Why are people in some places in the U.S. consistently less healthy and have a shorter lifespan than others?
If you look at health and fitness magazines, it may seem like poor diet, lack of exercise and other bad behaviors are to blame. Genetics and access to health care are also commonly cited reasons for why some people are healthier than others.
But where a person lives, works and plays also matters. Research shows where you live plays a powerful role in your health.
Dr Risa Lavizzo-Mourey, president of the Robert Wood Johnson Foundation, has stated: “We know that a child’s life expectancy is predicted more by his ZIP code than his genetic code.”
Researchers from the New York University School of Medicine recently used data from NYU Langone Health’s City Health Dashboard to find that 56 of the U.S.’ 500 largest cities are home to people who can expect to live at least 20 fewer years than those in other neighborhoods, even if they’re just blocks or miles away.
A ZIP code’s influence on the health of those living there is multifold. Where you live directly affects your health in several ways, from exposure to air pollution and toxins to accessibility of healthy food, green space and medical care. But it’s also a more subtle indicator of socioeconomic factors that are inherent to health and longevity, including race and income.
The cities with the widest gaps in life expectancy, the NYU researchers found, were those that were most segregated by race and ethnicity, with predominantly minority neighborhoods often facing obstacles — like poverty, untenable housing costs, unemployment and subpar social services — that don’t affect majority White neighborhoods to the same degree.
Links between race, poverty and health have been reinforced by years of inequality, and disentangling them won’t be easy. But understanding the ties between ZIP code and health can help local lawmakers, public health officials and community representatives begin to level the playing field for their residents, the NYU researchers argue.
Social Determinants of Health and Health Disparities
It’s easy to pick out the neighborhoods in our cities where the lifespan is shorter. They’re the poorest neighborhoods and the neighborhoods with the most crime. They’re the neighborhoods with few grocery stores or resources.
The items just described are called social determinants of health – the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of “forces and systems” shaping the conditions of daily life.
These “forces and systems” shaping daily life include:
Economic policies and systems – example: what is the minimum wage?
Development agendas – example: does my local government prioritize and incentivize the development of affordable housing, allowing environmentally unsafe construction near residential areas?
Social norms – example: is the norm in my community to fight with fists or with guns and discrimination?
Social policies – examples: job training, neighborhood renewal and disability services.
Political systems – example: has my state passed Medicare expansion, abortion laws, foster care policies and funding for education?
Social determinants of health have a major impact on health inequities – the unfair and avoidable differences in health status seen within cities. In cities, states, and countries, all levels of income, health and illness follow a social gradient: the lower the socioeconomic position the worse the health.
Research shows that social determinants can be more important than health care or lifestyle choices in influencing health. For example, numerous studies suggest that SDH account for between 30-55% of health outcomes. In addition, estimates show that the contributions from outside of health to population health outcomes exceed the contribution from the health sector.
Addressing SDH appropriately is fundamental for improving health and reducing longstanding inequities in health, which requires action by all sectors and civil society.
African Americans and Social Determinants of Health
What are some of the SDHs contributing to the low health outcomes of African Americans? If we can begin to address some of these issues, we can begin to improve life expectancy in some of these zip codes.
Education: Fewer blacks graduate from high school (72.5 %) than do non-Hispanic Whites (87.2 %), and more Whites than Blacks earn a bachelor’s degree.
Unemployment rate: While unemployment rates for all Americans is historically low, the Black unemployment rate remains double that of Whites.
Poverty: Poverty is a prime predictor for lacking basic human essentials including adequate clean water, nutrition, health care, education, clothing, and shelter. African Americans are the poorest ethnic group in America and have had the lowest median household income in America.
Other Neighborhood Issues
The quality of housing affects health, and African Americans live in some of the country’s lowest-quality housing. Asthma is related to poor housing, and African Americans are disproportionately affected from asthma. Segregated housing is correlated with a significant increase in cardiovascular disease.
Transportation is often a problem in poor communities, presenting obstacles to accessing health care services, especially preventive care.
Access to healthy foods is also a frequent problem in poor African-American communities. “Food deserts” describe neighborhoods without easy access to supermarkets that sell fresh produce and other healthy foods.
Several studies also document that the food that is available in poor Black neighborhoods is less fresh and of lower quality. In contrast, alcohol outlets are much more numerous in Black neighborhoods. It is not surprising that rates of obesity and diabetes are highest in poor Black neighborhoods.
Black people are significantly more likely to reside near sources of air pollution and other environmental problems having broad negative health impacts.
Violence is also a major determinant of health disparities. Firearm homicide was the leading cause of death for African-American males ages 15-34 with firearms being used in over 91% of homicides of African-American males ages 15-34.
It must also be noted that Black children are twice as likely to witness domestic violence and 20 times more likely to witness a murder than White children. Persons who live in poor neighborhoods are also much less likely to gain the benefits of exercise because of safety concerns
Incarceration – Approximately 50% of all inmates in U.S. jails and prisons are Back, even though they represent less than 13% of the population. One in six prisoners has a diagnosable mental illness. This population also suffers from infectious and chronic diseases at rates that are four to ten times higher than the total population.
Not only do prisoners come from disproportionately poor populations, but a lack of adequate healthcare has been well documented in many U.S. prisons and jails, although this population has a constitutional right to health services.
The impact of incarceration on the family is devastating. One of every 15 Black children has an incarcerated parent, compared to one of every 110 White children. Research has shown that children of incarcerated parents are six times more likely to be incarcerated themselves during their lifetimes
If we are to improve the life expectancy of Black people in America, which requires more than just better health care, we must begin to address these social determinants which can be more important than health care or lifestyle choices in influencing health.
By a look at the stats, there’s lots of work to be done.