June 01, 2017

The Social Geography of Health

Headshot 3.13 cropcompressBy Karen Sternheimer

Where we live matters, but not just for the reasons we might think. While we might associate the weather or terrain with a particular region or location, it's also important to consider the social forces that help explain how where we live shapes our health and even our life expectancy.

A recent study published in the Journal of the American Medical Association details how life expectancies vary dramatically by county in the United States. For instance, if you are fortunate enough to live in Marin County, California, or Summit County, Colorado, your average life expectancy is about 87. But if you live in Oglala Lakota County, South Dakota, or in some parts of West Virginia and Kentucky, your life expectancy could be a full two decades shorter.

Several counties with shorter life expectancy actually saw declines in life expectancy between 1980 and 2014. Eight of the ten counties with reduced life expectancies are in Kentucky, which The Atlantic reported is a state with a high rate of death from drug overdoses. Drug overdoses don’t happen in a vacuum either; they might be associated with lack of economic opportunity and the stress that might accompany this bleak reality.

For instance, in Kentucky industries that once dominated the region, such coal mining and tobacco farming have been in decline, thus the economy in parts of the state has struggled significantly.

Economists Anne Case and Angus Deaton describe this phenomenon as “deaths of despair.” In their research, they found that since 1999, suicide and deaths due to drugs and alcohol for middle-aged whites without college degrees has increased.

While Case and Deaton note that these “deaths of despair” are on the rise across the country, there are particular connections with education and the economy that help us understand the link between death rates and where people live. As those areas that once had plentiful blue-collar jobs watch those jobs disappear due to globalization, entire communities suffer.

Even the hardest working individual might be out of work if the company they work for relocates to another country or goes out of business. For those with families to support—which sometimes includes both children and aging parents in the 45-54-year-old age group most affected in Case and Deaton’s research—leaving town and/or attending college might not be a possibility.

As you can see from the clip below, job loss affects entire families and their ability to send their kids to college, further impacting the opportunities for those in entire communities, not just individuals:

When economic downturns occur, people might not be able to afford to remain in their homes, which may drive down home values, causing further economic difficulty for those who remain. Leaving behind friends, extended family members, and religious congregations that make up our social support systems can also contribute to despair.

Social scientists consider the social geography of communities to understand how and why place matters. Patterns of illness and death rates are important aspects of social geography. Along with epidemiologists, sociologists study how environmental hazards may cause higher rates of illness, or how the number of physicians and hospitals in a given area may limit access to health care.

Social geography reminds us that we are not just separate individuals living in regions based on our family history or personal preference, but that the communities we live in profoundly affect us as well.

How has your region fared? To find out, take a look at the map here or here; the blue regions have experienced increases in life expectancies, while the orange and red have experienced declines since 1980. What, if any changes do you see in your part of the country? What broad patterns do you hypothesize might explain increases or decreases in life expectancy where you live?

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