The rich get richer and the poor die younger. Too many Americans shrug these off as the facts of life. A new study in the Journal of the American Medical Association puts hard numbers on the life-threatening realities of poverty in this country while challenging assumptions about our ability to change things.

For all of America's bragging about exceptionalism, technological advancement and high living standards, the fruits of our success aren't doing much to help the country's poor. On average, their life expectancy is about the same as citizens of Peru and Colombia.

Some of the worst areas of the country, in terms of how poverty shortens lives, are within a 300-mile radius of St. Louis, including Louisville, Indianapolis and Gary, Ind. That's hardly surprising considering the high rates of obesity and cancer in those same areas.

Middle America also is witnessing a big spike in deaths among members of the lower middle class, especially women below age 55. Drugs and alcohol are wreaking a heavy toll, as are suicides, according to a recent Washington Post report.

It's a sad statement, considering that for decades, America has known about the social factors that make poor people less healthy than richer Americans. Some cities appear to be tackling the problem head-on. Others clearly aren't.

San Francisco, San Jose, Calif., and New York City have fewer wealth-based disparities in life expectancy. The reasons could involve policy decisions that encourage people to walk and exercise more. Hike and bike paths help reduce the reliance on cars. Bans on smoking in public places have been in effect for years.

Conversely, urban areas that make life more difficult and stressful for the poor also tend to be the places where life expectancy is shorter. Food deserts can be a contributing problem. When people lack easy access to markets with fresh food, the only choices tend to be high-fat fast foods or junk food sold in street-corner convenience stores.

There are other big contributors to bad health, including the toxic stress factors that the Post-Dispatch's Nancy Cambria and Laurie Skrivan documented in a special report in February. As the newspaper reported, doctors have been able to map the damage that toxic stress inflicts on growing children. It can advance development of diseases such as asthma, obesity, heart disease, high blood pressure, diabetes, kidney disease and stroke — conditions that later reach life-threatening proportions in adulthood.

There is no automatic cure-all. But smart public policy helps even the playing field. Nationally, expanding Medicaid would save 45,000 lives each year, a Harvard study found. Focused job-creation efforts and requiring a livable minimum wage would help parents raise their children in less stressful, healthier and safer environments. Before any of that can happen, people have to care.

REPRINTED FROM THE ST LOUIS POST DISPATCH

Photo credit: Marcin Grabski