speaking of unglamorous governance and willingness to keep the nose to the grindstone, that's what it takes to push life expectancy up a little bit each year and what makes the difference between New York and Oklahoma (two states where life expectancy were the same 60 years ago):
why have life expectancy in new york and oklahoma divergered after being almost the same 60 years ago
ChatGPT said:
That’s an excellent and revealing question — and it gets at the heart of how
social, economic, and policy differences between U.S. states have widened over time.
About 60 years ago (in the 1960s),
life expectancy in New York and Oklahoma were nearly identical, both roughly in the low 70s. By the 2020s, the gap had grown to
around 6–7 years — with New York among the top states (around 80 years) and Oklahoma near the bottom (around 74).
Here’s why they diverged:
1. Economic structure and inequality
- New York’s economy transformed from manufacturing to finance, services, and knowledge industries — sectors that tend to raise education and income levels, both strong predictors of longevity.
- Oklahoma’s economy remained more resource-based (oil, gas, agriculture), with slower income growth and greater volatility. Economic stagnation contributes indirectly to worse health outcomes through stress, limited access to healthcare, and underfunded public services.
2. Smoking, obesity, and chronic disease
- Smoking: In 1965, adult smoking rates were high everywhere. Since then, they’ve dropped sharply in New York (to under 12%) but much less in Oklahoma (still around 18–20%).
- Obesity: Oklahoma’s adult obesity rate is among the nation’s highest (~36%), compared to New York’s (~27%).
- Chronic disease: Consequently, rates of heart disease, diabetes, and respiratory illness are substantially higher in Oklahoma.
These behavioral and metabolic factors alone explain several years of the gap.
3. Healthcare access and public health policy
- Medicaid expansion: New York expanded Medicaid early and built strong public hospital networks. Oklahoma resisted expansion until 2021, leaving large populations uninsured for decades.
- Preventive care: New York invested more heavily in screening, smoking cessation, HIV prevention, and maternal health programs. Oklahoma’s public health infrastructure has been chronically underfunded.
- Rural access: Much of Oklahoma is rural, with hospital closures and long distances to care. New York’s population is heavily urbanized, giving easier access to medical services.
4. Education and demographics
- Educational attainment correlates strongly with life expectancy. New York’s share of adults with a bachelor’s degree has doubled since the 1970s; Oklahoma’s has lagged.
- Migration patterns: New York has attracted young, educated, and often health-conscious migrants (including immigrants from long-lived populations), while Oklahoma has experienced out-migration of the young and educated, and higher retention of older or less healthy populations.
5. Public health environment and regulation
- New York City’s activism: Since the 1990s, NYC pioneered public health measures (smoking bans, trans fat bans, calorie labeling) that influenced statewide health improvements.
- Oklahoma’s policy climate has been more laissez-faire. Lower tobacco taxes, looser workplace safety standards, and less emphasis on environmental or public health regulation all contributed to worse outcomes.
6. Opioids and “deaths of despair”
- Both states were hit by opioids, but the epidemic hit rural and small-town America hardest, where social isolation, poverty, and limited treatment options combined.
- Oklahoma’s rate of opioid overdose deaths and alcohol-related liver disease rose more sharply than New York’s. New York also had more robust addiction treatment infrastructure.
7. COVID-19 impact
- The pandemic widened the gap further.
- New York’s early shock in 2020 was followed by aggressive vaccination and mitigation.
- Oklahoma had lower vaccination rates and higher excess mortality through 2021–2023.