I was a resident of Harlem when this graph was first published in the New England Journal of Medicine in 1980. Nobody- including me- could figure out exactly why lifespan in Harlem was less than Bangladesh, at the time the poorest country on earth. It is clear to me now, that the reason is that Harlem like most urban core areas in America are food deserts. At that time and now, there is no real food available in Harlem, only fast food, and processed foods in corner stores and poor quality produce in a supper market that specializes in corporate food products, not food. No real food means that the people who live in that food desert will be the victim of poor health and shortened life spans. Harlem needs hoop house agriculture.
Lifespan crisis hits supersize America
Robin McKie, science editor The Observer,
19 September 2004
Bloated, blue-collar Americans - gorged on diets of fries and burgers, but denied their share of US riches - are bringing the nation's steady rise in life expectancy to a grinding halt.
Twenty years ago, the US, the richest nation on the planet, led the world's longevity league. Today, American women rank only 19th, while males can manage only 28th place, alongside men from Brunei.
These startling figures are blamed by researchers on two key factors: obesity, and inequality of health care. A man born in a poor area of Washington can have a life expectancy that is 40 years less than a woman in a prosperous neighbourhood only a few blocks away, for example.
'A look at the Americans' health reveals astonishing inequalities in our society,' state Professor Lawrence Jacobs of Minnesota University and Professor James Morone, of Brown University, Rhode Island, in the journal American Prospect .
Their paper is one of a recent swathe of studies that have uncovered a shocking truth: America, once the home of the world's best-fed, longest-lived people, is now a divided nation made up of a rich elite and a large underclass of poor, ill-fed, often obese, men and women who are dying early.
In another newly published paper, statisticians at Boston College reveal that in France, Japan and Switzerland, men and women aged 65 now live several years longer than they do in the US. Indeed, America only just scrapes above Mexico and most East European nations.
This decline is astonishing given America's wealth. Not only is it Earth's richest nation, it devotes more gross domestic product - 13 per cent - to health care than any other developed nation. Switzerland comes next with 10 per cent; Britain spends 7 per cent. As the Boston group - Alicia Munnell, Robert Hatch and James Lee - point out: 'The richer a country is, the more resources it can dedicate to education, medical and other goods and services associated with great longevity.' The result in every other developed country has been an unbroken rise in life expectancy since 1960.
But this formula no longer applies to America, where life expectancy's rise has slowed but not yet stopped, because resources are now so unevenly distributed. When the Boston College group compared men and women in America's top 10 per cent wage bracket with those in the bottom ten per cent, they found the former group earned 17 times more than the latter. In Japan, Switzerland and Norway, this ratio is only five-to-one.
Jacobs and Morone state: 'Check-ups, screenings and vaccinations save lives, improve well-being, and are shockingly uneven [in America]. Well-insured people get assigned hospital beds; the uninsured get patched up and sent back to the streets.' For poor Americans, health service provision is little better than that in third world nations. 'People die younger in Harlem than in Bangladesh,' report Jacobs and Morone.
Consumption of alcohol, tobacco and food can also have a huge impact on life expectancy. The first two factors are not involved with America's longevity crisis. Smoking and drinking are modest compared with Europe. Food consumption is a different matter, however, for the US has experienced an explosion in obesity rates in the past 20 years. As a result, 34 per cent of all women in the US are obese compared with 4 per cent in Japan. For men, the figures are 28 and 2 per cent respectively.
'US obesity rates jumped in the 1980s and 1990s, and the vast majority of the population affected by obesity had not yet reached age 65 by 2000,' state the Boston group. 'As the large baby boom cohort begins to turn 65 in coming years, a stronger connection between obesity rates and life expectancy may emerge.'
In other words, as the nation's middle-aged fatties reach retirement age, more and more will start to die out. Life expectancy in the US could then actually go into decline.
Excess Mortality in Harlem
Colin McCord, M.D., and Harold P. Freeman, M.D.
N Engl J Med 1990; 322:173-177January 18, 1990
In recent decades mortality rates have declined for both white and nonwhlte Americans, but national averages obscure the extremely high mortality rates in many inner-city communities. Using data from the 1980 census and from death certificates in 1979, 1980, and 1981, we examined mortality rates in New York City's Central Harlem health district, where 96 percent of the inhabitants are black and 41 percent live below the poverty line.
SMRs) for deaths under the age of 65 in Harlem were 2.91 for male residents and 2.70 for female residents. The highest ratios were for women 25 to 34 years old (SMR, 6.13) and men 35 to 44 years old (SMR, 5.98). The chief causes of this excess mortality were cardiovascular disease (23.5 percent of the excess deaths; SMR, 2.23), cirrhosis (17.9 percent; SMR, 10.5), homicide (14.9 percent; SMR, 14.2), and neoplasms (12.6 percent; SMR, 1.77). Survival analysis showed that black men in Harlem were less likely to reach the age of 65 than men in Bangladesh. Of the 353 health areas in New York, 54 (with a total population of 650,000) had mortality rates for persons under 65 years old that were at least twice the expected rate. All but one of these areas of high mortality were predominantly black or Hispanic.
We conclude that Harlem and probably other inner-city areas with largely black populations have extremely high mortality rates that justify special consideration analogous to that given to natural-disaster areas. (N Engl J Med 1990;322:173–7.)
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From the Departments of Surgery, Columbia University and Harlem Hospital, New York. Address reprint requests to Dr. McCord at the