PUMPING IRONY: Location, Location, Location

Many factors affect our access to healthcare, but new research suggests that where we choose to live may actually enhance — or limit — our lifespan.

Map of United States

A good deal of controversy ensued last week after a 30-person medical team at Walter Reed Medical Center rescued a certain resident of The White House from the converging ravages of COVID-19. This septuagenarian official was airlifted by helicopter from his backyard to the hospital, where he was treated with experimental drugs, supplemental oxygen, and who knows what else while lounging in a luxurious suite of rooms and enjoying 24/7 monitoring. The cost to the patient: zero.

Medicare for all, anyone?

Anyway, it wasn’t just the free treatment — worth more than $100,000, according to the New York Times — that elicited widespread disdain among those of us who have to foot our own bills when they come due. The fact that the president received drugs that would not even be available to an ordinary geezer provoked pointed questions among medical ethicists.

His medical team requested the experimental drug, REGN-COV2, from Regeneron Pharmaceuticals under what’s known as “compassionate use” rules, designed for patients with life-threatening diseases who are unable to participate in clinical tests — during which they aren’t told whether they’ve been given the drug or a placebo. The FDA and drug company evaluate these requests on a case-by-case basis and must agree before the drug is administered.

Despite the fact that more than 210,000 Americans have died from the virus, fewer than 10 requests for REGN-COV2 have been approved.

“It’s not clear to me that this was an emergency situation,” Steven Joffe, MD, MPH, medical ethics chief at the University of Pennsylvania, told the Associated Press. “I think there is something wrong with the privileged, the president, getting special treatment that’s not available to the rest of us,” he added. “There’s so much injustice in our healthcare system, with so many people not even having access to the basics.”

The current pandemic has laid bare America’s jarring healthcare disparities, as people of color and the elderly have borne the brunt of the virus’s death-dealing blows. But well before the novel coronavirus arrived on our shores, demographers were tracking geographic trends that describe two Americas: one teeming with robust seniors, the other dominated by elders dying before their time.

Though the average life expectancy for a 65-year-old has inched steadily upward since 1950, those gains vary considerably based on where one happens to reside. And, as Judith Graham reports in Kaiser Health News, that gap has widened considerably in the past 20 years. Urban-dwelling seniors in California, Oregon, and Washington, for instance, live on average almost four years longer than those residing in rural Alabama, Kentucky, and Mississippi.

“People living in ‘interior’ regions — particularly Appalachia and the East South Central region — have done worse than those on the coast,” University of Pennsylvania demographer Samuel Preston, PhD, tells Graham.

The findings, based on a study Preston coauthored with Yana Vierboom, PhD, of the Max Planck Institute for Demographic Research, suggest that access to high-quality medical services — as well as income and cultural norms — explain the divergent lifespans.

Americans, on the whole, are living longer than they were 70 years ago primarily because we’ve become more adept at preventing and surviving heart attacks and strokes. But that trend has not extended to all regions of the country, Preston notes. “It’s likely that medical treatments for cardiovascular disease have disseminated more rapidly in large metro areas than in rural areas,” he says. Rural America simply offers fewer heart specialists and hospitals.

And that’s also where you’ll find most of the nation’s smokers. “There are large differences in smoking rates across the country,” Vierboom notes. Rural and Southern women, for instance, are more likely to light up than women living in major metro areas.

“Geographic differentiation isn’t random,” explains Eileen Crimmins, PhD, AARP professor of gerontology at the University of Southern California. “People who are poor, or who smoke, or who are obese tend to be concentrated in certain places.” And cultural norms tend to perpetuate these behaviors and contribute further to nationwide health disparities.

People settle in one place for various reasons: family, a job, the cost of housing, the weather. Sometimes random circumstances land you somewhere and it’s just inertia that keeps you there. But I suspect concerns about longevity do not often rise to the top of the list. So, while it might be tempting for this geezer to congratulate himself for planting his roots in a city where high-quality medical services (and a smoke-free culture) predominate, I know there’s no guarantee that my ZIP code alone will transport me effortlessly through my 70s, 80s, and beyond.

You do what you can to live well in this moment, despite the whims of fate and the capriciousness of our healthcare system. Sure, it might be nice to know there’s a taxpayer-funded team of doctors ready to leap into action at the first signs of a serious illness, but it also might feel a little weird. Besides, my backyard is way too small to accommodate a helicopter.

is an Experience Life deputy editor who explores the joys and challenges of aging well.

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