Fifty years of economic changes have taken a severe toll on the health and longevity of less-educated Americans, according to a new study. Researchers found that the shifting economy has led to higher levels of chronic illness and shorter lifespans, particularly among those with lower levels of education.
Published in Epidemiology, the study, led by Arline Geronimus, a professor at the University of Michigan School of Public Health, examines the long-term effects of macroeconomic restructuring on health inequities. It highlights how the economic decline over several decades has exacerbated the health disparities between educated and less-educated Americans.
Geronimus and her team used data from 1990 to 2017 to investigate the impact of economic stagnation in different U.S. communities. They found that residents in economically struggling areas had life expectancies 1-2 years shorter than those in more prosperous regions, with the effects being especially pronounced among adults with lower education levels.
“These findings suggest that structural economic changes over the past half-century have had profound, long-term effects on health—especially for less-educated workers,” the study’s authors wrote.
The research revealed that the shift from stable manufacturing jobs to an economy driven by globalization and technological advancement has led to job losses, greater economic uncertainty, and heightened stress for less-educated workers. This, in turn, has contributed to a rise in chronic illnesses and a decline in life expectancy.
“The ability of less-educated workers to make ends meet, avoid food insecurity, or access needed health care has been consistently challenged since 1980,” said Geronimus. “In the face of prolonged economic hardship and social exclusion, these individuals engage in high-effort adaptive coping mechanisms, such as working multiple low-paying jobs. This intense effort, however, can cause significant physical strain, leading to cardiometabolic diseases and cancers.”
The study also debunks common narratives attributing the life expectancy gap to deaths from suicide or substance abuse. Instead, it points to higher mortality rates from chronic diseases like cancer, cardiovascular conditions, and metabolic disorders—conditions closely tied to the stress and hardships experienced by less-educated workers.
Geronimus emphasized that while the opioid epidemic is a critical issue in America, the primary drivers of the life expectancy gap are chronic conditions that result from economic instability. “It is important to recognize that such findings do not diminish the importance and devastation of the opioid epidemic,” she said. “However, other factors, such as the over-prescription of opioids and the increased availability of fentanyl, are significant contributors to the current crisis.”
The researchers argue that addressing the health crisis faced by less-educated Americans will require more than just individual health interventions. They advocate for policies aimed at improving economic opportunities and healthcare access for all workers, with a focus on reducing the effects of economic restructuring.
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