Tell me where you live, and I’ll tell you for how long: Inequality and within-city gaps in life expectancy in LAC

As I have discussed in a previous #GraphForThought on the geography of exclusion, inequality is manifested across the territory. Location is actually a critically important lens for thinking about how opportunities are unequally available to people. When spatial disparities arise in dimensions related to the provision of public services, such as education or health, this can be seen as a failure of the state to be equally responsive to all of its citizens. Inequalities in health are often broadly captured by comparing measures of life expectancy at birth across groups. As the recently released Human Development Report 2019 notes, gaps in life expectancy at birth are narrowing between countries with low levels of human development and countries with very high levels of human development (as measured by the HDI). While we are seeing convergence in the basic capability of living a long and healthy life—primarily driven by the fact that gains made in life expectancy among low HDI countries were three times the size of the gains made in very high HDI countries—the gap still remains unacceptably high. People in low HDI countries are expected to live 19 years less than those in very high HDI countries.

While gaps in life expectancy at birth across countries are narrowing, the available evidence shows that gaps in life expectancy within countries are increasing (for example, in Canada, Denmark, Finland, Japan, the UK, the US, and several Western European countries). There is much less evidence available on this issue in the context of developing countries – and where it is available, it often explores inequalities between rural/urban areas or is analyzed at the municipal level (see for example, in Chile). Very few studies zoom in further to the level of the city.

In LAC, cities are an important unit of analysis for understanding spatial disparities—as they are both home to the majority of the population (81% of the population in LAC lives in cities – the highest share among developing regions) and notorious for their high levels of inequality. The extreme gap in living standards between neighborhoods is often visually illustrated by this iconic aerial photo of São Paulo, which captures the staggering contrast of homes in the wealthy Morumbi neighborhood alongside homes in the bordering Paraisópolis favela. Indeed, while these two communities border one another, according to 2010 data from Brazil’s Atlas of Human Development, Morumbi has an HDI of 0.93 while Paraisópolis has an HDI of just 0.64. Estimates from 2018 find that the gap in life expectancy across this invisible border may be as much as 10 years.

But what do these disparities look like more systematically within LAC cities? A recent study by Usama et al (2019) helps us to shed light on this question. Using data from Panama City, Santiago, Mexico City, Buenos Aires, Belo Horizonte, and San José, the researchers measure gaps in life expectancy at birth between areas with different socioeconomic statuses. As this #GraphForThought shows, the results suggest that there is a systematic gap in life expectancy between people living in the richest areas (top ten percentile) and people living in the poorest areas (bottom ten percentile). For women, this gap reaches as high as 18 years (in Santiago), and for men this gap reaches as high as 11 years (in Mexico City). The smallest gaps for both women and men were in San José.

If we are to truly “leave no one behind” as we make progress toward achieving the SDGs in our region, addressing territorial inequalities is a priority. This means that we have to go beyond income. We must address inequalities at multiple scales.  Further research is needed to understand the primary drivers behind these gaps in different contexts—including the role of environmental disparities (such as exposure to air pollution or disaster risk), disparities in public services (such as access to quality health care or availability of clean water and sanitation services), or disparities in other living conditions (such as high incidence  of crime and violence).