Chapter One
Unpacking Neighborhood Differences in Life Expectancy
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The COVID-19 pandemic has put a spotlight on the links between systemic inequities and racial disparities in health outcomes. These issues, of course, predate the pandemic. For several years, news reports have revealed stunning differences in life expectancies for New Orleanians who live just a few miles apart.[note] Data from the United States Small-area Life Expectancy Project (USALEEP) released by the Centers for Disease Control and Prevention provides an unprecedented glimpse into the sharp gaps in life expectancy at the neighborhood level within the New Orleans region and across the nation. Metro area residents in the 20 percent of neighborhoods with the highest life expectancies can expect to live over 82 years on average, while residents in the lowest 20 percent live less than 71 years on average. In the city of New Orleans, the gap is even larger, from over 82 years to under 70 years.

Life expectancy by geography

Why are there such large differences in life expectancy across neighborhoods? How do these gaps relate to the relatively low average life expectancy across all 8 metro-area parishes, which falls 2.2 years below the national metropolitan average? This chapter explores the trends in life expectancy locally as well as nationally to provide greater insight into how the changing causes of death have affected overall life expectancy in recent years. Then it explores whether the New Orleans metro is unique in its life expectancy gaps by neighborhood and examines death rates by age group in the New Orleans metro. Last, it compares the life expectancy gap in the New Orleans metro with that of other large metros.

To be clear, all of the data reported below represents a snapshot of life expectancy and mortality trends before COVID (click here to find more current local data on the pandemic). Still, the geography of life expectancy provides context for the inequitable pathways that the pandemic has taken in ravaging the region.

What is Life Expectancy?

Nationally, gains in life expectancy have been stagnant.

 

After climbing steadily for more than 50 years, life expectancy in the U.S. stopped rising in 2010. Then in 2014, unlike in any other developed country in the world, life expectancy in the U.S. began to fall. The years-long stagnation of life expectancy goes deeper than deficiencies in the health care system and risky individual behaviors. The findings of national studies increasingly point to systemic causes like economic inequality, environmental conditions, and public policies.

The combined effects of increased detachment from the labor force, slowed wage gains, and reduced intergenerational upward income mobility may be underlying factors. For example, the decline of manufacturing jobs nationwide since the 1980s has narrowed opportunities for workers without a college degree. A recent study found that most of the gains in life expectancy between 2001 and 2014 were concentrated among high-income people. These trends coincide with the shifting causes of death driving U.S. life expectancy trends.

Life Expectancy in Selected Countries
 

Though life expectancy continued to rise until 2010, the origins of this alarming trend started earlier. In the 1990s, more and more Americans in midlife (ages 25-64) began dying of external causes such as drug overdoses, alcoholic liver disease, and suicide – so called “deaths of despair”. During the same time, reductions in death due to chronic diseases such as HIV, cancer, and heart disease were large enough to outpace the increases in “deaths of despair” until 2010.

Deaths per 100,000 from external causes and chronic diseases, 2000-2018
 

After 2010, “deaths of despair” outpaced reductions in deaths from chronic diseases, such that overall mortality rates (or death rates) for adults in midlife began to creep upward nationally. For every age group, people are dying at higher rates in the New Orleans metro than the U.S. average. As in the rest of the country, mid-aged adults in the New Orleans metro also started to die more frequently after 2010. Meanwhile, mortality rates have continued to decline for children and the elderly.

Midlife "deaths of despair" have affected our metro as well as the U.S. However, mortality improvements have been a bigger story locally. Age-adjusted mortality rates fell by roughly 20 percent between 2000 and 2018. Nonetheless, when compared with the U.S., local mortality rates remain higher for every age group, and life expectancy at birth is lower.

Mortality rate by age in years per 100,000, 2000-2018

Large differences in life expectancy exist between white and black people living in the U.S.

 

As consistently shown by national life expectancy studies, white people on average have longer life expectancies than black people of the same gender, even after controlling for factors that contribute to health such as income, education, and employment. In 2017, life expectancy was 71.5 years for black males and 76.1 for white males, according to a CDC report.

Mortality rates by race and age group in the New Orleans metro area follow a pattern similar to the nation’s. Despite some narrowing of racial disparities in mortality, African Americans continue to experience mortality at higher rates than white residents across all young adult and midlife age groups. However, regardless of race, deaths among 45-64 year-olds are happening at a much greater rate than deaths among 15-24 year-olds and 25-44 year-olds. Locally, the probability of death for every age group continues to exceed the national average.

Since average life expectancy began to stagnate and decline, media coverage has often centered on the opioid epidemic and less-educated whites living in rural or deindustrialized areas. However, mid-life mortality rates have risen among all racial and ethnic groups, following decades of narrowing racial disparities in life expectancy. This is especially troubling for groups with higher baseline mortality rates, such as African Americans and Native Americans. In our metro, 35 percent of the population is African American (compared with 13 percent nationally).

Discrimination inside and outside of health care contributes to health outcomes

 

Black and white mortality rates per 100,000, New Orleans metro, 2000-2018

On average, neighborhoods with more black residents have lower life expectancy than neighborhoods with more white residents.

 

Racial inequality in life expectancy is also apparent in differences by neighborhood or “census tract”. For the 10 percent of U.S. census tracts that are majority black, the average life expectancy is 74.4—fully 4.6 years below the 79 year average life expectancy of the remaining 90 percent of census tracts.

This pattern echoes across the New Orleans metro, where the mean life expectancy is 73.9 in our majority-black census tracts—3.8 years below the mean life expectancy of 77.7 in other census tracts.

The trauma of early deaths can ripple across social networks.

 

Distribution of life expectancies in the U.S. and Metro New Orleans

Neighborhood conditions can reinforce health inequalities.

 

The conditions in which we live are linked to our life expectancy. Our neighborhoods influence the quality of the housing we live in, the toxins and crime we may be exposed to, as well as the social networks and support systems, the community organizations, public services, food, education, and even the employment opportunities we may have access to. These factors all have a significant influence on a population’s health. This point is critical to interpreting disparities in neighborhood-level life expectancy, and the role of neighborhood racial segregation in perpetuating racial health disparities. Given the evidence of racial discrimination across multiple systems such as housing, employment, and criminal justice, a neighborhood’s racial composition often implies exposure to cumulative, mutually reinforcing factors that impact the health of its residents.

Neighborhood Life Expectancy and median income, New Orleans metro
 

Life expectancy and other social and economic outcomes tend to cluster together at the neighborhood level. Census tract indicators like median household income and educational attainment are closely related to life expectancy. Across the New Orleans metro, neighborhoods whose residents have higher educational attainment also have above-average life expectancy, and census tracts with lower educational attainment have lower-than-average life expectancy. Among neighborhoods with life expectancies below 70, none have median income above $40,000, and among neighborhoods with life expectancies above 80, none have median income below $40,000.

While no single factor can explain differences in neighborhood well-being or hardship, racial segregation tends to overlap with neighborhood socioeconomic status. Though exceptions exist, most black neighborhoods have both low socioeconomic status and low life expectancies, whereas most neighborhoods with high socioeconomic status and high life expectancies have very few black residents.

Neighborhood Life Expectancy and percent of population 25 and older with at least a bachelors, New Orleans metro

What is driving metro New Orleans’ low life expectancy rate?

 

At 76.6, life expectancy overall in the New Orleans metro is lower than the national average, which is 78.7. Why is this? We’ll tackle this question from a unique angle. First let’s examine life expectancies by state. In Louisiana and in the broader southern region of the U.S., life expectancies tend to be lower than in other parts of the U.S. But statewide averages blur the differences between parishes (or counties). Life expectancies in Louisiana parishes range from the high 70s to the low 70s.[source] Differences in life expectancy tend to be even greater when comparing across census tracts within a single metro area.

Life expectancy by State
# of States
 

Because USALEEP covers the entire nation, we can compare neighborhood inequality in greater New Orleans with inequality in other metros. For a single metro, the gap between census tracts with the highest and lowest life expectancies, specifically the 80th and 20th percentiles, provides a consistent benchmark for comparing with other metros. In metro New Orleans, 20 percent of all census tracts have a life expectancy below 73 at the low end, while at the top end, 20 percent of all census tracts have a life expectancy above 79 years. To be sure, disparities across neighborhoods are common to every medium and large metropolitan region in the U.S.

Metros with larger neighborhood disparities tend to have lower overall mean life expectancies. Metros that have less separation between life expectancies in the bottom 20 and top 20 percent of census tracts, like Boston and Los Angeles, rank at the top in overall life expectancy among metros with over 1,000,000 population. In contrast, the New Orleans metro ranks near the bottom in overall life expectancy while having one of the highest separations between the top 20 and bottom 20 percent of census tracts.

As with other metros with low life expectancies, a large share of our metro’s population lives in neighborhoods with very low life expectancies in the 60s and low 70s. These low life expectancies reduce the metro average, but our analysis found another contributing factor.

Life expectancy by census tract, New Orleans metro
# of Tracts
 

Within metros afflicted by high neighborhood inequality, residents expected to live the longest are still living shorter lives than the majority of residents in metros with less inequality. The 80th percentile census tract in greater New Orleans has a life expectancy of about 80, close to the median census tract in some metros with smaller gaps in life expectancy, such as Boston and Los Angeles. While this finding recalls previous international research associating higher inequality with poorer health and social outcomes in rich countries, it is beyond the scope of this report to examine why more privileged New Orleanians are not living as long as their peers in other U.S. metros. However, the finding affirms life expectancy gaps as a regional issue, not merely a problem within disadvantaged neighborhoods.

Life expectancy gap and average life expectancy for metros with population of 1,000,000+
 

Comparing the distribution of neighborhood life expectancies across metros reveals another unmistakably consistent pattern. Both overall metro average life expectancies and the within-metro spread of life expectancies tend to be closely related to the demographic composition of the region’s neighborhoods. Metros with a substantial number of majority-black neighborhoods have a wider range of expected lifespans, and, regardless of the region in question, majority black neighborhoods largely make up the lower end of the range. This pattern stems from the close correspondence between neighborhood racial segregation and the social and economic factors that shape life outcomes.

Distribution of life expectancies in majority black and non-Black tracts for selected metros

Conclusion

United States life expectancies have stagnated. Nationally and locally, the causes of mortality have changed. Although mortality rates have declined in the New Orleans metro, life expectancies remain low and inequitable relative to other large metros in the U.S. Even the census tracts with the highest life expectancy have lower life expectancy than peers in metro areas where the gaps are smaller. This report reveals that life expectancy and factors known to contribute to health (e.g. education and income) tend to be clustered at the neighborhood level in a pattern shaped by racial segregation. Furthermore, the close link between race and place-based inequities in life expectancy is consistent across metropolitan areas.

However, comprehensive solutions to the challenge of reducing early deaths will only be possible when one understands the systemic processes that have created and sustained inequalities across neighborhood over time. Chapter 2 goes deeper. It asks, how did neighborhood inequality today come to exist in the first place?

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What is Life Expectancy?
Life expectancy at birth is the average number of years a person might expect to live if mortality patterns stay the same. Life expectancy thus provides an intuitive, summary measure of population health outcomes. USALEEP estimates are based on deaths that occurred between 2010 and 2015 for all residents of a given census tract. According to the USALEEP data, average life expectancy is 75.9 in the city of New Orleans, 76.6 in the 8-parish metro, 75.9 in the state of Louisiana, and 78.7 in the United States.
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Discrimination inside and outside of health care contributes to health outcomes.
"The Institute of Medicine published a report in 2003 exploring these disparities in mortality rates, and found that people of color had less access to health care and that the care these populations did receive was often of lower quality compared to white patients. Since that time, more than a decade of research has explored how physicians' implicit bias—unconscious and involuntary attitudes about race—can influence their communication, treatment recommendations, pain management decisions, and empathy, depending on the race of the patient in front of them. A study in the Proceedings of the National Academy of Sciences reported that black patients are systematically under-treated for pain relative to white patients, due in part to white medical students' and residents' false beliefs about inherent or biological differences between racial groups (for example, that "black people's skin is thicker than white people's skin"). In addition to the harmful effects of individually-held racial biases and prejudice, there is growing evidence of how our society impacts the health of black Americans by failing to address conscious and unconscious discrimination across interconnected systems (e.g. health care, housing, education, employment, earnings, media, criminal justice). With this knowledge, public health efforts are beginning to move beyond a focus on individuals' actions to explore more broadly the conditions in which people are born, grow, interact, and age."
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The trauma of early deaths can ripple across social networks.
The death of a loved one can have significant social, emotional, and physical impacts on surviving family members. Grief can lead to further stressful events such as housing instability, divorce, job loss, or poverty. One nationally representative study found that black Americans experience more deaths of family members than white Americans regardless of age, gender, or educational attainment of parents. In contrast, white Americans are 30 percent less likely than black Americans to experience the death of a family member by the age of 60. When early deaths are disproportionately concentrated in specific neighborhoods, this can further fuel inequality over time.