Dr. Ali Mokdad from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington presents the latest U.S. County Life Expectancy estimates from 1989 to 2009, at the Association of Health Care Journalists conference in Atlanta, GA, April 19, 2012.

1. Latest life expectancy estimates by
county reveal big differences
nationwide
April 19, 2012
Ali H. Mokdad, PhD
Professor, Global Health UNIVERSITY OF WASHINGTON

2. Outline
How does US health compare globally?
How do local health outcomes compare to each
other and compare to global outcomes?
Are disparities getting better or worse?
What is driving these disparities?
Summary and road map
What can be the media’s role?
Tools demonstration
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3. Outline
How does US health compare globally?
How do local health outcomes compare to each
other and compare to global outcomes?
Are disparities getting better or worse?
What is driving these disparities?
Summary and road map
What can be the media’s role?
Tools demonstration
3

4. How does US health compare globally?
1. US spends the most on health and medical care in the
world: 16.2% of GDP
2. The vigorous debate on health reform follows three
themes:
• Lack of insurance
• Rising costs
• Poor outcomes
3. But how are we actually doing?
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5. Adult mortality trends: US, Australia, Japan
Females Males
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6. Outline
How does US health compare globally?
How do local health outcomes compare to each
other and compare to global outcomes?
Are disparities getting better or worse?
What is driving these disparities?
Summary and road map
What can be the media’s role?
Tools demonstration
6

7. Life expectancy by county
IHME’s county life expectancy estimates take CDC
mortality data and use small area measurement to find:
• County trends by sex
• County trends by race (black and white)
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8. Life expectancy for men nationwide
1989
2009
1999
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9. Life expectancy for women nationwide
1989
2009
1999
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10. Within states, there are wide gaps
Women in Fairfax, Virginia, have some of the best life
expectancies in the US.
Women in Greensville and Sussex have among the
worst.
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11. Urban progress
Rates of change in life expectancy (in years), 1989-2009
State County Men Women
Black White Black White
NY NEW YORK 17.1 12 9 6.1
CA SAN FRANCISCO 15.5 10.9 6.6 4.4
DISTRICT OF
DC COLUMBIA 10.4 7.9 6.1 4.2
GA FULTON 10.4 7.7 5.7 3.7
FL MIAMI-DADE 9 6.7 6.5 4.6
CA LOS ANGELES 8.3 6.2 6.1 4.3
IL COOK 7.7 5.8 5.5 3.7
TX HARRIS 7 5.5 3.9 2.6
UNITED STATES 7.4 4.2 4.7 2.2
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12. Counties vs. nations: men, 2009
Greece (77.3)
90% of counties
(66.3-77.1)
Cuba (76.9)
87% of counties
(66.3-76.9)
Syria (72.5)
22% of counties
(66.3-72.5)
Iran (70.3)
6% of counties
(66.3-70.4)
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13. Outline
How does US health compare globally?
How do local health outcomes compare to each
other and compare to global outcomes?
Are disparities getting better or worse?
What is driving these disparities?
Summary and road map
What can be the media’s role?
Tools demonstration
13

14. Women losing ground with each decade
Life expectancy for women in 661 counties either
stopped dead or went backward from 1999 to 2009.
For men, that happened in 166 counties.
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15. Widening disparities
Gap between best- and worst-performing counties
Year Men Women
1989 14.7 years 8.7 years
1999 15.4 years 9.3 years
2009 15.5 years 11.7 years
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16. Best- and worst-performing counties, women
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17. Black Americans have improved rapidly
Between 1989 and 2009, life expectancy for black
American men improved by 7.4 years, compared to
4.2 years for white men
Gap between black men and white men shrinking
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18. Outline
How does US health compare globally?
How do local health outcomes compare to each
other and compare to global outcomes?
Are disparities getting better or worse?
What is driving these disparities?
Summary and road map
What can be the media’s role?
Tools demonstration
18

19. What are the drivers of these trends?
Socio-economic inequalities
Lack of financial access to health care
Poor quality of care
Preventable causes of death
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20. Socio-economic status and health
• Compelling evidence that individual and community
socio-economic status is a powerful determinant of health
mediated through multiple mechanisms
• Progress on increasing educational attainment, reducing
poverty, decreasing discrimination, reducing inequality
will have health benefits
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21. Lack of financial access
• Central topic in US health care reform
• Lack of insurance clearly creates barriers for primary
care, acute care, and long-term management of chronic
diseases
• Lack of insurance not distributed uniformly in the US
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22. Quality of care
• Large variations in quality of care across
race/ethnicity, socio-economic status, and communities
• Time from onset to intervention
• Effective coverage
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23. Preventable causes of death
• Evidence for at least 12 risk factors is strong enough that
the burden of disease for each can be assessed for US
• Cohort studies and intervention trials provide strong
evidence on the relative risks of death associated with
these risk factors
• Community surveys provide information on exposures
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24. US deaths attributable to major risk factors,
2005
Danaei et al., 2009 PLOS Medicine
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25. Hypertension prevalence
Adults 30+, 2009
SBP ≥140 mm hg and/or self-reported antihypertensive medication use

26. High cholesterol prevalence
Adults 30+, 2009
Total serum cholesterol ≥240 mg/dL and/or prior diagnosis

27. Declining improvements in women
Change in life expectancy, 1989-2009
Men Women
4.6 years 2.7 years
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28. Lung cancer mortality rates in the US
(per 100,000)
80
70
60
Lung Cancer Mortality Rate per 100,000
50
40
Males
Females
30
20
10
0
1980 1985 1990 1995 2000 2005 2010
Year
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29. Diabetes: prevalence, diagnosis, and
treatment, ages 35-64
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30. Outline
How does US health compare globally?
How do local health outcomes compare to each
other and compare to global outcomes?
Are disparities getting better or worse?
What is driving these disparities?
Summary and road map
What can be the media’s role?
Tools demonstration
30

31. What does this all add up to?
1. Regardless of the metric of population health, the US
performs poorly relative to other high-income countries.
2. The US and most of its communities are steadily falling
behind each year compared to high-income nations.
3. Females are falling behind faster than males in most parts of
the country.
4. Large disparities exist across the US.
5. Disparities are worsening.
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32. What should be done?
• Provide local data and burden of disease
• Focus on preventable risk factors
• Engage medical providers in accountable care
• Fund local strategies to cut risk factors
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33. Outline
How does US health compare globally?
How do local health outcomes compare to each
other and compare to global outcomes?
Are disparities getting better or worse?
What is driving these disparities?
Summary and road map
What can be the media’s role?
Tools demonstration
33

34. A tornado hits Oklahoma and makes headlines
Photo by Niccolò Ubalducci
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35. Health disparities should be news, too
Percentage of counties that are above the US national
average for male life expectancy
Why should Iowans live longer than Oklahomans?
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36. Lifespans: King County vs. Fulton County
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37. Media’s role
1. Keep all of us honest
2. Focus the debate on what really matters
3. Ask the hard questions:
• Why do we have such disparities?
• What are you doing about it?
• Where are the success stories?
4. Focus on science and ignore politics
5. Get the word out
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38. Outline
How does US health compare globally?
How do local health outcomes compare to each
other and compare to global outcomes?
Are disparities getting better or worse?
What is driving these disparities?
Summary and road map
What can be the media’s role?
Tools demonstration
38

39. Data visualizations
Highest and lowest life expectancy by county and sex (US), 1989-2009
http://www.healthmetricsandevaluation.org/tools/data-visualization/highest-and-
lowest-life-expectancy-county-and-sex-us-1989-2009
Life expectancy by county and sex (US) with country comparison (Global),
1989, 1999, 2009
http://www.healthmetricsandevaluation.org/tools/data-visualization/life-
expectancy-county-and-sex-us-country-comparison-global-1989-1999-2009
Life expectancy by county and sex (US), 1989-2009
http://www.healthmetricsandevaluation.org/tools/data-visualization/life-
expectancy-county-and-sex-us-1989-2009
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40. Thank You
For more information:
www.healthmetricsandevaluation.org
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