The economic climate in the U.S. today, is one of great range. For a while now, the rich have been getting richer and the poor are getting poorer. These differences, or disparities in income and location of residence, result in huge differences in health outcomes. These are called health disparities. Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. They are a huge topic of concern in the world of Public Health, so it has been good to see it popping up in the news.
It’s important to make a distinction here before we move on. Health disparities simply refer to the differences in health we see between wealthy and poor populations. These differences often result from inequity. Health inequities refer to the environments that either promote or detriment health. Those in low-income communities have lowered living conditions which correlate with numerous health risks (air quality, water quality, crime rates), less financial resources to provide healthful food to their family, lack access to nature, and access to safe places to be physically active. Health disparities are NOT health inequities. Health disparities are a RESULT of inequity.
The New York Times published a post this week, “The Rich Live Longer Everywhere. For the Poor, Geography Matters.” The article shows an interactive map of the U.S. that is color-coded for lifespan and it is evident that lifespan ranges almost a decade across geographic locations. The gap in lifespan between rich and poor widened between 2001 and 2014. This means that the top 1 percent in income among American men live 15 years longer than the poorest 1 percent. (For women this gap was 10 years). The affluent (rich) not only have more resources that allow them to buy healthier products, but they also live in healthier ways; they exercise more, smoke less, feel less stress, and are less likely to be obese.
“There is a very strong correlation between income and life span,” Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said in an interview. “But it is not inevitable. There are things we can do to change the life trajectory of people. What improves health in a community? It includes wide access to social, educational and economic opportunity.” Preventative measures are more important to promote health, and community health initiatives can help us bridge the gap.
The same study was covered by Medical News Today. The authors of this research suggest that we can do this through local policy. “The strong association between geographic variation in life expectancy and health behaviors suggests that policy interventions should focus on changing health behaviors among low-income individuals. Tax policies and other local public policies may play a role in inducing such changes.”
This idea of zip code as a health factor, has been powerful and is gaining traction in our understanding of health in the U.S. And health directly correlates with success. Which is the American Dream, right? Talk Poverty covered health disparities in terms of pursuing the American Dream. It’s good that this topic is gaining momentum, as it is estimated that 97% of Americans believe that everyone should have an equal shot at success. But when you think about it, it’s pretty intuitive that there are some huge gaps in opportunities for success right now in our country. If you struggle to put food on the table, and don’t have safe places to be active, or adequate medical coverage, you have many more fundamental obstacles to overcome in your journey to success when compared to an affluent competitor.
It is suggested that if we want to change this unacceptable status quo we need to work on two fronts: reinvest in impoverished neighborhoods so that residents have access to high-quality housing, jobs, good schools, transportation, and other basics; and ensure that families with low-incomes have access to affordable housing in neighborhoods that already offer residents these resources.
Currently, for every 100 households earning below 30 percent of the area median income, there are just 28 affordable and available units. That adds up to a shortage of 4.5 million units just for those very low-income households. Keep in mind, that is households, not people. Which is crazy considering that housing is such a basic life necessity. And I’m not even touching on the issue of homelessness in this post — that is a whole other topic.
You can start to get the idea of just how impactful our greatly polarized wealth distribution in the U.S. is on our nation’s health. And as this post tip-toes towards a political line, I’ll leave you with this:
Quanda Burrell, a Boston resident who was able to relocate from a low-income community to a mixed-income community and reaped the health benefits of living in a safer/healthier community said this of community activism, “A lot of people say that the political leaders in the statehouse don’t care about them,” she said. “But you got to make them care. You got to visit them, speak out. If more low-income folks were talking, I think that would make a difference.”
Housing and Urban Development Secretary Castro seemed to agree, adding that the rental crisis is also harming the middle class. “How do you mobilize folks to impress upon policymakers at all levels about the needs of different communities?” Secretary Castro asked. “I don’t see that conversation right now happening enough.”
UPDATE: The New York Times recently published a follow-up, related interactive graph that educational abilities differ drastically among the rich and the poor, and between racial groups. Worth a look: http://www.nytimes.com/interactive/2016/04/29/upshot/money-race-and-success-how-your-school-district-compares.html?smid=fb-nytimes&smtyp=cur&_r=0