Vermont and Massachusetts have begun providing health care insurance to all their residents, and 11 other states are wrestling with ways to do so. A worthy goal, to be sure, but universal medical insurance isn’t the golden ticket to universally improved health, warn researchers at the Harvard School of Public Health.

In the most comprehensive study of life expectancy in the United States, published in 2006, Harvard researchers tracked death rates by county of residence and race, creating “race-county units.” To combine these units into a manageable number of groups, they settled on the idea of eight “Americas.” For each America, researchers estimated life expectancy, the risk of death from specific diseases at various ages, the percentage of people who had health insurance and the frequency of doctor visits. The findings: extreme differences in life expectancy—people in America 1 (Asians) live an average 13.8 years longer than those in America 8 (high-risk urban blacks)—but lack of health insurance is not the problem.

	Who's insured Compared with the wide variation in life expectancies, differences in health plan coverage across the eight Americas are slim. It’s the same story with routine medical checkups; in fact, America 8 (high-risk urban blacks, the group with the lowest life expectancy) reported the highest rates of doctor visits. (Hispanics do not have their own America; rather, they are accounted for in the black and white Americas, depending upon the group with which they identified in the U.S. Census.)
	Why they die The top killers across all eight Americas are cancer, heart disease and noncommunicable diseases such as diabetes and cirrhosis—consequences of such largely controllable risk factors as smoking, alcohol use, obesity, high blood pressure and high cholesterol. Low-income whites in Appalachia and the Mississippi Valley (America 4), for example, have a life expectancy similar to people living in Mexico and Panama because of such individual factors as diet, exercise and smoking.
	What needs to change “A risk factor such as high blood pressure is four or five times more important than lack of insurance,” says Christopher Murray, a professor at the University of Washington School of Medicine in Seattle, who led the 2006 study and its successor, which is due out this spring and expands on some of these findings. Yet educational campaigns and policies in place during the 20-year period studied seem to have had little impact on changing behaviors that could lower such risk factors.