Older people, poverty as a biological risk factor: the socio-economic gap cuts life expectancy by up to 9 years

The gap in life expectancy between high-income and low-income seniors is widening, with deaths occurring up to nine years earlier for the less affluent. This was reported by an analysis - conducted by the US National Council on Aging (Ncoa) and the LeadingAge long-term services and supports (Ltss) Center at the University of Massachusetts in Boston - that assessed the impact of adverse socio-economic conditions on the US over-60s involved in the Health and Retirement Study.

The report found that the majority of the elderly do not have sufficient resources to cope with long-term health care or health problems, with mortality increasing to reduce longevity by almost a decade. What happens then is that the elderly who belong to the poorest 20% of the population, with an average income of less than $20,000 per year, die almost twice as often as their peers with an annual income of $120,000 or more. In the period between 2018 and 2022, in fact, the mortality rate among the most economically disadvantaged over-60s reached 21%, while among the most affluent it stopped at around 10.7%.

It is precisely this difference of almost ten percentage points that translates the impact of poverty on life in concrete terms: on average, the elderly with fewer resources die about nine years earlier than the better-off. But it is not just a matter of having less means: socio-economic disadvantage, expressed in terms of income, education, housing, also 'makes its way' into the body, causing, in inverse proportion to income, a condition of chronic stress that can lead to systemic inflammation of all tissues. This represents fertile ground for the flourishing of neurodegenerative, cardiovascular and oncological diseases, to which is added the antagonistic effect on the immune system, resulting in the progressive loss of the body's ability to defend itself against external agents. Economic scarcity is thus also transformed into a biological risk factor that shortens existence and reduces the years lived in good health. These results, in line with years of research, however, show that today the problem is more serious than it was in the past because of the increase in income inequalities, with absolute poverty growing especially among the elderly, which in Italy affects about 1 million over 65, according to the most recent ISTAT data.

It must be said, however, that Italy is still among the longest-living countries in the world, but the US figures are a worrying sign that must make us reflect. The universalism of our health service, combined with prevention and basic medicine, has contributed significantly to reducing mortality and extending life expectancy to date, but an increasingly 'restricted' public health service, in the face of advancing privatisation, risks creating economic barriers that undermine life expectancy.

Public policies, in particular economic and social policies, are therefore a powerful tool for guiding collective health outcomes and ensuring healthy ageing. Consequently, every policy decision is also a health decision. Building a fairer society is therefore the most effective public health policy.