Monday, July 25, 2011

Be Rich; Live Longer

Here's anothe reason to have money and education: you live longer. This startling conclusion from a man who sits on the board at Citigroup and is a member of the Council on Foreign Relations, which makes him likely to live six years longer than you or me statistically. Peter Orsag used to be in a position when he was in President Obama's cabinet to influence the debate in favor of better and more inclusive health care. That was just one of many balls droped by our Democrat leader. It turns out being hi tech savvy is good for you. Or you could be born in Cuba instead of the US where infant mortality rates are lower than ours...

I now have more health information on my wrist than my doctor had about me 10 years ago, and I’m hopeful that it’s going to help keep me healthier.

But it’s worrisome, too, because the same technological change that allows any of us to walk around with all this personal data at a glance may wind up exacerbating the growing gap in life expectancy between people with high levels of income and education and those without.

New technologies allow us to collect our own health data and store it in an online record. When combined with information from doctors and other providers, it can present a picture of someone’s well-being more nuanced than anything available before.

I know from experience, for example, that if I weigh myself most days, I am more likely to eat nutritious foods and maintain my weight. But I’ve never succeeded in recording the results consistently, which is unfortunate because doing so would provide a useful history for my doctor, signaling potential health risks.

The admittedly minor hassle of looking down at the scale and then walking over to a computer to type in the numbers was apparently so onerous that I would do so for only a couple days and then stop.

Technology has overcome that obstacle. My wife and I now have a new Withings Wi-Fi scale: When I step on, it transmits my weight and body-fat readings to the computer over our home Wi-Fi network. The information is then automatically linked to my personal online health record. A similar wireless blood-pressure monitor has just become commercially available.

High-Tech Pedometer
The striking part comes when that information is combined with other data sources. Enter new devices like the Garmin Forerunner 610 watch and the Fitbit pedometer, both of which I use. The watch records my daily runs, including distance and pace, along with pulse and calories burned. The pedometer measures how many steps I take each day, and if I wear it on my wrist at night it can also measure the length and quality of my sleep. Both devices transmit their results wirelessly to my computer whenever I walk by it, and that information, too, is automatically deposited into my health record.

My online record thus contains an extraordinarily rich array of information about how much I exercise, how well I sleep, my blood pressure and my body mass. It also pulls data on my prescriptions and other more traditional health metrics, such as blood-test results.

Emergency Bracelet
And much of this information can be accessed by yet another new wristband device. As I write this, I’m wearing something called a VITAband, which is an emergency ID bracelet that is linked to online information about who I am, my allergies, my blood type, whom to contact in case of an emergency and so on. Importantly, with appropriate permission, it can also tap into my increasingly detailed online health record. (A particularly clever feature that isn’t directly connected to better health, except in the psychological sense, is the VITAband’s built-in debit card, which lets me make purchases or, if something goes terribly wrong when I’m out for a run, pay for a cab ride home.)

As you might be able to tell, I’m quite enthusiastic about these innovations. But I’m also aware of their risks, which may only increase as the technology advances.

Privacy Concern
One of these is a potential loss of privacy. Imagine, for example, if someone’s personal health record is hacked. I wouldn’t care if anyone found out how many calories I burned yesterday. But since the multiple sources of information about my health are now linked, anyone who could inappropriately obtain access to one bit of data may have a better chance of getting into the entire record, unless the system is explicitly designed to minimize that risk. Presumably, all of this new information should be private, not available even to my doctor or health- insurance company without my permission.

A longer-term worry is that the new technologies may widen gaps in life expectancy. Americans are living longer than ever -- but, as documented in a recent National Academy of Sciences report (“Explaining Divergent Levels of Longevity in High-Income Countries”), people with more education and income are enjoying much more rapid increases in longevity than others are.

Life-Span Gap
Among 50-year-old men, for example, those in the highest education group are now projected to live almost six years longer on average than those in the lowest education group -- and this differential has been rising sharply. The widening gap in life expectancy is also evident geographically. In 2007, men living in the American counties with the greatest average longevity could expect to live more than 15 years longer than men in the lowest- ranked ones. In 1987, that gap was less than 12 years. Sadly, life expectancy in some counties actually declined over that period.

The leading explanations for this involve health behavior -- including diet, exercise and smoking. For example, men 50 and older without a high-school education are more than twice as likely to smoke as those with a college degree. Exercise behavior also varies substantially. Among 45- to 54-year-olds in one study, only 16 percent of those without a high-school degree exercised vigorously at least once a week, whereas 56 percent of college graduates did.

Need for Technology
If the new personalized health technologies wind up being used disproportionately by people with more education and income, driving that group toward even better health, they will probably cause the gap in life expectancy to widen still further.

The true health-improving potential of devices such as the VITAband and the Fitbit will be realized only if they are used by those who most need to change their health behavior -- the same people who have been lagging in life expectancy. If not, just as technology has helped expand income inequality over the past four decades, it may likewise play a major role in expanding life-span inequality.

Peter Orszag is a Bloomberg View columnist where this essay originated.

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