This map, which I'm posting courtesy of the Incidental Economist blog, shows a trend that should concern anyone concerned about shortcomings in the American health-care system. But as IE guest blogger Bill Gardner points out, it's most likely a graphic illustration of something else: growing regional disparities in wealth, which not only reduce access to affordable health care but affect mortality in various other ways.
Red areas on the map show counties - a disturbing 42.8 percent of 3,140 U.S. counties - where female mortality actually rose between the mid-1990s and the mid-2000s, despite overall gains in average life expectancy. Nationwide, male mortality rates increased in just 3.4 percent of the same counties from the first study period, 1992-96, to the second study period, 2002-06 - in other words, before the Great Recession pushed more Americans into poverty.
Gardner, who obtained the data from a Health Affairs article by David Kindig and Erika Cheng, acknowledges the complex challenges of reading such trends. One factor undoubtedly depressing female life expectancy at the start of 21st century, for instance, is the spread of tobacco use among women. But Gardner, who also writes the Inequalities blog, was struck by the "strong regional pattern: just about every county showed had worsened female mortality in several southern states, while no county showed such decline in New England."
When I look at the graph, however, I am concerned not just about the women, but also about their children. The mental and physical health of mothers is a key determinant in children’s growth and development. What the map shows is that America has regions of communities with high concentrations of women experiencing substantial hardship. When women are not able to maintain their own health, how well can they nurture their children?
Gardner isn't the first to point out regional trends in poverty - or that America's poorest states are also politically "red" states, as even right-wing blogs have noted.
But it's worth noting that many of the states most resistant to Obamacare's Medicaid expansion are states also colored deep red by this map, because their female mortality has been rising, not falling. Pennsylvania, thankfully, shows only a handful of such counties, albeit during a decade when Pennsylvania was a standout for providing health-insurance coverage to poorer women and their children.
How will a map like this look a decade from now? Unfortunately, the answer may have more to do with retrogression in politics rather than progress in medicine.