The Great Health Divide

By Alex Piazza
apiazza@umich.edu

Life expectancy for women in the United States is 81 years.

Men average 76 years. So why do men live five years fewer than women?

For starters, men are less prone to seek medical treatment. Testosterone increases aggressive behavior in men, which leads to higher death rates from accidents and homicide. And research shows men are two times more likely than women to abuse drugs.

“Gender differences in mortality are mainly behavioral, and thus preventable, as they are learned in society and manifested in high-risk behaviors,” said Shervin Assari, a University of Michigan researcher who explores how gender, race and socioeconomic resources influence health. “It’s not in our genetics. It’s learned socially and it can be unlearned.”

With support from the National Institutes of Health, Heinz C. Prechter Bipolar Research Program and Richard Tam Foundation at the U-M Depression Center, Assari has pored through several national surveys to identify health disparities among men and women, whites and blacks, rich and poor.

His findings, which have been published in nearly 200 journal articles over the past decade, help shape how society looks at health.

Stressed Out

How do you deal with stress?

The answer could depend on your social status.

Life expectancy of white Americans is three years longer than black Americans. But when it comes to depression, anxiety and suicide, white Americans fare much worse.

“White Americans seem to be more vulnerable to certain psychosocial risk factors for a wide range of physical and mental health outcomes compared to other groups,” Assari said. “In other words, black Americans have better adapted to life tasks in the face of highly adverse conditions.”

Low education is a prominent stressor, so Assari drew on data from the Americans’ Changing Lives study to identify the effect low education has on mortality risk. The study, which is affiliated with the university's Institute for Social Research, followed about 4,000 Americans for 25 years—from 1986 until 2011.

In a study published in 2016, Assari found that people without a high-school diploma had a 20 percent higher risk of mortality over 25 years when compared to people who graduated from high school. When distinguished by race, though, his research shows the risk of mortality associated with low education is 30 percent larger for white Americans.

“Population groups differ in how resilient they are when they face stress and other adversities,” he said. “Although white Americans are, on average, the healthiest group, they are also far less resilient than black Americans. I see vulnerability as a cost of privilege, and resilience as a gift of adversity.”

Beyond race, Assari also looked at how stress impacts men and women. Assari examined data from the Americans’ Changing Lives study to analyze how stressful life events reported by men and women in 1986 influenced their depression rates 25 years later.

Research shows the effect of each life stressor on the risk of clinical depression was 50 percent stronger for men than women.

“Gender influences our risk of depression through various ways,” he said. “It determines our risk of exposure to adversity, it changes our vulnerability to stress and it also can shape what resources we can access to cope with depression.”

Employment Line

A job can do wonders for your health.

But like stress, the benefits of employment could depend largely on your social status.

In the United States, research shows white men reap the most health benefits from employment—particularly those who are most educated.

“Employment lowers the overall risk of mortality, though its protective effect is far from equal across population groups,” Assari said.

The effect of employment on health is due to income, less stress, better health behaviors and improved access to medical care.

Researchers reviewed 42 academic studies that together followed more than 20 million people, and the data show unemployment is associated with a 40 percent increase in the risk of mortality.

Assari again turned to the Americans’ Changing Lives study to test that notion. Here's what he found:

• Health gain from employment was 39 percent smaller for black Americans compared to white Americans
• Health gain from employment was 36 percent smaller for low-educated people compared to those with high education
• Health gain from employment was 30 percent smaller for women compared to men (In 2015, women earned 83 percent of what men earned, according to a Pew Research Center analysis of median hourly earnings of both full- and part-time U.S. workers)

And if unemployed, men lose more life expectancy than women.

“Our recent findings suggest that white men’s health, more than others, depend on resources, and that their health would decline faster than other groups if they lose the privilege they are benefiting from,” Assari said. “White men would do worse under the same adversity that other populations are living in. Understanding these gaps and the reasons for them might give us a better understanding of the social causes behind them and possible solutions.”