Deborah Lewis is a licensed social worker serving court-referred elderly clients in the Washington, D.C. metro area. Her work takes her to two hospitals, each in different zip codes in the city. She recently sat in the outpatient waiting area in the two different hospitals within a 48-hour period.
She was shocked and dismayed by the stark contrasts in the "health" of the populations at each location.
The predominately middle-class, largely white, elderly outpatients at one hospital were walking without walkers. Most were clearly there for wellness and prevention services.
Across town in the largest hospital serving African-Americans and Latinos, Deborah recalled being overwhelmed by the high levels of debilitation among these outpatients -- wheelchairs, walkers, canes were the norm, not the exception. Most of these patients were struggling to manage chronic diseases.
It was for her, an African-American professional and a baby boomer, a painful reminder that where you live in America makes a significant difference in your risk for illness and premature death.
Here in the United States, a zip code can tell us a lot about how well and how long you'll live. So can census tracts. Most people are stunned to hear the differences:
- In Bernalillo County, N.M., home to Albuquerque, people in some census tracts live an average of 22 years less than those in other some tracts.
- In Boston, the difference in life expectancy by census tracts is 33 years.
- In Cook County, Ill., which includes Chicago, the difference is 18 years. (These figures come from the Joint Center for Political and Economic Studies' Place Matters reports.)
What's behind these differences in life expectancy? Disparities in neighborhood conditions. Our history of residential segregation has concentrated not just certain communities (typically communities of color), but also poverty.
This history and a range of other social determinants serve as the foundation for health disparities inflicted on communities today. The alarmingly high levels of chronic disease and co-morbidities among low-income and public housing residents suggests that there is a strong link between the conditions of concentrated poverty and poor health outcomes.
Poverty's influence on health is not strictly about the affordability of health care itself. It pervades the lives of vulnerable families every day, from how parents get to work, to what their children eat at meals, to scores of other aspects.
Transportation Affects Health
Consider the role transportation plays. "Many low-income families have been forced to live outside city centers where housing is more affordable and access to public transportation is limited," according to a report by the American Public Health Association. "These families often spend more on driving than health care, education or food" (emphasis added).
The APHA report makes the strong case that investing in robust public transportation serving all people is a public health necessity.
Some communities, both urban and rural, have taken the challenge to make transit options like biking more safe. In Detroit, residents are working on a "complete streets" ordinance that ensures roadways are constructed with pedestrians, cyclists, transit users and drivers in mind. The Northeast Iowa Food & Fitness Initiative has held a community competition to design bike racks built by high school students; locals have used federal Safe Routes to School funding to make sure crosswalks are created near schools.
Healthy Food Access
Meanwhile, the links between poverty and poor health, especially obesity, have been well documented in recent years. The conditions at the root of these connections are varied. Low-income neighborhoods often have fewer safe places to exercise, for instance.
Families in poverty also have less access to healthy food, as the Food Research and Action Center points out. While farmers' markets are on the rise across the nation, there are fewer in low-income neighborhoods. Transportation issues may limit access to full-service supermarkets. Moreover, fresh produce and whole grains are often more expensive.
Here again, efforts are underway in communities across the country to make significant and replicable change.
Michigan's Double Up Food Bucks is one of several programs that doubles the value of SNAP benefits (formerly food stamps) at farmers' markets (an idea that 75 percent of Americans support). FoodCorps, a service program that brings school gardens and nutrition education to vulnerable kids, has expanded to 12 states. In New Mexico, MoGro uses temperature-controlled trucks to provide access to healthy, affordable food to Native American communities and others where location and cost often put it out of reach.
These projects are both encouraging and inspiring. Communities across the United States recognize that all of our children -- and particularly children of color -- are not growing up with the same opportunities to thrive, and many of these communities are taking action. We also need policymakers at all levels, from city councils to Congress, to support efforts that will correct our entrenched history of residential segregation.
We can work toward a vision in which geography does not have to be destiny -- or, put another way, in which where you happen to be born does not determine how long you get to live.
You can join in a live TEDMED discussion about poverty's effects on health February 14 at www.tedmed.com. It will also be archived at that site.
For more by Dr. Gail Christopher, click here.
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