A recent study in the Journal of the American Medical Association demonstrated that the rich in the United States live, on average, 15 years longer than the poor, that there is considerable community variation in lower income life expectancy and that the rich/poor life expectancy gap has been increasing.

In San Antonio, ranked 91st on the study’s list of 100 large metro areas, the early death penalty for being poor is severe: an eight-year gap between the top and bottom income quartiles. Moreover, we compare poorly with other diverse, big cities. Life expectancy for low-income people in San Antonio is three years shorter than in Los Angeles, Miami or New York City, cities with similarly large Hispanic populations but without our extreme economic segregation.

Much of recent research, including the JAMA study, is motivated by the fact that, after almost 200 years of steady increase, the average life span of Americans is declining. Back in 2009, an article published in the New England Journal of Medicine, Childhood Obesity – The Shape of Things to Come, predicted that the explosive rise in Type II Diabetes, growing from approximately 5 million people in 1970 to now over 22 million, would bring about a 2-5 year decline in life expectancy by mid century.

diabetes in US from 1958 to 2011_credit CDC

Last year, an article in the Proceedings of the National Academy of Sciences presented evidence that, even among middle-aged whites, life span is decreasing.

Both national average life expectancy and variation in life expectancy across racial/ethnic, age and income groups are alarming. San Antonio should be particularly alarmed by its poor ranking, begin to seriously take steps to address local health inequities and target intervention to where it is most needed. A good first step would be to map out zip-code-to-zip-code variation in life expectancy. An excellent model for this is the Robert Wood Johnson website City Maps where life expectancy gaps of up to 14 years have been identified in some cities. Creating a local life expectancy map is important public information that the San Antonio Metropolitan Health District has the capacity to produce. It should do so without delay.


Top image: One of many food stands at the 100th Oyster Bake in April 2016.  Photo by Scott Ball.

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Dr. Thomas Schlenker, former San Antonio Metropolitan Health District director (2011-2015), is a pediatrician who spent many years caring for sick children in Wisconsin and Mexico as well as directing...