There’s growing evidence that some American demographic groups need more help than others to live longer, healthier lives.
American Indians in Western and Midwestern states have the shortest life expectancy as of 2021, 63.6 years. That’s more than 20 years shorter than Asian Americans nationwide, who can expect to live to 84, according to a recent study by the Institute for Health Metrics and Evaluation at the University of Washington.
White residents live shorter lives in Appalachia and some Southern states, as do Black residents in highly segregated cities and in the rural South, the study found.
The data illustrates how Americans’ life expectancy differs based not only on race, but also on geography.
“Not everybody in this country is doing exactly the same even within a racial group, because it also depends on where they live,” said Dr. Ali Mokdad, an author of the study and the chief strategy officer for population health at the University of Washington.
“Eliminating these disparities will require investing in equitable health care, education, and employment, and confronting factors that fuel inequalities, such as systemic racism,” the report, which was published in November, concluded.
Yet the United States is seeing a surge of action this month to pull back on public awareness and stem investments in those areas.
In President Donald Trump’s first two weeks, he has stripped race and ethnicity health information from public websites, blocked public communication by federal health agencies, paused federal research and grant expenditures, and ordered a ban on diversity, equity and inclusion programs across the board, all of which can draw attention — and funding — to the needs of specific demographic groups.
The administration has removed information about clinical trial diversity from a U.S. Food and Drug Administration website, and has paused health agencies’ communications with the public and with medical providers, including advisories on communicable diseases, such as the flu, that disproportionately affect underserved communities.
The new administration’s policies are headed the wrong way, said Dr. Donald Warne, a physician and co-director of the Johns Hopkins Center for Indigenous Health. “With the stroke of a pen, they’re gonna make it worse.”
One of Trump’s actions on his first day in office was to dismantle equity programs, including reversing a 2021 Biden executive order promoting more federal support for Indigenous education, including tribal colleges and universities.
The problems Indigenous people face are inextricably linked to “toxic stress” and “just pure racism,” Warne said. “Less access to healthy foods, just chronic stress from racism and marginalization, historical trauma — all of these things lead to poor health outcomes.”
The South Dakota county where Warne grew up as a member of the Oglala Lakota tribe (the county is named after the tribe) has one of the lowest life expectancies in the country, 60.1 years as of 2024, according to localized estimates from County Health Rankings & Roadmaps, an initiative of the University of Wisconsin’s Population Health Institute.
‘10 Americas’
The Institute for Health Metrics and Evaluation study parceled the country into what it called “10 Americas,” each with different 2021 life expectancies.
Black Americans were represented by three groups; those in the rural and low-income South had the worst life expectancies (68 years) compared with those living in highly segregated cities (71.5) and other areas (72.3).
Racism is still a major contributor to inequitable health outcomes, and without naming it and addressing it, it will make it more difficult to uproot it.
– Dr. Mary Fleming, director of Harvard T.H. Chan School of Public Health’s Leadership Development to Advance Equity in Health Care
Asian Americans nationwide have the longest life expectancy at 84, yet can also suffer from stereotypes and locality based problems that prevent them from getting the best care, said Lan Ðoàn, an assistant professor in the Department of Public Health Section for Health Equity at New York University’s Grossman School of Medicine.
Considering Asian Americans as a single entity masks health differences, such as the high incidence of heart disease among South Asians and Filipino Americans, she said, and discourages the necessary study of individual groups.
“It perpetuates the ‘model minority’ myth where Asian people are healthier, wealthier and more successful than other racial groups,” Ðoàn said.
That’s another reason for alarm over the new administration’s attitude about health equity, said Dr. Mary Fleming, an OB-GYN and director of Harvard T.H. Chan School of Public Health’s Leadership Development to Advance Equity in Health Care program.
“With DEI (diversity, equity and inclusion programs) under attack, it hinders our ability to name a thing, a thing,” Fleming said. “Racism is still a major contributor to inequitable health outcomes, and without naming it and addressing it, it will make it more difficult to uproot it.”
Among white people and Hispanics, lifespans differ by region, according to the “10 Americas” in the Institute for Health Metrics and Evaluation study. Latinos live shorter lives in the Southwest (76) than elsewhere (79.4), and white people live longer (77.2) if they’re not in Appalachia or the lower Mississippi Valley (71.1), or in rural areas and low-income Northern states (76.7).
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