Map of life expectancy at birth from Global Education Project.

Saturday, April 26, 2008

Where has I been?

Sorry for the absence, I spent the past two days working on the Spanish language voice over for a video teaching therapeutic massage to people who care for loved ones with cancer. This had me locked in a studio all day and driving back and forth from Boston to Portsmouth before and after. I swear I don't know how people keep this up every day when they have day jobs.

Anyhow, let me try to catch up a little bit. First of all, regarding the study on life expectancy, I pointed out, correctly, that of the old confederacy most of Virginia escaped the decline, but I should have noted that the southwest corner of the state -- the part that remains rural and Old South in character -- actually suffered the worst of it. While this certainly helps to prove the point, it also sharpens the question of why exactly this happened.

One can only speculate at this point but my hypothesis is that these areas have the worst of both worlds. In the old days, rural poverty wasn't so bad for you. People ate from their own gardens, did physical labor, walked a lot. Now they eat at McDonald's, work as retail clerks, in call centers or other sedentary but stressful jobs, and drive everywhere. I should note that while women suffered the largest declines in life expectancy, they still live longer than men. It's not that they're necessarily getting the worst of it, just that women in these places have lost much of their former advantage.

Our friend Ana points out some of the limitations of mortality statistics and I endorse her comments. Causes of death on death certificates are notoriously misleading. After all, everybody dies of cardiac arrest. When heart disease is coded as the principal cause of death, one might think of the real causes in a given case as diabetes, hypertension, hypercholesterolemia, any of which might be related in turn to diet, physical inactivity, obesity, tobacco addiction, all of which are potentially related to socioeconomic status but amenable to some extent to medical intervention. But the death certificate doesn't tell any of that story.

It's important for people to understand the artificiality of the life expectancy construct. It doesn't really predict the future, as it purports to do, but it is a useful way of summarizing the present. The decline in life expectancy does tell us that more people in these areas of the country are dying before they reach their seventies than has been the case recently.

But that does present a nice segue into the question of the future, which was the subject of my previous post. Like many people, I'm not necessarily optimistic that we can pull our chestnuts from the fire. I'm expecting hard times. I think Lester Brown is as well. However, you don't gain anything by undermining people's self-efficacy, individually or collectively. We need to do the best we can and we aren't going to do that if we despair. The more we can do, and the sooner, to make the necessary radical changes in our way of life, the less unwelcome change will be imposed on us.

My complaint is that politicians -- including, let's face it, Barack Obama and Hillary Clinton -- aren't telling the people the truth and aren't making serious proposals to address the crises facing humanity. I understand why -- they've seen what happens to politicians who try to intervene against the profound denial and narcissism of the American people -- but I desperately hope that once he's elected, President Obama will have the courage and wisdom to talk realistically about the terrible perils we confront. Meanwhile, whoever can do it has to yell and scream.

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