A recent article in the Washington Post generated more than 4,000 reader comments online with a scary truth: U.S. life expectancies are getting longer, but almost exclusively for the rich. While author Michael A. Fletcher’s economic argument is valid, it left out two crucial factors: place and race. Unfortunately, where you live and your race or ethnicity have a huge impact on your health.
Gains (or the lack thereof) in life expectancy are highly correlated in the U.S. with the zip code we live in. Research consistently shows that our zip codes are one of the strongest predictors of our health. Essentially, place matters. The World Health Organization has already put this decades old research about place and health to use through its Healthy Cities initiative, which promotes place-based interventions to improve health in specific communities. A place-based approach for improving health is key because the landscape of poverty and the environments we live in vary from place to place, even within cities or towns. This is true also for rural places, and the blatant differences between rural and urban environments.
Although our country is lagging behind, the Centers for Disease Control recently started promoting similar health interventions through its Community Transformation Grants. Foundations have also followed suit, including Kaiser Permanente’s Healthy Eating, Active Living (HEAL) Zones and The California Endowment’s Building Healthy Communities initiative.
Race and ethnicity play a role too. Preventable chronic disease is a significant drain on California’s economy, resulting in $22 billion a year in medical costs and lost productivity, and people of color have a higher risk of suffering from preventable diseases such as diabetes. Obviously our nation’s approach to improving health hasn’t been working, and communities of color have been paying the price for it. Research from 2002 found that only 10 percent of our mortality is determined by access to health care and/or quality of our medical care (see pie chart above). There is no reason to think this has changed much.
Although the Washington Post article emphasizes health care and education, these factors are not the only ones that determine our ultimate life expectancy. The entire pie in the chart above is influenced by place and the social determinants of health, from the air you breathe to the choices you have available for things like exercise, nutrition, communal spaces, and public transportation. Placing blame on individual behavior for unhealthy lifestyles is blind to the different contexts in which we live, like our zip code or race.The 90 percent of the pie chart that isn’t medical care can be targeted through investments in public health prevention that can create more equitable lives for all, and promote healthy living regardless of race, income or zip code.
Circling back to Fletcher’s article, increasing the retirement age for Social Security payments is regressive because life expectancy gaps exist not just between the rich and everyone else, but also between races and locations. Investing in prevention may be more complex and require more up-front investment, but it is more cost-effective in the long run and benefits people of all ages.