1. Section Editor(s): Newland, Jamesetta PhD, RN, FNP-BC, FAANP, FNAP

Article Content

The title, "Ladies Last" caught my eye as I browsed the April issue of National Geographic1. Two colorful maps depicted life expectancy in the United States, comparing (state) county statistics from 1989 to 2009 with a line graph across the bottom indicating life expectancies in countries worldwide. Research from the Institute for Health Metrics and Evaluation (IHME) showed that in the United States, women outlived men by 5.1 years in 2009.2

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The title, however, reflects that even though women in this country live longer than men (81 years versus 76, on average), the life expectancy for men has increased by 4.6 years since 1989 compared to only a 2.7-year increase for women. In addition, how do we explain that from 1999 to 2009, life expectancy was either fixed or declined for women in 661 countries, while the same occurred for men in only 166 countries? Sub-Saharan Africa is the only region in the world where men outlive women, but both die decades younger than the world's average life expectancy. Japan continues to boast the highest life expectancies of 80 and 86 for men and women, respectively.


Socioeconomic impacts

One explanation for the slower increase in life expectancy for women in the United States is inadequate treatment for hypertension and high cholesterol related to prior standards of care, which were based on early cardiovascular research using only male participants. A look at the counties with the lowest and highest life expectancy reveals more about the differences. For females, the lowest (74.1 years) was McDowell County, West Virginia (WV), and the highest (85.8) was Collier County, Florida (FL). For males, the lowest (66.1) was Quitman County, Mississippi (MS), and the highest (81.6) was Marin County, California (CA). Differences across the country were associated with health disparities driven by socioeconomic inequalities, lack of financial access to healthcare, poor quality of care, and preventable causes of death, such as tobacco use, obesity, alcohol, hypertension, and high cholesterol.2


To find out what percentage of each county's population was living in poverty, I looked up vital statistics (2009 data) for the four counties on As expected, counties with the lowest life expectancies had higher rates of poverty-33.1% in MS and 37.7% in WV, while the counties with the highest life expectancies had much lower rates of poverty-12.6% in FL and 6.1% in CA. Financial resources and access are key determinants of healthcare quality and health outcomes and, thus, impact longevity. The only data Dr. Mokdad presented on racial differences indicated that the gap in life expectancy between Black men and White men was narrowing.


Men's health

The Men's Health Network expresses concern about men's health in view of life expectancy: "There is an ongoing, increasing, and predominantly silent crisis in the health and well-being of men. Due to a lack of awareness, poor health education, and culturally-induced behavior patterns in their work and personal lives, men's health and well-being are deteriorating steadily. "3 June is traditionally designated as Men's Health Month, and International Men's Health Week coincides with Father's Day, which is the perfect time to make sure the men in your lives are receiving preventive care and treatment for known health conditions.


Awareness and prevention

Regardless of which gender is first or last, increased awareness through education and prevention must be a priority for everyone. Advanced practice nurses are experts at this. Visit the IHME website, and use one of several interactive tools to learn the life expectancy for your county. Then you will know how much work is left to be done to reduce health disparities and improve outcomes universally.


Jamesetta Newland, PhD, RN, FNP-BC, FAANP, FNAP

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1. Ladies last. National Geographic. 2013;223(4):24-25. [Context Link]


2. Mokdad AH. Latest life expectancy estimates by county reveal big differences nationwide. Presented at Health Journalism 2012: the 14th Annual Conference of the Association of Health Care Journalists, Atlanta, GA, April 19, 2012. [Context Link]


3. Wear Blue: Support Men's Health Awareness. Washington, DC: Men's Health Network; n.d. [Context Link]