Where you live, combined with race and income, plays a huge role in the nation's health disparities — differences so stark that a report issued Monday contends it's as if there are eight separate Americas instead of one.
Millions of the worst-off Americans have life expectancies typical of developing countries, concluded Dr. Christopher Murray of the Harvard School of Public Health.
Asian-American women can expect to live 13 years longer than low-income black women in the rural South, for example. That's like comparing women in wealthy Japan to those in poverty-ridden Nicaragua.
Compare those longest-living women to inner-city black men, and the life-expectancy gap is 21 years. That's similar to the life-expectancy gap between Iceland and Uzbekistan.
Health disparities are widely considered an issue of minorities and the poor being unable to find or afford good medical care. Murray's county-by-county comparison of life expectancy shows the problem is far more complex, and that geography plays a crucial role.
"Although we share in the U.S. a reasonably common culture ... there's still a lot of variation in how people live their lives," explained Murray, who reported initial results of his government-funded study in the online science journal PLoS Medicine.
Consider: The longest-living whites weren't the relatively wealthy, which Murray calls "Middle America." They're edged out by low-income residents of the rural Northern Plains states, where the men tend to reach age 76 and the women 82.
Yet low-income whites in Appalachia and the Mississippi Valley die four years sooner than their Northern neighbors.
He cites American Indians as another example. Those who don't live on or near reservations in the West have life expectancies similar to whites'.
"If it's your family involved, these are not small differences in lifespan," Murray said. "Yet that sense of alarm isn't there in the public.
"If I were living in parts of the country with those sorts of life expectancies, I would want ... to be asking my local officials or state officials or my congressman, 'Why is this?"'