Research shows who dies when and where

In the United States, the best-off people, like Asian women in Bergen County, N.J., have a life expectancy 33 years longer than the worst-off, Native American males in some South Dakota counties - 91 versus 58 years. So concludes the most comprehensive study to date of who dies when and where in this country.

In order to determine how unequal life expectancy is in the United States, and why, researchers from the Harvard School of Public Health and Harvard Initiative for Global Health analyzed census and health statistics data for the years 1982 to 2001. They found what they call "an enormous gap" in life expectancies based on race, counties of residence, income, and a few other social factors.

The analysis led the researchers to the idea that there are "eight different Americas." White middle America and black middle America are different from each other (whites live longer than blacks) and from low-income white America, Southern low-income rural black America, Northern low-income rural white America, high-risk urban black America, and Asian America.

"Put in a global context, the disparities in mortality among the eight Americas are enormous," says Majid Ezzati, an associate professor of international health at the School of Public Health. "Our analysis indicates that 10 million Americans with the best health have achieved one of the highest levels of life expectancy on record, three years better than Japan for women, and four years better than Iceland for men. At the same time, tens of millions of Americans are experiencing levels of health that are more typical of people in developing countries."