Last week, I wrote about a discouraging study led by Raj Chetty about the association between income and life expectancy in America. The study finds that from 2001 to 2014, “among the population in the bottom income quartile, the shortest life expectancy was found in Oklahoma and in cities in the rust belt, such as Gary, Indiana, and Toledo, Ohio.”
The New York Times coverage of the high-profile study adds, “places where poor citizens had long life spans also tended to have a high concentration of college graduates and high local government spending.” Also, some find an optimistic message in the study because it shows that “the right mix of steps to improve habits and public health could help people live longer, regardless of how much money they make.” Sure enough, the JAMA study recommends that health professionals “make targeted efforts to improve health among low-income populations in cities, such as Las Vegas, Nevada; Tulsa, Oklahoma; and Oklahoma City, Oklahoma.”
I was thrilled that my mentor, Sandy Ingraham, sent me much more hopeful research on improved health outcomes across America for poor young people. Ingraham has a long career dedicated to improving the lives of children, and she was inducted into the Oklahoma Women’s Hall of Fame. She sent me a study published in Science that shows targeted health programs are reducing mortality rates for teens and young adults.
The study’s co-lead authors, Janet Currie and Hannes Schwandt, find that death rates for all children declined and “the improvement was much more pronounced in the poorest counties.” Some excerpts of note:
It’s an important message, opposing the popular narrative of “Everything is getting worse.” It tells people that their tax money is not wasted. Going forward, we need to find out which policies were most effective and how to scale them up in order to maximize their positive impact on the lives of the poor.
It is important to emphasize that our results for middle and older ages are entirely consistent with those of previous studies such as … Chetty et al. … What is new here and more hopeful is the investigation of what is happening to death rates at younger ages.
The tragic decrease in life expectancy for poor undereducated middle-aged Americans in much of the nation contrasted with the improved health of younger poor people across the country is a complex phenomenon.
The increased death rates for older Americans — especially whites and women — is almost certainly rooted in the decline of economic opportunity, a lost sense of community, and dwindling hope as well as political and personal choices. Complicating the issue further, the rise of the global economy and immigration has probably contributed to the malaise of older Americans who once assumed that good-paying jobs would be open to them indefinitely. (Immigrants tend to be younger, however, and it is likely that immigration helps explains the good news regarding low-income youth.)
An educator’s perspective
I primarily approach these issues from an educational perspective. In doing so, I’m first struck by similarities between patterns in public health and schools. During the 1990s, especially when the economy picked up at the end of the decade, student performance increased significantly. Then, it slowed after the No Child Left Behind Act of 2001 and stopped around 2009 when Oklahoma (and almost all of the nation) adopted most of the market- and competition-driven agenda.
The Science study notes, “The improvements were strongest for young children between 1990 and 2000. For older children, there were also large declines in deaths between 2000 and 2010.” During this era, I would add, high school graduation rates rose dramatically, and violence declined markedly.
In education, as the New York Times Magazine’s Paul Tough explains, market-driven school reform was a legacy of “liberal PTSD” for supposedly losing the War on Poverty. Corporate school reformers were under the impression that old-fashioned liberalism and public health efforts were unable to make enough of a dent in child poverty, so they took a completely different approach to urban education: Rather than try to address the deficits caused by poverty that made it maddeningly difficult to improve inner-city schools, they imposed a series of incentives and disincentives that they hoped would would attract more entrepreneurial-style, data-driven school policies.
A tale of two studies
My previous piece didn’t address my longstanding concerns about the work of Chetty, the lead author of the JAMA study. Chetty is a MacArthur “genius” grant winner who conducts careful research but is less constrained in interpreting his data. Chetty pushes his education data far beyond what the evidence allows. Even in his more recent work on poverty and health, Chetty’s scholarship remains above reproach, but he overreaches when interpreting his findings. I argue that Chetty consistently downplays the roles of history and economics while overemphasizing the power of individual choice, rational thought, incentives and disincentives. He seems to seek a niche in academic debates where he emphasizes personal responsibility, not structural injustices, and he previously seemed to underestimate the great good that has come from bigger investments in social services, schools, public health and the social safety net.
Currie and Schwandt, however, offer a reminder of what old-fashioned liberalism did right, and Chetty doesn’t necessarily disagree with most of it. He cites the successes in Birmingham, Ala., where the life span for adults in the bottom quarter of income rose 3.8 years for men and 2.2 years for women from 2001 to 2014. That state expanded availability of preventive health care like vaccinations and mammograms, opened clinics in poorer neighborhoods, directed a portion of local taxes to hospital care for those who cannot pay, and banned smoking in restaurants and workplaces. These efforts were promoted by governments and philanthropies.
Similarly, Currie and Schwandt conclude, “health insurance, income support, anti-tobacco initiatives, and reductions in pollution really do make a noticeable difference at the population level, especially at younger ages.” The authors, “hope the results will encourage policymakers to take measures that promote public health.”
Hang together — or hang separately
We in Oklahoma can be forgiven for seeing our glass as half empty, even as the rest of the country’s glasses are half full. But, we take it too far when echoing The Oklahoman’s implicit complaint that the Oklahoma City Public School System’s graduation rate is “only” about 80 percent. Before MAPS for Kids, the OKCPS graduation rate was half as large. Even in an era of failed reform, we have seen the great benefits of mentoring programs and providing counselors who guide students to graduation. Were we to expand those efforts, we could build a community spirit that would also benefit the mentors and could thus improve the lives of older, at-risk Oklahomans.
During the last generation or so, Americans have set our sights too low. The Great Society and our social safety net worked far better than the win-lose, survival-of-the-fittest approach of recent decades. We need to reject today’s reward-and-punish mentality as unworthy of our democracy. We should also reject the corporate-reform tactic of pitting generation against generation, of “exiting” higher-paid veteran teachers and replacing them with low-paid 20-somethings struggling in today’s “gig economy.”
As Randi Weingarten, president of the American Federation of Teachers, reminds us, in our schools and our social services and politics, we should honor the Jewish concept of L’Dor V’Dor, or “from generation to generation.” If we hang together, the improved health outcomes of younger Americans will likely persist into their middle age, but if we allow our social fabric and community values to fray further, we will hang separately.