Two Texas counties. In one, you’ll live almost a decade longer
Suburban affluence buys better health care, funds better choices than rural poverty
M oney doesn’t come easy to Polk County. If you take the Livingston exit off U.S. 59, heading west on U.S. 190, you’ll pass the town’s Wal-Mart, one of the area’s large employers.
Take a left on FM 350, and after five miles of country road, you’ll arrive at the water tank that marks Allan B. Polunsky State Prison, another major source of jobs. People in the county work in lumber, too.
It’s a different story 120 miles away, in Fort Bend County, a sprawling suburb of Houston. Large employers there include Schlumberger, an energy technology company, and Texas Instruments. Sugar Land, one of Texas’ fastestgrowing cities, is there. City websites promote the place as both an economic powerhouse (“Sugar Land means business”) and a tourist destination (“Summer is sweeter in Sugar Land”).
But it’s not just that summer is sweeter in Fort Bend; lives there are longer, too. On average, residents of Polk County die almost a decade before those of Fort Bend.
“Inequalities of life expectancy between counties are getting larger and worse,” says Dr. Ali Mokdad, an epidemiologist at University of Washington’s School of Public Health. Recently in the journal JAMA Internal Medicine, Mokdad and colleagues published a county-level analysis of mortality data over the past 35 years.
What they found is both remarkable and alarming: What county you live may determine how long you’ll live.
FROM 1980 to 2014, U.S. life expectancy grew from 74 to 79 years. But the gains aren’t evenly distributed.
The longest lives tended to be in counties on the West Coast, northeastern coast, Rocky Mountain regions and in Minnesota. Some counties in Colorado averaged 87 years.
Counties with the lowest life expectancy were mainly in the South, especially along the Mississippi River, and in the coal country of eastern Kentucky and western West Virginia. North and South Dakota also fared poorly. Some counties logged 66 years.
In Polk County, people live to 73 on average. In Fort Bend County, it’s 82.
CLARK EVANS, 78, has been mayor of Livingston for the past 10 years. He’s lived in Polk County almost all his life.
His vice, he said, used to be smoking. But that was back when “everyone smoked,” and he quit 50 years ago.
“Life is about choices,” he said, and people should be allowed to make them.
Data from 2014 show that the while the average Texas county had smoking rates of 17 percent, Polk County was much higher, at 29 percent. This has devastating effects: Out of 254 Texas counties, Polk had the second-highest death rate from lung cancer and the sixth-highest from cardiovascular disease.
In Fort Bend, only 10 percent of people smoke. And many cities in Fort Bend ban smoking. In 2007, Sugar Land outlawed smoking in parks, restaurants, public spaces and arenas. Since then, smoking has decreased by 16 percent, and death from cardiovascular disease and lung cancer has dropped by 15 percent and 21 percent.
There are connections between public policy and health.
FIFTEEN MILES east of Livingston is the Alabama Coushatta Tribe Reservation, home to more than 500 people.
Native Americans have one of the country’s highest rates of Type 2 diabetes, and about three years ago, federal money allowed the reservation’s health clinic to launch a wellness program. It offers Zumba and yoga classes, organizes community walks and pays nurses to counsel tribe members on healthy eating and physical activity.
The program is a success, says clinic director Myra Sylestine. She tells of a tribe member who seemed to eat nothing but fried food. When a nurse asked why, the resident explained that she didn’t own an oven. The nurse helped her find one, and now she can bake and broil.
IT’S SIGNIFICANTLY harder to stay healthy in places that are rural or poor.
Not surprisingly, counties with a high percentage of uninsured residents have lower life expectancies. Also not surprisingly, the quality of a county’s health care matters — “for example, how well your health care provider does in trying to control your high blood pressure,” says Mokdad.
All that works in Fort Bend’s favor, and works against Polk. In 2014, 20 percent of Fort Bend residents were uninsured; that number is 29 percent in Polk.
As a rule, the higher a county’s unemployment, the lower its life expectancy. In Fort Bend, in 2014, unemployment was 6.1 percent, a little below Texas’ average. In Polk, it was more than 8 percent.
Fort Bend also has one of the highest median household incomes in Texas: $89,000. In Polk County, it’s $39,000.
SO HOW do we improve health in the state’s rural counties — the very places with conservative values that clash with government interference?
Local leaders have many options, including education and public awareness. Though most people know that healthy eating and physical activity are good for them, showing them specific practical information is effective.
Still, healthy living isn’t a panacea, and the contrast between Polk and Fort Bend is clear: Counties where residents have access to decent-paying jobs, higher education and quality health care are some of the healthiest places to live.
But we need to start somewhere. And giving these counties tools to promote healthier living could significantly improve the quality — and length — of residents’ lives.