There are vast differences in the health of population groups in the United States. For example at the county level life expectancy for men ranges from a low of 65.9 years in Holmes County, Mississippi to a high of 81.1 years in Fairfax County, Virginia (a wealthy suburb of Washington, DC)—a difference of more than 15 years. Life expectancy for women ranges from 73.5 years Holmes County to 86 years in Collier County, Florida (which includes Naples), a difference of 12 and a half years.

There are also vast differences in behavior which is thought to affect health. At the county level, differences in smoking and excessive drinking vary by a factor of more than two to one. Adult obesity, physical inactivity and lack of access to healthy foods are 50 percent higher in some counties than in others.

Why is that?

Much of the research on inequality of health status has been funded by the Robert Wood Johnson Foundation and a summary article in Health Affairs attempted to report on what is known about the The Relative Contribution of Multiple Determinants to Health.” From an economist’s perspective, this article is disappointing for three reasons: