goal of universal health insurance.
Perhaps this is the real war on women.
No comments:
Post a Comment