My research investigates the “social causes” of death and disease. I am particularly interested in educational attainment as a social cause, but I also examine gender, geography, and the intersection of these three causes. In my research I use data from large national surveys and analyze it with demographic and statistical methods.
My research has three main themes:
- Trends in Life Expectancy According to Education Level
- How U.S. States Influence the Health and Longevity of their Residents
- How Childhood Experiences Influence Health and Longevity in Adulthood
Scroll down to see a synopsis of each theme.
1. Trends in Life Expectancy According to Education Level
Gains in life expectancy in the U.S. have not kept pace with other high-income countries during the past three decades. While the U.S. used to be in the middle of the pack among high-income countries, it is now at the bottom or near bottom. The trends are particularly troubling for women, especially for white women without a high school credential. Their life expectancy has surprisingly declined since the mid-1980s.
The figure below illustrates the trends using mortality risk instead of life expectancy. The left panel shows that since the mid-1980s men’s mortality risk has declined for all education levels. In sharp contrast, the right panel shows that women’s mortality risk has declined only for college graduates: it remained steady for high school graduates and for women with some college, and increased among women without a high school credential.
The trends for black adults look similar to the figure above, although the rising mortality among black women without a high school credential is either not as pronounced or non-existent depending on the study. Trends for other race and ethnic groups are less certain due to a lack of good data and replicated studies.
So, why is the U.S. losing ground in its international ranking in life expectancy? Why have the trends in life expectancy been more troubling for women than for men? Why have they been especially troubling for lower-educated women? Is it possible to reverse these trends? My research addresses these questions. As a “big-picture” sociologist, I am more interested in the structural reasons for the trends than the proximal reasons. In other words, I am more interested in identifying the societal changes (e.g., the information economy) that have made education an increasingly vital resource for health than identifying the personal ways in which education affects health (e.g., smoking behavior).
2. How U.S. States Influence the Health and Longevity of their Residents
Life expectancy differs dramatically across U.S. states. In 2000, the “best” state had a life expectancy at birth that was 7.4 years longer than the “worst” state (Wilmoth et al 2011). Historically the differences across states have been larger among men than women, but since the 1980s the differences have grown more among women than men. Lately, researchers have become concerned about the growing differences in women’s life expectancy across the U.S.
Why does life expectancy differ so much across states? Is it because the characteristics of the people who live each state tend to differ? For example, some states have higher-educated populations than other states. Or is it because the characteristics of the states differ? For example, states differ in their tax policies, cigarette sales taxes, affordable housing, and Medicaid programs, among other differences.
In a study I recently published with Anna Zajacova and Mark D. Hayward (click here to read) we found that the characteristics of people AND states matter. But states matter much more for women’s mortality than for men’s. This makes sense given that, in the U.S., women are more likely than men to raise children on their own, live in poverty, interface with the public health care system, and face other such hurdles which make states’ resources and policies particularly important to their lives.
The slide show below illustrates the differences in women’s mortality across states.
- SLIDE 1: The center of each vertical line is the difference between the mortality for women in each state and the average mortality for women in the U.S. overall. States above the line have higher mortality than average; states below the line have lower mortality than average. The vertical bands around each line represent a 95% confidence interval around the estimated mortality for each state.
- SLIDE 2: If women in all states had the same characteristics–same age, race, education level, income level, employment status, and marital status–the differences between each state and the average state would would shrink somewhat.
- SLIDE 3: If in addition to women in all states having the same characteristics, all states had the same characteristics–for example, the same cigarette taxes, same Medicaid programs, same amount of income inequality–the differences in women’s mortality between each state and the average state would essentially disappear.
As states’ economic and policy environments continue to diverge, what will happen to life expectancy across the U.S.? Will the U.S. become an increasingly unequal society? Will people in some parts of the country die almost a decade sooner than people in other parts simply because they live and work in a state that has assembled a toxic mix of economic and social policies? Since all Americans cannot move to states that have a healthy mix of these policies, changes in social and economic policies must occur across local, state, and national governments.
3. How Childhood Experiences Influence Health and Longevity in Adulthood
Our experiences in very early life (for example, the prenatal environment, childhood nutrition, poverty, and parental divorce) can have lasting implications for health and longevity in adulthood. Sometimes these experiences matter simply because they shape our adulthood circumstances. For instance, a child raised in a poor family is less likely to graduate from high school than a child raised in a rich family; and not graduating high school can, in turn, severely limit opportunities for good jobs, a living wage, and social relationships. However, other childhood experiences matter because they leave a lasting imprint on our bodies and minds. A child raised in a poor family may get inadequate nutrition, experience physical abuse, and suffer from chronic stress: all of which can impede their physiological, social, and psychological development.
The figure below illustrates how one particular childhood experience-parental socioeconomic circumstances-may influence the number of healthy years U.S. adults can expect to live (a term often called “Healthy Life Expectancy”). It is based on research that I conducted with Mark D.Hayward.
The height of the bars represent the number of years a white man can expect to live without a physical health problem after age 50 (the patterns are similar for women and for black adults). The left-to-right axis shows the number of socioeconomic adversities (e.g., being raised by parents who were low-educated; being raised by parents who received welfare) a man experienced in childhood. The front-to-back axis indicates his educational attainment (less than high school, high school, more than high school).
The figure illustrates that experiencing socioeconomic adversities in childhood appears to have long-term consequences. These consequences occur regardless of whether someone goes on to achieve high levels of education as an adult. For example, at age 50 men who had achieved at least one year of college could expect to live an additional 14.4 years in good health if they had experienced no socioeconomic adversities in childhood. Their their college-educated peers who experienced 5+ adversities in childhood could expect to live just 11.0 more years in good health. Read more about this study: Click here.