“Tell Me Your Zip Code And I Will Tell You How Long You Will Live”
As a young medical student, I began noticing the correlation between healthy residents and their socio-economic status. It quickly became clear that your zip code impacted your health more than your genetic factors.
There can be as much as a 25-year difference in life expectancy between neighborhoods 1.5 miles away from each other.
When I got to East Baltimore and I saw the conditions of inner-city America, I was really quite shocked. I was a medical student at Johns Hopkins at the time, and immediately began seeing the impact living conditions had on health of residents. Later, as the director of the Public Health Department for Alameda County, I signed thousands of death certificates, and noticed similar patterns in the ages, causes of death, ethnicities, and the zip codes of the deceased.
I got really excited at the technological possibilities of using these death certificates to start painting a picture of the distribution of death across Alameda County. Then we began replicating geographical information system (GIS) data to analyze Baltimore, Seattle, Boston, Minneapolis, and other cities across the US. The findings were the same.
We haven’t seen a city in the United States yet that doesn’t have a significant life expectancy difference between neighborhoods. This is the American pattern, as sad as it is.
All this was confirmed by the data. But before we had the technological ability to bore down into neighborhoods and use large data sets to discern these patterns, we didn’t really understand this.
So what causes this change in life expectancy? People in low-income communities are facing inexorable stress. Basically, every system that they are trying to engage is failing them — transportation, housing, employment, criminal justice, even water in some instances. This creates chronic stress. And that changes your physiology and changes your genetic expression and over time, it mimics premature aging.
Our current healthcare system is failing to address conditions like stress. The notion that experts hold the answers is a flawed notion. Our healthcare system is still a 19th-century system design where you go to an expert and that expert gives you a drug and solves your problem. The 21st-century problems are heart disease, cancer, stroke, chronic lower respiratory disease, which are chronic diseases, which are more related to the environments and the lifestyles that people are living in.
Patients and communities can play a role in championing their own health by contributing to local and national policy discussions — and technology can enable that.
I have seen this firsthand in my current role as the senior vice president of the California Endowment’s Building Healthy Communities initiative, where we focus on improving health conditions in 14 low-income communities throughout California. When you see communities that are suffering from poor health, typically they feel like they have very little control.
I think that is the big challenge for us. But technology can help. Healthcare institutions are starting to study the social determinants of a patient’s health, including factors like housing, transportation and access to healthy food. An example of this is Health Leads, which takes information about a patient’s basic resource needs and adds it to his or her medical record. The organization then helps connect the patient to community organizations that can assist them.
The next step beyond that is to start to aggregate this data and use it in the policy space to push for policies that will further the access at a community level to these kinds of resources.
We want to use technology to improve civic engagement, and give struggling communities a voice in the decisions that are being made by city councils and the school boards that are affecting their lives.
The bottom line is feeling like you lack control of the risks that impact your health is bad for your health. Technology that allows people to participate in their governments, and make agencies more accountable to their government helps provide more equitable outcomes.
We must have a new social compact in California, because our current social compact is frayed and that is another factor in driving a public health crisis.
Healthy, affordable housing, neighborhood parks, libraries, community centers and safe jobs that pay livable wages are essential to good health. With the future of public funding for community programs at stake, now more than ever before, we need a new social compact reaffirming our commitment to an inclusive society in which all Californians have access to these opportunities and high-quality community resources.
This new social compact must recognize the responsibility of government to serve the well-being of people, and promote a fair an inclusive society for all Californians.
Our strategy in our 14 Building Healthy communities is to give residents the tools to help improve their neighborhoods and improve their health. We’ve made huge improvements in these communities and we will continue to give our residents a voice.
Building Healthy Communities partners are changing the odds so that every Californian gets a chance at a long, healthy life by addressing the causes of poor health.
— Dr. Tony Iton is senior vice president of the California Endowment overseeing the 14 Building Health Communities projects. He has a medical degree from Johns Hopkins University School of Medicine and a law degree from the University of California, Berkeley.