The World’s Poor Have Been Hit Hardest by COVID, Reflecting Longstanding Health Trends

In countries as varied as Estonia, Hungary and Japan, annual life expectancy for men jumped from 2011 to 2017.

In the United States, it stayed stubbornly the same.

According to Sir Michael Marmot, one of the world’s leading public health experts, one factor is the growing inequality in the U.S. that has stagnated incomes, worsened health and shortened lives. Even before COVID, the same was true in many other countries: The richer somebody was, the longer they lived.

In a briefing for the National Press Foundation and the Association of Foreign Press Correspondents in the United States, Marmot showed data on how life expectancy at age 50 has changed over time in the United States.

By income groups among men, he said, “The poorest 10% got a small improvement. The next 10% somewhat bigger improvement – then bigger, bigger, bigger, bigger, bigger. The richer you were, the bigger the improvement so the social gradient got much steeper. The inequalities got much bigger. That’s men.

“The next slide is women – and, oh my gosh, life expectancy went down for the poorest 10%, as it did in England,” he said. “For the bottom 30% life expectancy at age 50 for women declined, and then increased the richer you were. The inequalities got dramatically bigger.”

That held true by region as well.

“If you’re rich, it doesn’t matter where in the country you live,” Marmot said. “Life expectancy is good and improving.”

Marmot is a professor of epidemiology at University College London, director of the UCL Institute of Health Equity and past president of the World Medical Association. In 2000, he was knighted by Queen Elizabeth II for his services to epidemiology and the understanding of health inequalities.

Marmot detailed the basics of what is know as the social determinants of health –the influence of socioeconomic status on health and lifespan. Factors include income, regular access to health care, as well as diet and lifestyle issues that differ by region, town and neighborhood. In the U.S. and the United Kingdom, a major driver of stagnating life expectancy has been the so-called “deaths of despair” from opioids, suicide and alcohol.

Diabetes, hypertension, obesity are considered the chronic diseases of poverty, said Dr. Otis Brawley, a professor of oncology and epidemiology at Johns Hopkins University and the former chief medical and scientific officer of the American Cancer Society. (Brawley’s March 2020 briefing to NPF fellows on the social-economic determinants of cancer is here.)

Diabetes, hypertension, obesity and cancer all make people more susceptible to COVID-19.

The current health system, however, treats illness – not may have led to it. And the poor and working-class are least able to obtain healthcare. That is why COVID-19 has become a “perfect storm for death” that has hit the poor hardest, Brawley said.

The disease first emerged in the U.S. in major metropolitan areas such as New York City, Detroit, Chicago and New Orleans, where people are disproportionately poor and don’t have the luxury of socially distancing due to their working and living conditions.

“The socioeconomically deprived – often minorities – are the mostly likely to get the disease, the most vulnerable to it and to the causes of it, and the least able to deal with it,” Brawley said.

COVID will be the third leading cause of death in the United States this year, after cardiovascular disease, which killed 647,000 Americans in 2019, and cancer, which killed 599,000, Brawley noted the death toll has already surpassed that from accidents, stroke, Alzheimer’s disease, diabetes and other common causes of death.


This program was funded by Bayer LLC. The National Press Foundation and the Association of Foreign Correspondents are solely responsible for the content.


Sir Michael Marmot
Professor of epidemiology, director, Institute of Health Equity, University College London
Otis Brawley
Sidney Kimmel Comprehensive Cancer Center, School of Medicine
Otis Brawley on Poverty
Sir Michael Marmot on Poverty
Q&A with Otis Brawley and Sir Michael Marmot
Subscribe on YouTube
More Presentations
Help Make Good Journalists Better
Donate to the National Press Foundation to help us keep journalists informed on the issues that matter most.
You might also like
American’s Child Care System in Crisis
How Poverty Affects Children’s Health
How Poverty and COVID Shape Children’s Lives
How Poverty and Trauma Affect Brain Development
A “Perfect Storm for Death”