(Updated 11/17/2014) Since the genetic code was fully mapped at the turn of this century, we have been schooled by science articles, TV crime shows, and medical breakthroughs that our DNA is the master of our destiny.
It’s time for a rethink.
A set of maps produced by the Robert Wood Johnson Foundation’s Commission to Build a Healthier America dramatically illustrates that your ZIP code may shed as much light on your likely life expectancy as your genetic code. Move just two or three subway stops or highway exits away from your current neighborhood, and you may find your life expectancy prolonged…or reduced.
Take a look at the maps. You’ll see that in New Orleans, the difference in life expectancies between the French Quarter and the Lower Garden District, only a few miles apart, can be as high as 25 years. Live in Virginia’s Fairfax or Arlington counties instead of the nation’s capital, 14 miles away, and you could live an extra six or seven years. Similar disparities can be found in Minneapolis/St. Paul, Kansas City, the San Joaquin Valley, and probably your municipality.
Not too long ago, inoculation campaigns and surgical breakthroughs were health care’s cutting edge. Today, public health hinges on how and where we live, learn, work, and play.
On almost every international ranking, we have worse medical outcomes and shorter lifespans than people in other affluent nations, despite spending far more on health care per capita. These maps demonstrate that we also suffer extreme health disparities even within a single county.
The geographic disparities have little to do with access to or quality of health care. In fact, medical care accounts for only 10 to 15 percent of preventable early deaths. Nor is it about a lack of personal responsibility, a favorite scapegoat of many commentators. Rather, it is the variations in education, income, race, ethnicity, and lifestyles of our neighborhoods that explain much of the difference. Consider these factors:
- College graduates can expect to live five years longer than high school dropouts.
- Middle-income people can expect to live five years less than higher-income people, even if they have health insurance.
- People who are poor are three times more likely to suffer from a chronic illness than middle- and higher-income people.
To determine why, and come up with solutions, RWJF reconvened the Commission to Build a Healthier America, a national, nonpartisan group of leaders from both the public and private sectors, after a four-year hiatus. The Commission elaborated on the 10 recommendations it made in 2009 for improving the health of all Americans, many of which require action outside of a doctor’s office. Early childhood education, adequate shelter, access to full-service grocery stores—all have an impact on health, as does the high level of stress produced by living in poverty.
Creating a healthier America clearly requires a concerted effort by all sectors of society—employers, schools, public health authorities, families, and each and every one of us. For a start, you can look around your own community and try to figure out why the folks who live just a few miles down the road might have a better or worse health outcome than you. It doesn’t require a DNA test to come up with some answers.
*The maps were developed using vital statistics obtained from state and local health agencies and the Centers for Disease Control and Prevention. The data was used to calculate how long a newborn can expect to live based on population counts and death rates for the geographic area in which they are born.
Risa Lavizzo-Mourey, MD, MBA, is president and CEO of the Robert Wood Johnson Foundation, the nation’s largest health and health care philanthropy.