Healthy People Need Healthy Communities

Good health, like good real-estate value, is largely a matter of “location, location, location.”

Americans continue to be very unequal in terms of personal health, and recent studies find African Americans and other minority groups to be at far higher risk than white Americans for many major health problems.

The Robert Woods Johnson Foundation reports the following:
• African Americans die from diabetes at twice the rate of white Americans.
• The life expectancy of African American men is 6.3 years shorter than that of white American men; African American women’s life expectancy is 4.5 years shorter than that of white American women.
• Native Americans are 2.6 times more likely than white Americans to have diabetes.
• Among 2,608 children under age three, 90% of white children were reported to be in good health compared with only 72% of Hispanic children.

The primary source of these inequalities, according to the Foundation public-affairs director Adam Coyne, is differences in living space: Some Americans’ neighborhoods are more conducive to health than others.

“Much of it has to do with where they live, work, and play,” he says. For instance, Native-American men in South Dakota live to an average age of 58 if they live near a reservation, but they live into their 70s if they live elsewhere, according to the report.

A patient who lives in a low-income neighborhood may face many obstacles to healthy living, such as an abundance of convenience stores that sell alcohol and tobacco, a scarcity of markets that sell fresh fruits and vegetables, and an absence of public space in which to exercise.

“If you’re in inner-city Detroit, where there are hardly any supermarkets, where are you going to get fresh foods? It’s structured such that it discourages some from leading healthy life,” says Jim Marks, the Foundation’s senior vice president.

Marks hopes that communities will do more to promote exercise, balanced diets, and other healthy living habits. They might follow the example of Pennsylvania, which mandated the opening of 58 new supermarkets in inner cities across the state, or the example of U.S. public-school systems that banned high-sugar foods from school vending machines.

Research by Thomas LaVeist, director of the Center for Health Disparities Solutions at Johns Hopkins University, underscores the extent of the problem. In a 2008 study of inner-city communities around the United States, he and co-authors noted that:

• Supermarkets are 4.3 times more likely to be located in predominantly white neighborhoods.

• Full-service restaurants are 3.4 times more likely to be located in predominantly white neighborhoods.

• Low-income African-American neighborhoods have eight times as many liquor stores compared with other neighborhoods.

• Tobacco companies advertise more heavily in African-American neighborhoods.

Clearly such environments matter to health.

“You put anyone in a low-income environment, and they are going to be sick. It doesn’t matter what race they are,” says LaVeist.

When LaVeist and researchers surveyed white and African American residents who lived in the same disadvantaged communities, the disparities shrank or even disappeared: Rates of physical activity were roughly the same, obesity rates were only marginally higher among African Americans than whites, and whites were slightly more likely to smoke.

“When people are living in the similar social conditions, the outcome is more similar,” he says.

LaVeist’s findings corroborate those of the Robert Woods Johnson Foundation’s “Road to Reform” report, which urged a comprehensive approach to public health. The strategy would combine universal health coverage and expanded health-care services with community enhancements that promote residents’ health.

“The entanglement of disease, race, geography, economics, and behavior is terrifically complex and will not lessen until policy and funding decisions match the reality of daily life of people in communities with poor health,” concludes Risa Lavizzo-Mourey, Foundation president.

Marks is optimistic that we can achieve good public health and lower costs. If we invest in public health now, we will get returns in the form of a healthier population that requires less care later.

“If we can lower the amount of illness we might be able to deliver better quality to those who need it,” he says. “We see these as very much tied together.”—Rick Docksai

Sources: Jim Marks, senior vice president of the Robert Woods Johnson Foundation. Web site, www.rwjf.org.

Thomas LaVeist, Johns Hopkins University, Bloomberg School of Public Health. Web site, www.jhsph.edu.