The bigger your paycheck, the greater your life expectancy, new research suggests. While the poor are at a disadvantage, the odds of living a longer life are better for less affluent people in certain parts of the country than others. 
 
 Stanford researchers analyzed more than one billion tax and Social Security records and report that there's an increasing gap in life expectancy between the richest one percent in the United States and the poorest one percent. For men, the difference in life expectancy is 14.6 years. For women, being in the top one percent means living an average of 10.1 years longer. 
 
 But the authors also found that it wasn't only about earnings. Where you live can also impact how long you live, especially if you don't have money, said lead author Raj Chetty, professor of economics at Stanford University. 
 
 The poor have a much higher life expectancy in prosperous urban areas like San Francisco and New York City, said Chetty. 
 
 "I would have thought these very expensive big cities, like New York City and San Francisco, for most poor would be stressful and would be places with poor health among the poor, but that's not at all what these data suggest," Chetty said. 
 
 Part of the reason might be due to local public health programs and policies. Those two cities were among the first to restrict tobacco and ban trans fats, for example. 
 
 In contrast, in more rural areas and some rust belt states such as Michigan, Ohio, Indiana, Kentucky, Tennessee, Arkansas, Oklahoma and Kansas -- including cities like Detroit -- life expectancy for the poor is especially low. 
 
 "The poorest men in America have a life expectancy comparable to those living in Sudan and Pakistan," Chetty said. 
 
 Meanwhile, the study showed that the richest men in America have a better life expectancy than any men in the world. Over the past 15 years, life expectancy climbed by 2.3 years for the wealthiest 5 percent of American men and increased nearly 3 years for the most well-off women. 
 
 Usually conversations about inequality in America address issues at the national level, Chetty said, but the new findings suggest more discussion needs to be happening at a local level where the disparities have a greater impact on health and lifespan. 
 
 "A lot of variations seem to be driven by health behaviors," he said, even when there is access to health care. For example, life expectancy is on the rise for the poor in Birmingham, Alabama, but in Tampa, Florida, the poor are on the downslide when it comes to life expectancy. 
 
 In an accompanying editorial in JAMA, the Journal of the American Medical Association, Dr. J. Michael McGinnis of the National Academy of Medicine wrote that "community is powerfully associated with life expectancy." 
 
 McGinnis told CBS News, "The study suggests that, although employment conditions and levels of income inequality did not independently explain differences among communities in life expectancy, factors such as healthier behaviors, higher graduation levels, higher expenditure levels for government assistance -- issues related to supportive community cultures -- helped moderate the impact of the gap." 
 
 While it's been known for some time that higher incomes are linked with longer lives, McGinnis said the findings are helpful because they offer insights on how to help blunt some of the adverse health issues faced by Americans who are not affluent. 
 
 "The study suggests that a relatively few individual leaders committed to working together to strengthen community-wide attention and action on behalf of health of populations, might make a difference," McGinnis said. 
 
 The study results also suggest a revamp of Social Security and Medicare might be in order, said Chetty. As it stands, due to life expectancy differences, men and women in the top one percent are on track to claim Social Security and Medicare for 11.8 and 8.3 more years than men and women in the bottom one percent of the income distribution. ||||| SAN FRANCISCO — This city is full of parks that invite exercise and bike lanes that make commuting a workout. It's home to social services that tend the poor, and taxpayers who willingly fund them. Smoking is banned at restaurants and bars — as well as in workplaces, at bus stops, throughout public housing, at charity bingo games and even inside stores that sell tobacco. 
 
 These factors may help explain why the poor live longer in the San Francisco area than they do in much of the rest of the country. According to a large study published today about how income and geography shape life expectancies, a poor person living in the San Francisco area can expect to live about three years longer than someone making the same income in Detroit. That difference is equivalent to how much national life expectancies would rise if we eliminated cancer. 
 
 "If you think about the cancer comparison, having cancer is not just about having a shorter life. It's also about having an unhealthier life, a much lower quality of life," says Stanford economist Raj Chetty, the lead author of the study, published in the Journal of the American Medical Association. Seven economists, from MIT, Harvard, the U.S. Treasury and McKinsey and Co., were co-authors. 
 
 Think about their new data as if the poor in Detroit get cancer and the poor in San Francisco don't. "Then," Chetty says, "you can see that this is a big deal." 
 
 The research, based on the tax and Social Security records of everyone in America between 1999 and 2014 with a valid Social Security number and earnings, gives the most precise look yet at a pattern that has long troubled health experts: In America, the richer you are, the longer you live. But what's especially striking is that the poor live even shorter lives in some places than others. They have longer life expectancies in affluent cities with highly educated populations, such as San Francisco, New York and Los Angeles. Among the 100 largest commuting zones ranked by the researchers, six of the top eight for low-income life expectancies are in California, a state with a strong safety net and a history of regulating where you light your cigarette or what comes from your car's tailpipe. 
 
 The poor live shorter lives in Las Vegas, Louisville and industrial Midwest towns, such as Gary, Ind. Geography also matters much more for the poor than the rich. The health behaviors of the wealthy are similar wherever they live. For the poor, their likelihood of risky behaviors such as smoking depends a great deal on geography, on whether they live in a place where smoking is common or where, as in San Francisco, cigarettes have been shunted out of view. 
 
 The findings pair with earlier research led by Chetty, using the same fine-grained tax data, that illustrates how crucial life outcomes — including economic mobility, adult earnings and now health — vary greatly with geography in America. 
 
 "It is as if the top income percentiles belong to one world of elite, wealthy U.S. adults," Nobel Prize-winning economist Angus Deaton writes in a JAMA editorial accompanying the new paper, "whereas the bottom income percentiles each belong to separate worlds of poverty, each unhappy and unhealthy in its own way." 
 
 Overall, the new study offers the most exhaustive account yet of the rich-poor gap in American life expectancy. The data reveal that life expectancies continuously rise with income in America: The modestly poor live longer than the very poor, and the super-rich live longer than the merely rich. 
 
 For men, the gap between the top and bottom 1 percent nationwide is nearly 15 years. For women, it's 10 years. And these disparities have widened since 2000. People in the top 5 percent have gained about three years of life expectancy. People at the bottom have gained almost nothing. 
 
 The economists don't have definitive explanations for the relationships they observe between income and health. It's not that more money alone buys better health. Poor health can lead to lower incomes, just as low incomes can lead to poor health. And it's hard to imagine, for instance, that the richest Americans can buy things that make them healthier that people who are just slightly less rich can't afford, says Harvard economist and co-author David Cutler. 
 
 But among the poor, the differences in what money can buy probably explain an important part of the longevity gap. 
 
 "At some point, it does become causal: You can buy better housing, you can buy better food," Cutler says. "You own a car that actually works, so you can drive to the grocery store more regularly." 
 
 But it's also true that the stress of poverty can have lifelong health consequences. 
 
 "An emerging body of science is showing that adversity itself will shorten your life span," says Nadine Burke Harris, a pediatrician in San Francisco and a founder of the Center for Youth Wellness, which tries to treat the role of toxic stress in undermining health in the city's poorest neighborhoods. Her patients, who deal with adversity from neighborhood violence to childhood abuse, come in with high rates of asthma and cardiovascular disease, or even repeated cases of uncommon autoimmune diseases. 
 
 Her health center — overwhelmingly funded by local philanthropy — is precisely the kind of resource that's harder to find outside of an affluent city like San Francisco or New York. 
 
 What's driving early death 
 
 Across the country, shorter life expectancies for the poor, measured at age 40, were most closely correlated with places that had lower exercise rates and higher rates of smoking and obesity. For both men and women, stretches of the industrial Midwest promised the lowest life expectancies. Some of the results also align with the findings of a recent Washington Post analysis of mortality rates that found deteriorating health, particularly for whites, outside big cities in rural America where unhealthy behaviors are on the rise. 
 
 Below is a map of where poor women live the longest and shortest across the United States. Poor men's life expectancies are mapped above. 
 
 Across these maps, places with high shares of college graduates, high population density, high home values and high government expenditures per capita were correlated with better life expectancies for the poor. In some ways, this finding is surprising: Health experts suspect that higher inequality may be connected to poor health. But the authors found little correlation between income inequality and life expectancy. And wealthy San Francisco, New York and Los Angeles, among the places in America with the widest income inequality, look here like the healthiest. 
 
 Burke Harris offers her own caveat to that finding: "Poor people only have better health status when they’re living in a wealthy environment if the people in that wealthy environment believe in investing in the safety net." 
 
 That is certainly true in San Francisco, a city with both private wealth and major public expenditures. To the extent that fostering health requires money — either to fund a clinic like Burke Harris's or to invest in parks and city services — San Francisco has it. 
 
 Rajiv Bhatia, the former environmental health director in San Francisco's Department of Public Health, points to other policies the city has pursued, such as universal preschool, paid sick leave and paid parental leave. These policies aren't aimed at shaping health behaviors in the same way that a smoking ban is, but they may well ease the stresses associated with poverty that affect health, too. 
 
 Policies like these, and New York's universal pre-K, are notably the result of more than the money needed to fund them. They're also the product of a particular idea about the role of government in supporting the poor and shaping behaviors linked to health. 
 
 "It's no coincidence that New York City banned trans fats," Cutler says. "New York is a very rich city. People there feel like, 'Look, socially it’s not doing anything for us, we know it’s harmful. Why not get rid of it?'" 
 
 New York Mayor Michael Bloomberg also famously tried to ban oversize sodas. He pushed for calorie labels on restaurant menus, higher taxes on cigarettes and tighter restrictions on buying them. He even issued an executive order trying to nudge city employees to take the stairs more. 
 
 Critics outside of New York called Bloomberg's public-health policies draconian, and less out-there ideas like expanding Medicaid have been met with public skepticism, too. But in the new research, New York City ranks as the place where the poor have the longest life expectancies, ahead of all the California cities. Life expectancies between the rich and poor there still vary widely. And it's still better to be rich in Detroit than poor in New York. But something about the environment there, as in San Francisco, is counteracting at least some of the massive national disparities by income. 
 
 Perhaps in highly educated cities people are savvier about health, Cutler suggests, more likely to advocate for smoking bans or to push doctors to adopt the latest medical advance. Or perhaps it's that more educated, wealthier cities also tend to be more politically progressive, believing in the power of government to make people healthier and to shape what are fundamentally personal decisions about lifestyle. New York and San Francisco also are more walkable and transit-friendly, factors that have been associated with health as well. 
 
 Burke Harris suggests there is a lot going on in San Francisco that the economists did not directly measure. "It’s the living wage," she says. "It’s the greening of the city, it’s the bike lanes, it’s the universal preschool. It’s all of these things that together add up." ||||| Eight counties with the largest decreases in life expectancy since 1980 are in Kentucky. (Michael S. Williamson/The Washington Post) 
 
 Life expectancy is rising overall in the United States, but in some areas, death rates are going conspicuously in the other direction. These geographical disparities are widening, according to a report published Monday in JAMA Internal Medicine. 
 
 Life expectancy is greatest in the high country of central Colorado, but in many pockets of the United States, life expectancy is more than 20 years lower, according to the report from the University of Washington’s Institute for Health Metrics and Evaluation. 
 
 “Life expectancy in many places in this country is declining. It’s going backward instead of forward,” said Ali Mokdad, a co-author of the report and a professor at the university. “These disparities are widening, so this gap is increasing.” 
 
 
 
 
 
 People are less likely to live longer if they are poor, get little exercise and lack access to health care, the researchers found. Mokdad said the quality and availability of that health care — for example, access to screening for signs of cancer — has a significant effect on health outcomes. The United States, he said, needs to rethink how it delivers medical care, with a much greater investment in prevention, and a more holistic approach to creating healthy communities. 
 
 Andrew Cherlin, a professor of sociology and public policy at Johns Hopkins University, said that the increasing inequality in death rates at the county level is troubling. “But it’s unclear from this study what has caused it,” said Cherlin, who was not part of the research team. "It’s hard to separate out the consequences of lower incomes, unhealthy conditions such as obesity, less access to health care providers, and of healthier people moving out of some counties.” 
 
 The new research echoes other findings in recent years that show that the United States is failing to keep up with improvements in longevity seen in other affluent nations. In 2013, researchers described what they called a “health disadvantage” in the United States when compared to peer countries. More recent research has focused on “diseases of despair” that have contributed to a dramatic spike in death rates among midlife working-class whites. 
 
 The Post's Lenny Bernstein explains a report that shows life expectancy for Americans has declined in 2015 for the first time since 1993. (Monica Akhtar,Gillian Brockell/The Washington Post) 
 
 Mokdad said countries such as Australia are far ahead of the United States in delivering preventive care and trying to curb such harmful behaviors as smoking. “Smoking, physical inactivity, obesity, high blood pressure — these are preventable risk factors,” Mokdad said. 
 
 “We are falling behind our competitors in health. That is going to impact our productivity; that’s going to take away our competitive edge when it comes to the economy,” Mokdad said. “What we’re doing right now is not working. We have to regroup.” 
 
 The Institute for Health Metrics and Evaluation researchers looked at death certificates from 1980 through 2014. Among the places with sharply increased life expectancy and lower deaths over that period are the District of Columbia and Loudoun County, Va. — where life expectancy is up 12.8 and 12.4 percent, respectively. Fairfax County has the lowest all-cause death rate in the metropolitan Washington region, significantly lower than the national average. 
 
 Of the 10 counties where life expectancy has dropped the most since 1980, eight are in Kentucky. The other two are in Oklahoma and Alabama. The report includes an interactive map of death rates county by county (and sometimes by city, when a city is not part of a county). The areas with the worst mortality metrics include central Appalachia, the Mississippi Delta and areas in the Dakotas with large Native American populations. 
 
 
 
 
 
 The list of counties with the most improved life expectancy includes a number of remote locations in Alaska, including the North Slope and the Aleutian Islands, and the boroughs of Manhattan (a.k.a. “New York County”) and Brooklyn (Kings County), as well as San Francisco. 
 
 An earlier study from the same research institute showed a huge disparity in the death rate from lung cancer. Summit County in Colorado, home to ski resorts and the town of Breckenridge, had almost no lung cancer mortality — a death rate of 11 per 100,000 population in 2014. The county with the highest rate, 231 per 100,000, was rural Union County, Fla., a small county that is home to a large prison population. 
 
 Read more: 
 
 A new divide in American death 
 
 Life expectancy improves for blacks, and the racial gap is closing 
 
 An addiction crisis along the 'backbone of America' 
 
 Life and death in the United States, in two maps 
 
 Where living poor means dying young
– A new study says America's wealthy live longer than its poor, which is hardly surprising. But it also says low-income people live longer in certain places—like affluent cities including New York and San Francisco, NPR reports. Why isn't clear, but lead study author Raj Chetty of Stanford University was surprised. "I would have thought these very expensive big cities ... for most poor would be stressful and would be places with poor health among the poor, but that's not at all what these data suggest," he tells CBS News. Media reports note that local health policies may have an effect (New York City and San Francisco banned trans fats and restricted tobacco use early on), and Chetty agrees that "thinking about policies that change health behaviors at a local level is likely to be important." The study's other findings highlight the crushing effects of inequality. By analyzing over a billion tax and Social Security records, the Stanford researchers found that the richest 1% of men live roughly 15 years longer than the poorest 1% of men. And in the 21st century, life expectancy has risen 2.3 years for the richest 5% of men and 3 years for the richest 5% of women, while the poorest 5% of Americans saw hardly any improvement. An overall three-year boost in lifespan, the Washington Post notes, is about the difference we'd expect to see from curing cancer. As Chetty puts it, "The poorest men in America have a life expectancy comparable to those living in Sudan and Pakistan." (One study says that eating like the Japanese will make you live longer.)