Living Longer, Living Unequally: The Socioeconomic Implications of Longevity

By Adama Diarra, DO, FACP

Introduction: The Uneven Gift of Time
Longevity is often viewed through a celebratory lens—an aspirational marker of health, resilience, and fulfillment. But beneath this optimistic narrative lies a more complex and sobering truth: the gift of extended life is not distributed equally. As medical science extends lifespans, it has also exposed and, in some cases, widened the gap between those who can afford to age well and those who cannot.

Working in primary care, I often see firsthand how longevity intersects with issues of income, education, and access. Two patients of the same age and with similar diagnoses may chart very different paths depending on the resources they can leverage—not just financial, but social, psychological, and geographic. This divergence isn't simply about health literacy or adherence; it's about the cumulative effect of social determinants over a lifetime.

Part 1: Longevity Is Expensive
One of the great paradoxes of modern medicine is that while we have more tools than ever to extend life, those tools often come with a hefty price tag. From biologic medications to concierge care to longevity-focused clinics offering gene testing and custom supplementation, the market for extended healthspan is thriving—but largely inaccessible to the average patient.

A study in Health Affairs found that Americans in the highest income quartile live, on average, 10 to 15 years longer in good health than those in the lowest quartile (Chatterjee et al., 2021). This disparity is compounded by the fact that low-income individuals are more likely to develop chronic diseases earlier, have fewer opportunities for preventive care, and retire later—if at all.

While we may celebrate longer life expectancy as a national achievement, it raises the question: longevity for whom?

Part 2: The Retirement Trap and Long-Term Care Divide
Longer life doesn't just stretch our bodies and relationships—it stretches our finances. Retirement planning for many was based on a lifespan of 75 to 80 years. But living into our 90s or beyond poses the real risk of outliving one’s savings.

Women are particularly vulnerable. They tend to live longer than men but often with fewer financial resources due to gender wage gaps, career interruptions, and caregiving responsibilities (Weller & Tolson, 2020). As a result, aging can bring not peace—but precarity.

Long-term care is one of the most financially devastating and poorly understood aspects of aging. Medicare does not cover most long-term care services, and Medicaid eligibility often requires individuals to spend down their assets to poverty levels (Johnson, 2019). While wealthier individuals can afford private caregivers or memory care facilities, low-income patients frequently rely on underfunded and overwhelmed public systems.

My own father, a chemical engineer, retired in the 1990s at age 55. He’s now almost 87. Without family support, he would simply not be able to afford his lifestyle or care needs. In this way, longevity—without a robust social safety net—can become a liability.

Part 3: Health Equity and Aging Well
If we want longevity to be a shared benefit—not a luxury good—we must rethink how we deliver healthcare and design policy. Aging well should not depend on zip code, wealth, or insurance coverage. It should be the outcome of our collective investment in health equity, education, nutrition, housing, and environmental safety.

One promising innovation is social prescribing, a model gaining traction in the UK and Canada. Instead of only prescribing medications, clinicians also refer patients to community resources, housing support, or group activities. This approach recognizes that health is inseparable from social context (Drinkwater et al., 2019).

As physicians and citizens, we must advocate for policies that dismantle structural barriers to healthy aging. These include universal access to primary care, robust food security programs, financial education, and long-term care coverage. Yet, at a time when many social services are being defunded, the current system paradoxically penalizes people for living longer.

I see this daily in my practice—preventive screenings, diagnostic tests, and even life-saving treatments delayed or denied under the guise of “medical necessity criteria not being met.” The irony is striking: the more services insurers deny, the higher their profits. It’s no coincidence that major health insurance companies have reported record earnings over the past five years, while hospitals and clinics struggle to stay open or are forced to consolidate. And some frustrated doctors are choosing to leave traditional practice like myself or some are retiring early.

This system—reactive rather than preventive, profit-driven rather than patient-centered—must change.

Conclusion: A Moral and Medical Imperative
Extending life should not deepen inequity. As a society, we are morally obligated to ensure that longer lives are also better lives—for everyone. That means challenging the assumptions and systems that treat aging as a reward for affluence rather than a right of humanity.

Longevity must be more than a personal aspiration; it must be a public health goal that includes our most vulnerable neighbors. If we fail to address the socioeconomic implications of aging, we risk creating a future where vitality becomes yet another privilege of the few.

As a physician in concierge medicine, I wrestle with this dual reality daily. My patients receive care that honors their individuality, respects their time, and invests in their future. But the goal is not just to serve those who can afford it—it’s to be a voice in a broader conversation about how we make such care available, accessible, and just. Because the true test of a healthcare system—and a society—is not just how long its citizens live, but how equitably they do so.

References

Chatterjee, P., Cubanski, J., Neuman, T., & Orgera, K. (2021). How much do health disparities contribute to racial and ethnic health differences? Health Affairs. https://doi.org/10.1377/hlthaff.2021.00066

Drinkwater, C., Wildman, J., & Moffatt, S. (2019). Social prescribing. BMJ, 364, l1285. https://doi.org/10.1136/bmj.l1285

Johnson, R. W. (2019). What is the lifetime risk of needing and receiving long-term services and supports? Urban Institute. https://www.urban.org/research/publication/what-lifetime-risk-needing-and-receiving-long-term-services-and-supports

Weller, C. E., & Tolson, M. (2020). Retirement income inequality in the United States. Journal of Aging & Social Policy, 32(1), 66–84. https://doi.org/10.1080/08959420.2018.1536805