Eliminating Smoking and Obesity Could Shrink U.S. Health Disparities, But Where People Live Matters Too

Smoking and obesity are the two leading causes of preventable death, disability, and chronic disease in the United States. New research shows that eliminating them could go a long way in reducing racial health gaps. But location also plays a key role in health disparities, with neighborhood setting and state-level policies shaping residents’ health, this new study and another suggest.[1]

“We know that, compared to white peers, black men and women enjoy fewer years of life expectancy and healthy life expectancy, which is the number of years individuals can expect to live without disability. Meanwhile, immigrant- and U.S.-born Hispanics live longer than U.S.-born whites, despite their ethnic minority and lower socioeconomic status,” says Michelle Frisco of Penn State University, who conducted the first study with her Penn State colleague Jennifer Van Hook and Robert Hummer of the University of North Carolina, Chapel Hill. Their research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

The researchers wanted to explore how obesity and smoking contributed to these differences because both health problems are concentrated in some groups in ways that are likely to produce health disparities. For example, white men and women smoke more than Hispanic immigrants, and black women are more likely to be obese and have a tougher time quitting smoking than white women.

Eliminating Smoking and Obesity Would Reduce the Black-White Health Gap

The research team analyzed data on health and mortality from almost 20,000 U.S.-born white, black, Hispanic, and foreign-born Hispanic men and women from the National Health and Nutrition Examination Survey. They focused on life expectancy and years spent disability-free for each racial or ethnic group. They then simulated how many years each group could expect to live overall and disability-free if no one ever smoked or was obese. Their findings showed some striking reductions in group differences.

“The actual disparity in the life expectancy between white and black women in the U.S. is approximately two years,” Frisco reports. “When we simulated the elimination of smoking and obesity, that gap was reduced to three months. Nearly every significant group difference was reduced to the point that gaps between groups were no longer statistically significant.”

There was one exception: Foreign-born Hispanic men and women retained their nearly three-year life-expectancy advantage over white peers even when the simulation eliminated both obesity and smoking.

“Hispanic immigrants typically have a longer life expectancy than whites to begin with. Eliminating obesity and smoking did not change this,” says Frisco. Not only do Hispanic immigrants smoke less than their U.S.-born peers, they are more likely to eat diets healthier than the typical American diet and live in tight-knit communities with widespread social support. They are also less likely to have substance abuse disorders, according to the researchers. In addition, they report that Hispanics who migrate to the United States tend to be healthier than their counterparts who remain in their country of origin.

Not Just Individual Behavior—Neighborhood Setting Shapes Health

The findings suggest that interventions aimed at preventing obesity and weight gain, reducing smoking, and increasing smoking cessation could be more effective if they’re tailored to specific populations. However, the researchers noted that these programs shouldn’t blame the victim by focusing only on individual behavior.

“We know that the places where people live influence smoking and obesity. For example, segregation leads U.S. black men and women to have elevated risks of long-term smoking and obesity in part because of the ways that tobacco companies disproportionately target minority neighborhoods, as do fast food restaurants and corporations who sell soda. These and other forms of structural racism must be addressed if we want to ensure greater health equity in the U.S.,” Frisco says.

The Disproportionate Health Consequences of State Policies

Some states invest more heavily in the health and well-being of their people, and these investments have “disproportionate consequences” for people with low education and income levels, Mark Hayward of the University of Texas at Austin, Jennifer Montez of Syracuse University, and Anna Zajacova of Western University show in the second study.

American adults with less education tend to report more chronic diseases and disabilities, and die sooner than those with more education, and these disparities have widened in recent decades, according to Hayward.

While more-educated people usually have higher incomes and less physically demanding jobs than less-educated people, the dynamics are more complicated than that, he explains. Blaming lifestyle differences between the two groups neglects the economic and social contexts where people live, he says.