A recent study underscores the fact that good health isn’t just a matter of personal choice for Americans.

It’s tied — in some cases, painfully so — to income levels and geography.

Funded partly through Harvard University and the University of Washington and released this month, the study evaluated death rates across the U.S. by county, for each year between 1961 and 1999.

It gave researchers this wakeup call, and it should be giving us one too:

That the United States, for all its advances in science and medicine, is increasingly populated by two very different groups — a wealthy class that has access to good health care, and a poorer class, which does not.

In some areas of the U.S. — chiefly the South, southern Midwest, Texas and areas of the Rocky Mountains — life expectancies actually have been losing ground since the 1980s. And it’s the chronic, lifestyle-related diseases that are the culprits: High blood pressure, diabetes, lung cancer, chronic obstructive pulmonary disease.

Women’s death rates since the 1980s also were increasing in these regions, researchers said, due to (yet again) chronic diseases that come from smoking and being overweight.

What did this lead researchers to conclude?

“The findings suggest that beginning in the early 1980s and continuing through 1999, those who were already disadvantaged did not benefit from the gains in life expectancy experienced by the advantaged, and some were even worse off.”

And they capped their results with this warning:

“The study emphasizes just how important it is to monitor health inequalities between different groups, in order to ensure that everyone — not just the well-off — can experience gains in life expectancy.”

King County actually did quite well in this study, with the third-highest increase in life expectancy in Washington.

But before we begin to pat ourselves on the back, we need to take a good look around us.

Good health costs money. It costs money to get a checkup; it costs money to eat well. Fat-free isn’t free, folks.

And for all of its affluence, King County has a high number of poor and working poor, the numbers of which are climbing. Since the years of this study (which ended in 1999) those numbers have continued to grow. In 2004 alone, the number of King County residents living in poverty jumped to 10.4 percent, up from 7.3 percent the previous year. And the recent setbacks in our economy, coupled with increasing costs for everything from gasoline to bread, will push these people even deeper into the black hole of poverty.

It’s a no-brainer that the first thing to go is preventative health care, when you can’t pay your bills. By the same token, medications get rationed.

And don’t even think about shopping in the organic-food aisle.

Every day I see the struggles of families here in the Kent valley, where I live.

When you are hungry, you buy your food for calories and cost, more than nutritional content. It’s sad to see what’s rolling down the conveyor belt at the grocery store where I shop, and sadder still to see people digging through their purses and wallets attempting to pay for it. Sometimes, food gets put back.

And if hot dogs are going back on the shelves, it’s a safe bet that medications aren’t getting filled, either.

Which brings me to my original point: Good health is more than just waking up one morning and deciding to eat healthier and to get some exercise.

It’s not just about us.

It’s a choice we make as a society.

It’s about making health care — and healthy food — accessible to all, regardless of income levels.

When it comes to solutions, there is no magic bullet here.

But I can tell you, the first step to this problem is looking beyond the daily grind of our own lives, and considering the realities our neighbors must face.

The ones who don’t have jobs. The ones who are working multiple jobs in a desperate attempt to make ends meet.

We’re not really healthy until they are, too.

To learn more about the study, which is titled “The Reversal of Fortunes: Trends in County Mortality and Cross-Country Mortality Disparities in the United States,” please go to

http://medicine.plosjournals.org.

Laura Pierce is editor of the Kent Reporter. She can be reached at (253) 872-6677, ext. 5050, or by e-mail at lpierce@reporternewspapers.com.