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Invited Commentary
January 21, 2020

Intergenerational Economic Mobility—Invest in Children’s Economic Futures to Improve Adult Health?

Author Affiliations
  • 1Department of Epidemiology and Biostatistics, University of California, San Francisco
  • 2Department of Medicine, University of California, San Francisco
JAMA Intern Med. 2020;180(3):436-438. doi:10.1001/jamainternmed.2019.7209

As a cause of excess mortality, socioeconomic disadvantage rivals smoking, hypertension, cancer, and cardiovascular disease. At age 40 years, the poorest US women can expect to die about a decade sooner than the richest; for men the gap is 15 years.1 Socioeconomic inequalities are so pervasive that it is easy to assume they are immutable. Historical evidence demonstrates that tremendous progress toward narrowing inequalities is possible. Unfortunately, recent trends in the United States indicate that it is also possible to exacerbate inequalities: gaps in adult life expectancy have grown ever-larger since the 1980s.2 Declines in life expectancy for disadvantaged individuals have increased so much that they outweigh small improvements among advantaged groups, and the United States has recently experienced overall declines in average life expectancy.3 This decline interrupts a century of life expectancy gains and is primarily owing to changes in adult rather than child mortality rates. The excess adult mortality reflects both “deaths of despair” linked to substance use and suicide, and the flattening of progress on cardiovascular disease among those without high school education.4

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