Fifty years of economic change have taken a heavy toll on some Americans—especially those with less education—who not only have been left behind but are also experiencing poorer health and shorter lives, according to new research from the University of Michigan.
The study, published in Epidemiology and led by Professor Arline Geronimus of the University of Michigan School of Public Health, examined how long-term economic restructuring in the U.S. has contributed to growing educational inequities in health outcomes and lifespan. The research focused on local communities and drew on national data from 1990 to 2017.
Key Findings
The research shows that Americans living in economically stagnant areas, particularly those with lower educational attainment, face greater levels of chronic illness and stress—and have life expectancies one to two years shorter (between ages 25 and 84) than their peers in more prosperous regions.
“These findings suggest that structural economic changes over the past half-century have had profound, long-term effects on health—especially for less-educated workers,” the study authors wrote.
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Professor Geronimus, a member of the National Academy of Medicine, explained that macroeconomic changes such as globalization, automation, and job offshoring have disproportionately harmed workers without college degrees, leading to a widening gap in life expectancy between education levels across racial and gender lines.
The Role of Chronic Stress and Disease
Unlike previous theories that attribute shortened life expectancy to “deaths of despair” (suicide and substance abuse), this study points to chronic stress-related conditions—such as cancer, cardiovascular, and metabolic diseases—as the primary drivers of mortality among less-educated populations.
Geronimus elaborated:
“In the face of prolonged economic hardship and social exclusion, less-educated workers engage in high-effort adaptive coping—working multiple low-paying jobs, for instance—believing that their economic uncertainty can be overcome with effort and tenacity. This constant strain results in wear and tear, or weathering, of the body’s critical systems.”
The stagnation in life expectancy for this group predates the COVID-19 pandemic and aligns with decades of deteriorating economic conditions that began in the early 1980s.
Implications for Policy
The researchers emphasized that reversing these health disparities requires systemic policy reforms—not just individual behavior changes. Targeted economic and health policies must consider the negative effects of large-scale structural economic shifts on vulnerable populations.
“Reducing chronic disease deaths will require societal action to level the playing field for all workers,” said Geronimus, “not simply encouraging changes to their individual health behaviors.”
Collaborators and Support
Co-authors of the study include Timothy Waidmann and Vincent Pancini of the Urban Institute, John Bound of the University of Michigan and the National Bureau of Economic Research, and Meifeng Yang of the University of Michigan.
This research adds a crucial dimension to national conversations about inequality, public health, and economic policy—reminding policymakers of the deep and lasting impacts that macroeconomic forces have on human health.
