موضوعات داغ در امید به زندگی سالم در ایالات متحده، 1970-1990: تفاوت های جنسیتی، نژادی و آموزشی

This paper examines healthy life expectancy by gender and education for whites and African Americans in the United States at three dates: 1970, 1980 and 1990. There are large racial and educational differences in healthy life expectancy at each date and differences by education in healthy life expectancy are even larger than differences in total life expectancy. Large racial differences exist in healthy life expectancy at lower levels of education. Educational differences in healthy life expectancy have been increasing over time because of widening differentials in both mortality and morbidity. In the last decade, a compression of morbidity has begun among those of higher educational status; those of lower status are still experiencing expansion of morbidity.

Inequality in health is one of the most important health issues facing low-mortality countries today. Socioeconomic status is related to virtually all health outcomes in most countries. People with more education or income live longer and experience fewer adverse health events. Differences in healthy life expectancy summarize the combined effects of different levels of mortality and morbidity on the overall length of healthy life and provide a good summary indicator of the total health impact of differences in socioeconomic well being. Changes over time in healthy and unhealthy life expectancy can be used to measure the overall effect on population health of time trends in the processes of mortality and morbidity (Robine, Romieu, & Cambois, 1997). Differences in time trends by socioeconomic status can be evidence of inequality in health progress. Increases in life expectancy accompanied by an increased proportion of life spent healthy can be regarded as evidence of compression of morbidity; changes in life expectancy with a decreased proportion of life healthy can be evidence of an expansion of morbidity (Bone, Bebbington, & Nicholaas, 1998; Fries, 1981). This paper examines healthy or disability-free life expectancy at three dates for racial and education subgroups in the United States. The major questions addressed include: how does healthy life expectancy differ among educational groups of the population and how have the differences changed over two decades? Did all educational segments experience the expansion of morbidity during the 1970s and the compression during the 1980s?