Southern Women Living Shorter Lives

Women in the southern part of the U.S. are dying earlier than before, according to a new study of life expectancy among women in the deep south and lower Midwest. The study's lead author, Dr. Christopher Murray, explains the findings. And Dr. Wendy Klein, who specializes in women's health, discusses what could be causing the change.

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MICHEL MARTIN, host: I'm Michel Martin and this is Tell Me More from NPR News. Coming up, he became a voice for American families long before he had one of his own. Senator Chris Dodd talks about why he's been fighting for family leave and other family-friendly policies. And, Part Two of our conversation with the former U.N. Ambassador, Andrew Young, about why he has turned his attention to Africa.

But first, the kind of news we do not expect to see in the United States. A new report says that for the first time in almost a century, life expectancy is falling for a significant number of women. In nearly a thousand counties that are home to 12 percent of American women, life expectancy is now shorter than it was in the early 1980s. The study also found a decline in life expectancy for some men, but in fewer places, for a smaller percentage of men.

The study was led by Dr. Christopher Murray, a physician and professor at the University of Washington, and he's with us to talk about it now, and we're also joined by Dr. Wendy Klein, professor emeritus of medicine obstetrics and gynecology at Virginia Commonwealth University. I welcome you both. Thank you so much for speaking with us.

Dr. WENDY KLEIN (Specialist, Women's Health, Virginia Commonwealth University): Thank you for having us.

Dr. CHRISTOPHER MURRAY (Lead Author, Life Expectancy Among Women Study, University of Washington): Thanks for having us.

MARTIN: Dr. Murray, as I understand it, we haven't seen a decline like this since the Spanish flu epidemic at the turn of the century. What is behind this? Why is this happening?

Dr. MURRAY: Well, it's - the details of why it's happening in some places and not others - one way to address that is to ask, what are the causes of death behind this? Why are more women dying? And if you drill down and look at it, it's a rise in death rates from diabetes, other chronic diseases, chronic lung disease and lung cancer. And so then, of course, the next question is, why are those going up? And to answer that question, we have to go some of the root causes behind the rise of chronic disease in the country.

MARTIN: Why - and some of the places where this is most pronounced are the deep South, Appalachia, lower Midwest, and one county in Maine. Why these places and not others?

Dr. MURRAY: Well, in fact, this pattern of rising death rates in young and middle-aged adults, adult women, from chronic conditions, is more general. It's happening all over the country. The reason life expectancy is dropping in those particular counties is that in the rest of the country this adverse health trend is being masked by continued progress and reducing heart disease, but - where life expectancy is dropping, the reduction in heart disease is not enough to make up for the fact that these other causes of death are going up.

MARTIN: And finally, well, not finally, because we're going to ask you to stand by, but why are women more profoundly affected than men?

Dr. MURRAY: Well, I think there's three reasons behind that. First, the decline in heart disease is still bigger in men, so there's more masking going on in men. Secondly, women, they start to smoke more, and men's smoking went down. So, the gap between men and women in terms of the smoking has been narrowing. We're seeing the effect of smoking showing up now.

MARTIN: I'm sorry, Dr. Murray, we're having a little trouble with your line, so I'm going to talk to Dr. Klein for a few minutes and let's see if we can call you back and get a little clearer line. So, if you'll just stand by for a minute.

Dr. Klein, anybody who works with specific groups notices things. I notice that when I went to my college reunion a while back, I noticed that I thought a disproportionate number of my classmates had died of strokes or heart attacks, and I was wondering to myself, what's going on here, given their ages and what I thought should have been their relatively good health? So, as a person who's worked in women's health for all these years, particular in areas like the ones in the study, have you noticed this or were you surprised by these findings?

Dr. KLEIN: Actually, I was not surprised. You know, it is well established - this reflects disparities that have long been identified. The literature, the medical literature, is replete with studies that tell us that health outcomes are worst for those who are the least educated and those in the lowest socioeconomic strata. It's been well known. We know that smoking rates, prevalence of smoking in the United States has declined in general, but among people who are the least educated, in particular women, they are three times as likely to smoke as those who are in higher socioeconomic strata and who are better educated. We know this. It's not new. There's been a lack of attention to those people who are the most vulnerable.

MARTIN: If you're just joining us, we're talking about new findings that suggest that life expectancy for a significant number of women in the U.S. is actually falling, and we're talking with one of the authors of the study, Dr. Christopher Murray, and women's health expert, Dr. Wendy Klein. And Dr. Klein, I wanted to ask you, is it your take that - is it tobacco or obesity that you think is the most prominent factor here? Smoking or obesity?

Dr. KLEIN: Great question. Great question. Tobacco is a toxin that I can tell you that the leading cause of cancer death in women is lung cancer, that women who smoke have a ten times risk of dying of chronic obstructive pulmonary disease, COPD, which is one of the factors, one of the causes of death that Dr. Murray identified. We're seeing this now because this is the end effect of the fact that women have been now smoking for a couple of decades. Obesity, as you know, is epidemic, and again, the prevalence of obesity is greatest among those who are most disadvantaged. You know, fast- food is cheap food.

MARTIN: But talk to me about smoking for a minute. We've had decades of public advocacy against smoking. Is the message not getting through to this particular population, or do you think that there are some reasons why these women are not able to heed it?

Dr. KLEIN: Both. We are not reaching the people who need to hear the message, the women who need to hear the message, and also, we are only just beginning to understand sex and gender-based differences in health and disease. If we have - we have hundreds of years' worth of data that's based on the male model, but women are not small men, and we only have just a decade or two of research that's helping us to understand these differences.

MARTIN: And why do you think that the - there is such a significant difference between the U.S. and our sort of peer countries like Canada or Japan or even Western Europe?

Dr. KLEIN: I think that is because our model of health care is an illness-based model rather than wellness-based model. We put a lot of money into acute care and critical care, and not enough into prevention. And the prevention - go ahead.

MARTIN: No. I was going to ask you. So, as a doctor, you're both a professor who looks at these things, an academic who looks at these things, and you also see, sort of, patients. How do you deal with this with patients, given that there seem to be high hurdles to people actually following the advice that we know they should follow, right? It seems to be harder for people to modify their behavior than we'd like it to be. How do you handle that?

Dr. KLEIN: Very much so. You know, it's using the platform that we're given as health-care providers. I mean, it is imperative that we use that platform much more aggressively to reach out, again, to young women. As you well know, the media makes smoking look attractive. Smoking is still marketed heavily. And we know that women, in particular, are vulnerable to peer pressure. So there are certainly better ways that we can reach out to the communities, but also, we are - we need to continue to foster research that helps us understand the differences, and why women struggle, what are the other issues. You now, I have to quote, also, paraphrase Marian Wright Edelman, who once made a very powerful statement.

MARTIN: Who's the founder of the Children's Defense Fund, a children's advocacy organization, for those who don't know.

Dr. KLEIN: Yes. And she once said something to the fact - of the fact that we live in a time of painful discordance between our capacity to prevent disease and our political will to do so. I think that really sort of points to the issue. We are still promoting smoking. And we are still - it is being marketed to young women. And clearly, especially among disadvantaged women, the prevalence of smoking is greater. And we're seeing the end effects smoking makes. Cardiovascular disease worse, makes diabetes worse, heightens the risk of peripheral vascular disease, obviously leads to lung cancer, leads to COPD, Chronic Obstructive Pulmonary Disease, these are all the causes of death that Dr. Murray identified.

MARTIN: Obviously, there's no quick fix for people when you have a situation in this broad of an area, with this significant result from these behaviors. But what would an initiative to address this look like to you?

Dr. KLEIN: What a difficult question. You know, it's tricky. Change takes time and money. It takes reaching out to communities. It takes community engagement. We have an unfortunate situation where women's health is somewhat politicized. And for example, there was a network of Centers of Excellence in Women's Health, of which 11 were in rural areas. And many were based in communities. There was a network around the country that had been begun in the '90s and grew and was very effectively reaching out into underserved communities. They were de-funded. All 48 of them were de-funded this past fall by the Department of Health and Human Services.

MARTIN: Because?

Dr. KLEIN: Good question.

MARTIN: Well, we - I have Dr. Murray back with us. And so, Dr. Murray, briefly, we're talking about what kinds of - obviously, there's no quick fix for a problem like this - but what would you like to see? What would a public health initiative to address something like this look like, in your view?

Dr. MURRAY: I think the response here is somewhat clear, because it's both a combination of public health interventions around tobacco and obesity, but also, if you look at the root causes in women, in these target communities, hypertension, cholesterol and high blood sugar are as important. And that's really, probably the most effective routes to tackle those issues are through better primary health care. So it's not simply a question of, you know, promoting public health or healthier lifestyles. It's also a question of addressing the fact that, you know, 60 percent of women with high blood pressure are untreated, and another 20 percent of 100 percent are poorly treated. Those types of opportunities mean that targeted intervention to the communities where things are getting worse, I think, are likely to succeed.

MARTIN: We're going to have to leave it there. Dr. Christopher Murray is a physician and epidemiologist at the University of Washington. He lead this study on declining life expectancies among women in 1,000 counties across the U.S. He joined us on the phone from Minneapolis. We were also joined by Dr. Wendy Klein. She's an associate professor emeritus of medicine, obstetrics and gynecology at Virginia Commonwealth University, and she joined us from there. And I thank you both so much for speaking with us.

Dr. KLEIN: Thank you so much for the opportunity.

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