What Accounts for Mississippi's Very Low Life-Expectancies Exclusive!
The Fundamental Attribution Error argues that people will assume victims cause their own problems. For example, people might blame a person who is a little overweight for having a heart attack even though there are many explanations for heart disease. For example, family history also contributes to heart attacks. In addition, poor people may eat the cheapest food which is likely to be unhealthy. In some parts of the country, fast food dominates and it’s difficult to find quality foods like fruits and vegetables. People adopt unhealthy lifestyles in childhood that can be difficult to change. Some people are not exposed to information about the dangers of an unhealthy lifestyle. Public health messages can become lost in a sea of fast-food advertisements which use healthy looking people to sell their products. Medical conditions can contribute to obesity.
The Fundamental Attribution Error would suggest that reporters when reporting on explanations for causes of death would tend to give greater weight to personal factors (e.g., obesity or smoking) that blame the victim while ignoring external factors for causes of death (e.g., problems within the health care system, the addictive nature of cigarettes, advertising tobacco products to kids, more money being spent on promoting tobacco products than is spent on convincing children not to smoke, genetics, pollution, culture and misfortune). The same effect might even occur in researchers who focus their attention on individuals and not on organizations, systems and culture.
Mississippi has the lowest life-expectancy in the country (average – 74.8 years) and Hawaiian live an averaged of 81.5 years. Hawaiians live seven years longer, on average, than Mississippians. In some parts of Mississippi, the life-expectancy is much lower. The rural, poor and African-American counties along the Western edge of Mississippi have even lower life-expectancies (see Table 1 below).
The U.S. average life-expectancy is ranked 50th in world. But for these Mississippi counties, the average life-expectancy is similar to Bhutan which is ranked 158th in the world. That ranking is well below the rankings for North Korea, Iran and Iraq. On average people in these counties, live eight years less than the state average and nearly fifteen years less than the Hawaiian average.
So why do Mississippians die so young and do reports in the news media accurately convey that information to their readers? According to ABC news, even though we have better health care, it’s caused by Mississippian’s poor diets. Naked Capitalism, CNN, Discovery News, The Economist, Health Day and CBS cited a study that reported on changes in life-expectancies in the U.S. overtime. The authors of that study were quoted as stating that county-to-county disparities can’t be explained by ethnicity but by unhealthy lifestyles (e.g., smoking, obesity). However, these reports in the news didn’t cite any research that specifically looked at whether obesity explained health disparities in Mississippi counties with lower life-expectancies.
Another interesting aspect of these reports is that most of them just focused on one lifestyle factor—obesity. That focus might be consistent with the data but it’s also consistent with the Fundamental Attribution Error. People have frequently blamed and made fun of obese people. Among all the risk factors for disease, obesity is the Fundamental Attribution Error’s ideal choice for blaming the victim. Not one of these news reports even suggested that the health care system (e.g., lack of health insurance) might play a role and ABC news implied these people were receiving quality care. Many newspapers didn’t publish a story about the health disparities in Mississippi at all. However, the only source cited was a quote by an author of a study that did not investigate the cause of Mississippi’s problems. Most of the media didn’t comment on the problem at all.
According to the Fundamental Attribution Error, these news reports might be highly misleading exaggerations when they claim that high obesity rates are the cause of these Mississippi counties’ shockingly low life-expectancies. Therefore, The Impartial Review News decided to examine state and county level data to determine if obesity and other lifestyle factors really are the culprits for the low life-expectancies. While we began our investigation, we also looked for other news reports that looked at this data since reports of low life-expectancies had been around for years. We didn’t find any.
There are a number of factors that can influence life-expectancy including access to care, the quality of the public health care system and pollution. In addition, life-expectancies can vary by gender, ethnicity and wealth. For example, the report from the Institute for Health Metrics and Evaluation (IHME) that was cited and quoted by most newspapers found
" Across US counties, life expectancy in 2009 ranged from 66.1 to 81.6 years for men and 73.5 to 86.0 years for women. From 1989 to 2009, life expectancy for men improved by 4.6 years on average but only by 2.7 years for women.
In 661 counties, life expectancy has stopped dead or went backwards for women since 1999."
In 2011, government analysts ranked Mississippians as having the least healthy lifestyles. Mississippi ranks 47th for eating fruits and vegetables, 49th in terms of smoking, 50th for obesity, 50th for physical activity, 48th for cholesterol, 49th for high blood pressure, 47th for strokes, 49th for diabetes, 47th for heart attacks and 29th in heart disease.
The results in Table 1 are adapted from data from the CDC and Kaiser fund data. The table shows why some experts have suggested that obesity is the problem in poor Mississippi counties. Compared with other counties in Mississippi and nationally, these counties have very high rates of diabetes, obesity and physical inactivity. The last column in the table shows the average number of years of life in these counties which more than ten years less than the national average of 78.5 years.
Table 1 Physical Activity, Obesity and Diabetes
County – Obesity1 Inactivity2 Diabetes3 Life4 Bolivar – 39.2% – 31.1% – 13.3% – 67.8 Coahoma – 45% – 36.1% – 14.7% – 66.9 Holmes – 40% – 35.4% – 14.1% 67.2 Jefferson – 44.9% – 37.2% – 15.3% – 67.9 Quitman – 44.1% – 34.8% – 15.1% – 66.1 Sharkey – 40.2% – 35.2% – 13.3% – 67.6 SunFlower – 41.4% – 34.6% – 14.4% – 67.3
1 Percentage of county that is obese
2 Percentage of county that is physically inactive
3 Percentage of population diagnosed with diabetes
Although Mississippi as a whole was associated with high numbers of fast-food outlets and few places to buy fresh fruits and vegetables, this problem was not present in the counties with the lowest life-expectancies, perhaps because they were designated as rural counties by the 2010 census where farm fresh food is available.
Sexual behavior is also a lifestyle factor not mentioned in prior news reports. Mississippi has the highest teen birth rate, and ranks last in infant mortality, low birthweights, premature infants and preterm births. Infant mortality and low birthweights are associated with younger mothers. Furthermore, African Americans in Mississippi are dying from AIDS at a rate 64 percent higher than the nation’s average.
The Mississippi state data isn’t consistent with the obesity is the only big problem idea that was suggested in the newspaper reports. In fact, other lifestyle factors appear to be equally important such as smoking, physical activity, high quality food, sexual behaviors and violence. When all of these factors are presented together it also suggests that perhaps the problem relates to a culture under duress or the result of a low quality public health system that isn’t helping people to change their lifestyles. However, other aspects of Mississippi’s public health system appear to be working across the state Mississippi which ranks tenth for immunizations, fourth for binge drinking, 13th for early prenatal care and 16th for violent crime.
Also, the state data suggests that factors unrelated to lifestyle contribute to mortality in Mississippi. Mississippi ranks 41st in terms of air pollution and 43rd in occupational fatalities. The county data also isn’t completely consistent with the obesity and/or lifestyle hypothesis. These counties report excessive deaths due to heart disease, cancer(not-lung), kidney, blood poisoning, hypertension, homicide and diabetes.
Did local newspapers in those poor Mississippi counties shed any light on the issue? Citing state and local experts, a Bolivar county newspaper agreed with the national newspapers. However, this news report cited several public health officials who blamed the issue on several other factors beyond their control including claiming that perhaps the data wasn’t very good. However, as the reporter noted these statistics have been consistent over time and across counties that share borders. The officials also suggested that younger and healthier people are leaving which leaves behind a sicker population. Census data indicates there has been over a 10% decline in the population in these countries between 2010 and 2000. However, leaving a community is correlated with having income and a job. Therefore, it might be that wealthier people with better insurance are leaving and therefore those without insurance are left behind. That was an issue apparently overlooked by state officials.
Poverty also influences life-expectancy. The poor live five years less on average. According to Wikipedia, Monaco has the world’s highest GDP nominal per capita at $172,676 and GDP PPP per capita at $186,175. Monaco also has the highest life-expectancy in the world. Those who live the longest in the U.S., live on some very expensive real estate Hawaii. Mississippi also ranks 50th among the states in terms of personal income per capita and median income, and it ranks 1st in child poverty.
Poverty can create health care access problems and lower the quality of care. Mississippi ranks 44th for lack of health insurance, 48th in preventable hospitalizations and primary care physicians(82.2 per 100,000 people compared with 149 nationally), 35th in checking for cholesterol and 49th for annual dentist visits. National Public Radio(NPR) also suggested that obesity was the problem in Holmes County. However, they also pointed out that poor people often choose the least expensive foods which are also the foods linked to obesity. Clearly, poverty creates greater lifestyle problems but what NPR missed is that it also creates problems with the quality of health care services that one receives.
The county-level results suggest that obesity and lifestyle are not the only reason for these counties’ low life-expectancies. Table 2 looks at access to care and water quality in these counties. Data on water quality was from the EPA. The data suggests that lack of access to health care is a big problem in these counties. In addition, nearly 30% of the population is uninsured. Also, the data show that when one goes to the hospital, one is likely to go for reasons that could have been prevented. The number of preventable hospitalizations is more than double and in some cases triple the national average. Women received 25% less mamographies in these counties. These counties averaged 192 physicians less per 100,000 residents than the national average. In the Delta, which includes most of the counties with the highest mortality rates, the Mississippi Department of Health estimates that half of H.I.V.-positive Mississippians currently don’t receive treatment. Lack of access to care wasn’t mentioned in any of the newspaper reports.
The drinking water in these counties is polluted and inadequately monitored. Water quality data for these Mississippi counties is out of date. Yet, Mississippi has a record number of water quality violations since 2004 (see Table 2).
One possibility for the lower quality care is that Mississippi spends less on it’s health care. However, Mississippi spent more than eleven other states on health care per capita. For example, Utah spent $1,500 less yet had significantly better outcomes: life-expectancies in Utah were five years longer. In 2012, Mississippi state and local governments spent 28% of their budgets’ on health care.
Table 2: Access to Healthcare & Water Quality
County – Access1 Water2 Uninsured3 Hosp4 Mam5 Bolivar – 125.9 – 61 – -27% – +76 – -24% Coahoma – 145.3 – 66.9 – 28% – +85 – -26% Holmes – 77 – 27 – 30% – +32 – -23% Jefferson – 44.9 – 33 – 23% – +89 – -29% Quitman – 60.8 – 33 – -29% – +135 – -31% Sharkey – 61 33 – 29% – +55 – -16% SunFlower – 37.4 – 33 – 31% – +75 – -31%
1 Number of physicians/100,000. National average is 271.
2 EPA water score. A higher score is better. National average is 55.
3 Percentage of county without health insurance
4 Number of preventable days hospitals above national average of 49
5 Percentage of county receiving mamographies – national average(74%)
The Environmental Working Group found violations relating to drinking water were far greater than they were in the rest of the country. Since 2004, they found that there had been 23,125 violations for failures to monitor water quality regularly and 1,690 violations for failure to report information to public and state agencies. There were 558 violations for water having too many contaminants and 268 violations relating to national primary drinking water regulations. There were 485 violations for failure to monitor for the Coliform bacteria and 70 repeated failures. There were 60 violations for failures to report information to the public.
These data suggest that Mississippi has less concern about its water quality than other states. Even New York with a population more than five and half times greater than Mississippi had fewer EPA water violations. Most states had 1/10th as many violations. Furthermore, most cities provide data about water quality. However, cities in these counties didn’t. According to water quality.org, cities within these counties have some of the worst quality water in the country that includes high levels of radium and uranium. According to water quality.org, Mississippi ranks 49th in water quality. In terms of water quality, out of 2,379 counties, Coahoma County ranks 2,370th, Bolivar County ranks 2,316st and Sunflower County ranks 2,308th. As noted above, cancer rates are very high in these counties.
In August, a former operator of several waste water and drinking water systems in North Mississippi, was sentenced to probation for a period of five years, including six months of home confinement with electronic monitoring and was ordered to pay restitution in the amount of $34,900 following a guilty plea to one count of submitting false material statements in regard to the operation of various publicly owned waste water treatment facilities and public drinking water systems and to one count of failing to establish and maintain records, make reports, and sample effluents as required by the Clean Water Act. According to the Justice Department, these actions threatened water quality and drinking water safety.
Table 3 shows that some pollution levels in the state of Mississippi are close to national averages. However, pollution rates in the counties in the table are much higher.
Table 3. 2005 EPA National-Scale Air Toxics Assessment Risk Estimates
County ~ Cancer ~ Neuro ~ Res. ~ Form. MISSISSIPPI ~ 54% 70% 31% 62% BOLIVAR ~ 78% 72% 64% 64% COAHOMA ~ 98% 99% 69% 64% HOLMES ~ 71% 68% 65% 69% JEFFERSON ~ 71% 50% 62% 70% QUITMAN1 ~ 78% 77% 63% 68% SHARKEY2 ~ 44% 89% 63% 89% SUNFLOWER ~ 75% 54% 58% 63%
Neuro. = Neurological Problems
Res. Respiratory Problems
Form. = Formaldehyde Formaldehyde may cause respiratory problems and cancer.
1 EPA used Tallahatchie county assessments for this estimate
2 EPA used Washington county assessments for this estimate
In Table 3, percentages are percentiles ranking of counties and States from 0 (lowest) to 100 (highest) except for Formaldehyde which is an estimate of the probability that cases of cancer will develop.
Prior newspaper reports also claimed that ethnicity wasn’t an issue. However, over 60% of the people in these counties are African-American. These counties appear to be a classic example of institutional racism.
So what is the solution to Mississippi health problems? Recently, a New York Times article suggested adopting a community health model that insures equal treatment for everyone regardless of income. Similar models have worked in the U.S. for violence prevention. That is, you have to have a model that targets the people who need care and a system that doesn’t divert money elsewhere.
You can click here for an interactive map of all U.S. counties to find out about the life-expectancy in your county.
You can click here to find out about your water but don’t forget about the people living in Mississippi.
by Todd Miller
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