RAM in Wise County
RAM in Wise County

By Peter Galuszka

Call it a tale of two Virginias.

One is rich with military retirees, ample benefits and gated communities. The other is remote, poor and polluted, where the life expectancy for men is merely 64 years.

The former is Fairfax County at the heart of NOVA, Virginia’s economic engine, the land of federal largesse. The other is 350 miles away in McDowell County, in the coal belt of southern West Virginia just a stone’s throw from the Old Dominion border.

In one of the best and most glaring reporting of income disparity in this country, Annie Lowery of The New York Times lays out the stunning contrasts in two very different places maybe a six-hour car ride distant. The nut of her report is that higher income means longer lives thanks to better access to decent food, retirement benefits and medical care.

In Fairfax County, men live to be 82 and women 85. In McDowell County, men (as noted) live to 64 and women to 73. Even more astonishing is that this is happening in 21st century America, the supposed land of plenty. If ever there were a call to do something about health care, this is it.

Think what you will about the Affordable Care Act, the prior system of managed care with Big Insurance calling the shots just isn’t working. One also wonders, in the case of McDowell, where Medicaid and Medicare are. Where are the benefits from the coal companies that used to dominate employment in the area?

This hits home for me because I grew up partially in West Virginia when my father, a Navy doctor, decided to retire and go into practice there. I also traveled about researching a recent book on the coal industry. I spent a lot of time in Mingo County, the next one over from McDowell. I drove plenty of times through the small town of Williamson, a major rail marshaling yard, and was struck by how many elderly people I saw pacing slowly with oxygen tanks strapped to their aluminum walkers. Coal-related black lung? Too many cigarettes? Breathing air dirty from coal trains and trucks  and strip mines? Over in Fairfax, people of a similar age are more likely to be in a warm swimming pool at an aquatic aerobics class.

Back in the Appalachians, one morning my photographer Scott Elmquist and I were traveling from Kentucky back into Mingo County and I happened to see a Remote Area Medical free clinic at a high school in Pikesville. We turned in and found more than 1,000 people thronging the gymnasium floor waiting for doctors or for their turns at the more than seven dozen dental chairs for free care they couldn’t otherwise afford. Some I spoke with had been waiting there since 1:30 that morning. RAM runs a circuit that includes Wise County in Virginia, also in coal country.

So how did these people slip through the cracks? The Times notes that in McDowell, there aren’t any organic food stores or Whole Foods. The place in inundated with fast food and convenience stores that sell ready-to-go hot dogs, energy drinks and salty chips.

Another reason is the connection with the coal industry which has been so lucrative over the years that it should have provided plenty for the elderly. Instead, as coal seams play out and natural gas usurps coal’s role in electricity generation, coal firms are setting up to skedaddle. One is Patriot Coal, an offshoot of St. Louis giant Peabody, that took over its Appalachian interests so the mother firm could concentrate on richer areas in the U.S. West and Asia. Patriot was set up to fail and perhaps take retirement benefits with it. It’s an obvious scam. You spin something off to get some distance between you and having to pay pensions and health benefits.

Another factor is what they are doing with the local environment. Mountaintop removal is a powerful instrument in places around McDowell. At the blog Blue Virginia, they ran an intriguing map showing just how this highly destructive form of mining that rips up thousands of acres overlays with high poverty areas. Out of sight out of mind. It’s a shame how many in the green movement are forgetting the horrors of mountaintop to beat up on fracking which may be closer to home for them.

I realize that some participants of this blog are simply going to dismiss the disparity with a simple shrug that “so there’s poverty.”

The Times piece traces income disparity over time, showing that longevity years have risen significantly in Fairfax from 1990 to today while they are distinctly heading the other way in McDowell for the same period.

These are facts that can’t be easily dismissed by the upper middle-class types in NOVA or the West End of Richmond. They are as real as a death certificate of a McDowell County man only in his mid-sixties.


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24 responses to “The Terrible Link Between Income and Longevity”

  1. and the additional irony – NOVA and Hampton/Tidewater are powered by Federal slush fund spending.. deficit spending… the rest of the country – from the farmer in Nebraska to the coal miner in SW VA is paying the salaries of the many if not most NoVa and Hampton Roads “workers” and the miners live where the mountain-tops are blown off and the streams and rivers polluted by acid runoff as a result of providing coal to power plants to provide electricity to all those government workers…

    what do they call that? a “transfer payment” or some such ??

    we need to teach those slugs and lazy ass jerks in SW Va to stop sucking on the govt teat by golly!

  2. DJRippert Avatar
    DJRippert

    Smoking rates:

    1. Farifax County – 14.7%
    2. National average – 23%
    3. McDowell County WVa – 31.5%

    People who smoke take at least 10 years off their life expectancy.

    Obesity rates:

    1. Fairfax County – 15.1%
    2. National average – 26.2% (adult)
    3. McDowell County, WVa – 31%

    No exercise:

    1. Fairfax County – 14.6%
    2. National average – 25% (adult)
    3. McDowell County WVa – 39%

    Living wage calculator ($/Hr, 1 Adult)

    1. Fairfax County – $13.22
    2. National average – NA
    3. McDowell County, WVa – $8.11

    Median income (men) / 2080 hours

    1. Fairfax County – $60,503 / 2080 = $29.09, $29.09 – 13.22= $15.87
    2. National average – NA
    3. McDowell County – $25,994 / 2080 = $12.50, $12.50 – $8.11 = $4.39

    Medicaid payments per enrollee in West Virginia were $6099 per year, making that state #20 out of 50 states and the District of Columbia. Virginia’s payments per enrollee were lower placing the Old Dominion at #25.

    Per capita health care spending in West Virginia was $7667 in 2009 making it 12th highest among the 50 states + DC.

    Of the 10 states with the longest life expectancy (for men and women) only 4 were among the 10 states with the highest per capita spending on health care.

    DC, with the highest per capita spending on healthcare, was 43rd in life expectancy (out of 51).

    West Virginia, with the 12th highest health care spend per capita, was 50th out of 51.

    “In 2013, press reports indicated that the average lifespan of a man in McDowell County was 63.9 years, compared to a national average of 76.3. This was the shortest lifespan for men in the country. Women in the county could expect to live 72.9 years; the national figure is 80.9. This was the second-worse number in the United States, with only Perry County, Kentucky doing worse.”

    Of the 100 poorest counties in the United States, McDowell County is 28th poorest. Virginia is among the 26 states which do not have any county on the list of one hundred poorest counties.

    Of the 192 countries in the world, McDowell County would be statistically tied for 147th place in men’s life expectancy along with Russia, Cambodia, Botswana and Ghana. If Fairfax County were a country it would come in 6th place for men’s longevity, just ahead of the Iceland and Sweden but behind Japan, Singapore, Monaco, San Marino and Hong Kong.

    Some questions:

    What responsibility do people have for their own longevity / health with regard to smoking, obesity and exercise?

    Is the quality of health care in McDowell County, WVa really worse than the quality of health care in Mongolia and Papau New Guinea – both of which have longer men’s longevity than McDowell County, WVa? The per capita GDP of Papua New Guinea is $2,736 per year. How much state funded health care could the people in that country possibly be getting? Yet the male life expectancy exceeds McDowell County, WVa. Is our government run Medicaid program really that bad? Should we expand a program that is so obviously failing?

    The analysis in this column and related comments is sorely lacking. Utah spend less per capita on health care than any other state yet has the 10th longest overall life expectancy.

    Something tells me that the LDS aversion to alcohol and tobacco is worth a lot more to Utah’s longevity than any state sponsored health insurance will ever be.

    1. the smoking rate among the less educated and poor worldwide is higher than the better educated and more well off folks.

      but DJ does make a strong argument, I admit.

      but one more thing – there are a good number of countries in this world that spend less than what we do per capita on health care – and their poor and uneducated have just as good longevity rates.. because they get good health care early on when disease is detected and doctors can urge/help smokers stop.

    2. LifeOnTheFallLine Avatar
      LifeOnTheFallLine

      When someone suggests maybe we should consider curbing our carbon output it’s the War on Coal and these good, salt of the Earth people need their way of life preserved. When it’s pointed out that coal country poverty correlates positively with early mortality they’re fat slobs with no will power.

      Of course this second narrative leaves out the negative effects of poverty on cognitive development. It ignores the effects scarcity has on decision making. It ignores the pressures in closed off cultures to conform to certain norms. And etc.

    3. LifeOnTheFallLine Avatar
      LifeOnTheFallLine

      Utah also ranks 14th in median household income, but I guess that’s irrelevant.

  3. Peter Galuszka Avatar
    Peter Galuszka

    Don the Ripper,
    I can’t argue your points but when I was researching my book I did find that unless you are a hunter, chances are that you don’t exercise. Smoking and booze are part of the culture. So are meth and oxycontin — huge problems in that part of the world. When I researched my book, I was at a conference where a Norfolk Southern executive spoke. This refers to maybe the period 2008 to 2011 when coal was going gangbusters, especially coking coal for Asia. NS was caught short something like 1,500 locomotives and about the same number of hopper cars. They needed people quickly and they pay pretty well although the work can be dirty and dangerous. They would advertise for 100 jobs and maybe get 30 possibilities. Then they’d end up with five or so serious ones after drug testing and people saying no when they realized the type of work.

    I’m not saying Fairfax should feel guilty but there is a big and hidden problem in America both in rural areas like this and in inner cities. It’s not something that can be skipped past with a lot of neocon or “smart growth conservative” banter. It needs to be addressed and never has been.

    1. The difference between liberals and conservatives. Liberals don’t want people be responsible for their own decisions when the alternative is a government program, spending public tax dollars and giving people in the Washington, D.C. area jobs.

      The only person who can make me exercise is me. The only person who can stop me from smoking or doing drugs is me. I started a medication for a recent illness that came on me unexpectedly in November. The docs told me not to drink alcohol with the pill. I haven’t had a cold beer or a glass of wine since. The only person making me follow that rule is me. And, my wife would tell you, my will power is not that good.

      Better access to doctors would help, but better access to doctors is not going to change people’s self-destructive behavior. Something about “free will” as I remember.

      1. re: ” Better access to doctors would help, but better access to doctors is not going to change people’s self-destructive behavior. Something about “free will” as I remember.”

        so better access to health care – earlier in the process – before you get lung cancer is a futile effort?

        i.e. poor people are self-destructive and would not listen to a doctor if they had access to one?

        wow!

        we should just kill the MedicAid program all together as a failure because poor people will not listen to doctors anyhow?

        bzzzzttttt!!!

        try again TMT!

        1. Larry, you have been too focused on Obama and his foolishness. The idea is not to smoke or drop oxycodone in the first place. Seeing a doc isn’t going to help if you don’t stop the self-destructive behavior. And do you really think going to a doctor is going to make a person stop smoking?

          And don’t forget, the Oregon Medicaid expansion trial showed the newly covered didn’t have a primary care doc, but went to ERs more often.

          1. re: ” Larry, you have been too focused on Obama and his foolishness. The idea is not to smoke or drop oxycodone in the first place. Seeing a doc isn’t going to help if you don’t stop the self-destructive behavior. And do you really think going to a doctor is going to make a person stop smoking?”

            TMT – do you realize that more people die from prescription drugs than illegal? http://healthimpactnews.com/2011/prescription-drugs-now-kill-more-people-than-illegal-drugs/

            I do not think any doctor is going to make anyone do anything but a doctor might well convince someone to stop smoking by a cessation program and drugs to help wean them.

            nothing what-so-ever to do with Obama Care and everything to do with regular access to a doctor no matter your income. It’s the reason why we rank last in OECD countries in longevity.

            “And don’t forget, the Oregon Medicaid expansion trial showed the newly covered didn’t have a primary care doc, but went to ERs more often.”

            they do – mostly out habit… .. it will take time… to change bad habits all around.

            how many who abuse and die from prescription drugs go to ERs for their care?

          2. Why would one think people who get free Medicaid would change their behavior? Maybe, they’d change their behavior if we paid their rent too. The Oregon experiment showed failure, not success.

            The big argument is that expanding Medicaid will save money. It’s false. Under those circumstances, why should people believe those supporting expansion? It’s just one more Democratic Party way to take money from some to give to others.

          3. re: ” Why would one think people who get free Medicaid would change their behavior? Maybe, they’d change their behavior if we paid their rent too. The Oregon experiment showed failure, not success.”

            they’d change their behavior the same way you would if you visited a doctor or a regular basis – and had a problem – that he discovered early on – and advised you to change your behavior – no matter how much money you make or not – the key issue is – do you visit your doctor on a regular basis?

            “The big argument is that expanding Medicaid will save money. It’s false. Under those circumstances, why should people believe those supporting expansion? It’s just one more Democratic Party way to take money from some to give to others.”

            bull hockey ….

            you already get money from others by not paying taxes on compensation give to you or your spouse – tax free health insurance..thousands of dollars you do not pay taxes on.

            People on Medicare – get full coverage health care for 100.00 a month. Tell me who can get that kind of insurance for 100.00 a month?

            Do you think if poor people were offered full coverage health care for 100.00 a month that many would find a way to pay it?

            why do you stand silent on the huge subsidies given to many who are very well off for health insurance but resent it for the less well off?

            it’s immoral and unconscionable to support subsidies for health care for some and oppose it for others..

            how in the world can any of us justify full coverage healthcare for some folks at 100.00 a month and argue against that approach for others?

            we support a grotesquely unfair system where we penalize some and reward others – for no real good reason other than our own biases…

            you want a truly fair system? get rid of employer-provided health care and Medicare and watch what happens?

            it’s easy to blame the poor when we’re secure… isn’t it?

  4. cpzilliacus Avatar
    cpzilliacus

    Peter Galuszka wrote:

    Back in the Appalachians, one morning my photographer Scott Elmquist and I were traveling from Kentucky back into Mingo County and I happened to see a Remote Area Medical free clinic at a high school in Pikesville.

    Did you mean Pikeville (no “s”), county seat of Pike County, Kentucky?

  5. Les Schreiber Avatar
    Les Schreiber

    Why don’t the politicians realize that coal is a 19th century industry and if they really wanted to help these people set up high school or Jr. college programs to give these Virginians the skills they need to compete for jobs in other industries.In the long run it might be in everyone’s interest to make this segment of the labor market as mobile as possible.

    1. because that would mean that NoVa would have to subsidize it!

      seriously. that seems to be the objection…

      it’s sorta like the health care issue.. can’t give the uninsured subsidies to get care but we can pay for their ER visits instead..

      can’t give education money to SW Va – because they don’t deserve it…and it’s their fault they are poor and uneducated…

  6. Peter Galuszka Avatar
    Peter Galuszka

    Les,
    Small point but we are talking WEST Virginia in the hills. They are not Virginians.Big difference in the states.
    Peter

  7. dobermanmacleod Avatar
    dobermanmacleod

    I feel so bad for the people who live unhealthy, particularly when it is a morass that they can’t escape. What isn’t widely known is that expected technological advances called RLE (radical life extension) will very likely extend the average lifespan of humans to well over a century. In other words, while it is tragic that people in McDowell County are dying about ten years earlier than their more prosperous neighbors, it is a double tragedy when that will mean, in the future, a score or more difference, and possible much much more.

    My experience is that when you get pockets of poverty and despair, you also have a cultural aspect that is very intransigent. In other words, in response to a unhealthy environment, most people simply accept it as inevitable, and embrace it as a virtue. The first step is to go into those communities and preach the gospel of science and health, and especially the potential for utopian like improvement. This is particularly important in the early ages when attending primary and secondary schools, when their minds are more open. Obviously, there will be great resistance from the community, who will vigorously protect their unhealthy lifestyle as a cultural heritage.

  8. poverty and a lack of education become vicious cycles for those caught up in it.

    and there is another irony. There are countries with universal health care that have higher smoking rates than the US but longer longevity.

    http://en.wikipedia.org/wiki/List_of_countries_by_cigarette_consumption_per_capita

    1. Bull! My grandfather died in a dentist’s chair in 1931, leaving my grandmother with four young sons and a $68 per month WWI veterans pension. Each one of her sons grew up, worked for a living and raised families. My grandmother was dirt poor, but instilled a work ethic in her sons. But back then, there weren’t so many people in the professional caring class whose use of their advanced degrees depends on dependency.

      Why do so many immigrants – legal and illegal alike – work their %%% off?

      1. re: ” Bull! My grandfather died in a dentist’s chair in 1931, leaving my grandmother with four young sons and a $68 per month WWI veterans pension. Each one of her sons grew up, worked for a living and raised families. My grandmother was dirt poor, but instilled a work ethic in her sons. But back then, there weren’t so many people in the professional caring class whose use of their advanced degrees depends on dependency.”

        I’ve got a similar life story – so what?

        Why do so many immigrants – legal and illegal alike – work their %%% off?

        are you familiar with the term – working poor? these are folks who work 40 hours a week and more – and do not have health insurance.

        what would you do if you did not have health insurance and could not get it because you have pre-existing conditions?

        you benefit from something right now that you did nothing yourself to deserve – at the same time others – who have done nothing wrong cannot get it.

        you defend that.

        why do some of us get health care and others not? It’s not because you’re better .. or earned it. If you had a pre-existing condition and did not have access to employer-provided health insurance, you’d be in the same boat as those you call lazy…waiting for handouts, etc.

        be honest TMT.

        you’re lucky and others are not.

        that’s not a fair system.

      2. LifeOnTheFallLine Avatar
        LifeOnTheFallLine

        Oh boy, personal anecdata…that’s anecdata of the least rational type!

        Follow up questions include: was your grandmother poor when she birthed her sons thus exposing them to stress hormones? How long did those boys have a stable environment before dad died? How many non-poor family members and friends did she have in her network? And on and on.

        But no, no…please continue on with personal stories and hoary cliches about hardworking immigrants.

  9. Darrell Avatar

    A fair system.. yeah, ok. You know what a fair system is? Highway US-21 was a fair system. It provided the avenue for tens of thousands to make their way to places like Cleveland, Akron, Detroit, Erie, Buffalo, and Rochester. Going the other way got you to Charlotte, Aiken, and eventually a path to Orlando. Places where it didn’t much matter whether you had an education but the will to make something of yourself with a positive work ethic. US-21 gave way to the interstates, providing mobility to seek out a better life, not much different than older routes like the Oregon Trail or the Ohio River. Thanks to the utopian idea behind globalism, people have to travel a bit farther now days because most cities that used to provide the jobs are as dead as the hollows. A good percentage of people today would rather not even start the journey and spend their lives turning themselves into 30 year old meth aged geriatrics. The more educated pride themselves on their good fortune and superior intellect while sucking up debt to offset their dwindling paychecks and lost benefits. Fair? There’s nothing fair in life. Never has been. Otherwise there would be no words called Reward or Risk. America will find that out some day.

    1. In 30 other OECD countries the view is that medical care is like education – and as Darrell points out – Mobility – i.e. transit and rail.

      In this country, we derisively refer that as a “Welfare State”.

      nevermind – it is the fundamentally definition of what OECD means compared to other countries and the 3rd world where people are born into tribes, live in tribes, and die in tribes because there is no public education, no health care and virtually no public roads beyond basic cow paths.

      I am NOT a believer in a welfare system nor do I believe in giving handouts to people who do not deserve them but I have a hard time looking at education and public roads as “welfare” when both provide fundamental opportunity to all – and yes.. neither one was “in the Constitution of – this or any other OECD country.

      On the other hand – I think it is despicable to demonize those in poverty as them essentially “deserving” their fate which is code talk for “I’ve got mine, screw you” mentality.

      We’re not even true to our claimed values that people should work to get health care but we do not have a level playing field because who you work for – not how hard you work – determines whether you can get employer-provided health insurance, indeed insurance at all if your employer does not offer it and you or your family member has pre-existing condition. In those circumstance, no matter how hard you work – you’re screwed when it comes to health insurance.

      that’s a fundamentally unfair system that those who say they oppose handouts apparently could care less about because they’ve stood around for decades and did nothing about it then when ObamaCare comes along – they are so totally beside themselves that all they are capable of is focusing … essentially hate…

      they never cared about the plight of those without access to health care to start with .. never cared if nothing was ever done .. but now that something has been done – it’s wrong… and we should have done this or done that… instead.

      If you do not like ObamaCare then where is your alternative?

      it’s easy to oppose something but where is the concurrence and agreement among the opponents for a better alternative?

      It’s not there because their alternative is “I’ve got mine, screw you”.

      “keep your filthy government hands off my tax-free employer provided insurance and my Medicare…and stop giving handouts to others like you gave me”.

  10. cpzilliacus Avatar
    cpzilliacus

    The Los Angeles Times just ran this, which might be relevant: In healthcare, what makes Maine different?

    Now she crisscrosses huge stretches of Maine’s North Woods region, leaving her house as early as 5 a.m. to visit some of the area’s sickest residents. She is part of a team of doctors, social workers and other nurses who work together to help patients manage their illnesses, live healthier lives and stay out of the hospital.

    Many of the nation’s healthiest communities are wealthy and have large numbers of college-educated residents. But northern Maine is among a handful of telling exceptions, making it an important guidepost as the country searches for ways to improve health.

    Once a booming hub of America’s lumber and fishing industries, the region now is among America’s poorest. Smoking is common. So, too, is obesity.

    Yet northern Maine ranks high on national measures of health, according to a yearlong review of healthcare data from communities around the country that The Times conducted with help from public health researchers.

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