Declining Life Expectancy Is An Inexcusable Scandal

I have spent the past 30 years of my life digging deep roots in the state of Arkansas, a place I love with all my heart and soul.

With its beautiful mountains, pristine waters and down-to-earth community, Arkansas has provided me an amazing opportunity to pursue my own American dream.

With such great pride in my state, I was naturally horrified to read a study published by the Public Library of Science that showed a steady decline in the life expectancy for women and poor people who reside in rural areas, including many Arkansas counties. Quite simply, when it comes to health care, Arkansas — and nearly every other state in the nation — is failing its citizenry.

Researchers from the Harvard School of Public Health and other collaborative institutions studied county-level mortality rates between 1983 and 1999 to determine how life expectancy varied among U.S. counties. Ultimately, the results showed a steady increase in mortality inequality, resulting from stagnation or increase in mortality among the worst-off segment of the population, including rural and poor communities. Female mortality increased in a large number of counties, primarily because of chronic diseases related to smoking, being overweight and high blood pressure.

Arkansas is a largely rural state, with the majority of its citizens classified as being part of the "working poor." For poor Americans who live in rural areas, very limited access to health care and lack of insurance contribute to a decrease in overall health, quality of life and life expectancy. In addition, poor health habits lead to an increased incidence of obesity, high blood pressure, heart disease, stroke and cancer, all of which contributed to increased mortality rates.

Ultimately, this information about inequalities in life expectancy portrays a different picture than once thought. While life expectancy has been rising in general, this does not necessarily filter down to all Americans. Some citizens consistently get left behind.

When analyzing the data correlating a lower life expectancy with where you live, it is clear that the issue is complex. Beyond mere health habits and medical care, economics, culture and access to information also play a role in how well and how long you live. In a recent study published in the journal Stroke, researchers found yet another link between income and health. The study showed that the poorest segment of the population is five times more likely to have a stroke than the wealthiest segment, who, despite being overweight and sedentary, have the lowest risk of stroke.

These studies should be a clarion call to everyone. Our broken health-care system must be reformed. The richest country in the world having a declining life expectancy is pure scandal. But we must stop turning to politicians, business and insurance companies for solutions.

The answer is more than just assuring that every American has health insurance. While this may help, it is only a small element of the solution. Health-care reform must be led by health-care professionals, by the people who work in the trenches, and by those who understand what it takes to solve our health crisis. We cannot leave it to politicians and lobbyists.

It is time to reform how we think about health care. First, we must only practice medicine based on sound scientific evidence of benefit. We must focus on prevention and health promotion; this strategy will have a far greater impact than spending millions of dollars on futile care performed at the end of life.

We must solve the problem of the disappearing primary care physician, who should assume a greater and more important role in coordinating all aspects of care. Physicians must be discerning in the tests they order, should use the most appropriate but least expensive medications and should assure that every procedure is clearly justified with proven evidence of tangible benefit. We must also take advantage of the tremendous technological resources, including telemedicine, that make it possible to monitor patients closely wherever they live.

The fact that mortality rates are rising in any American county is totally unacceptable and must be addressed immediately. Affordable, accessible and rational health care must be a right available to all Americans, no matter their social circumstance or where they live.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.

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