GUEST WORDS - Where you live is how long you live.I often say to people, “Give me your address and I’ll tell you how long you are going to live.” The statement typically elicits a burst of startled laughter. We Americans are socialized to believe that control of our fate lies squarely in our own hands. But the truth is that our zip code is often more important than our genetic code in shaping our likelihood of premature death.
How do I know this? Death certificates. From 2003 to 2009, when I was the health officer for Alameda County, Calif., I was also the official Registrar of Deaths. Death certificates tell you not only when a person died, but also where the person lived. From looking at over 400,000 death certificates over a 45-year period, we were able to calculate the average life expectancies of residents of more than 150 neighborhoods in Alameda County.
What we found were shocking patterns of disparity. The people in the neighborhoods with the highest life expectancy statistics were living over 85 years on average. The people in neighborhoods with the lowest life-expectancy statistics were living only 65 years on average. That’s a 20-year difference! A life expectancy of 65 years is on par with Pakistan or Tajikistan. A life expectancy of over 85 years exceeds that of Japan, the country with the longest life expectancy in the world.
In other words, within one county, population 1.51 million, we found the ecological equivalents of Tajikistan and Japan, and everything in between.
With this analysis in hand, we could tell anybody whether he or she lived in the ecological equivalent of Japan, Iran, Honduras or Peru. We also looked at numbers in many other American cities, including Philadelphia, Cleveland, Seattle, Baltimore and Los Angeles. In every case, we found disparities of a similar magnitude.
Many people react dismissively to such findings. “This doesn’t apply to me,” they say. “I work out. I eat healthily.” We all like to believe that we are somehow immune to these larger forces that influence our lives. And, to be sure, avoiding smoking, being physically active and eating healthy food are good habits that offer us some protection from premature death. But even for those of us with the healthiest behaviors, geography often plays a big, if hidden, role.
Good neighborhoods provide access to good schools, to parks and open space, to transportation, to decent employment and to healthy food. Good neighborhoods support social connectedness through religious institutions, fraternal societies, community centers and other social gathering places. Bad neighborhoods, by contrast, fail on all of these fronts. In bad neighborhoods, health risks are abundant and resources scarce. Schools are poor, parks are few, jobs are scarce and crime is high.
The differences between good and bad neighborhoods also create differences in levels of stress. In good neighborhoods, stress is low and manageable. In bad neighborhoods, stress is high and unrelenting. People in bad neighborhoods must contend with inadequate services, unpleasant surroundings and fear of crime. This sort of stress has demonstrable physiologic consequences. Chronic stress lowers our immunity and contributes to tissue and organ damage. It “weathers” us, wearing us down and, ultimately, shortening our lives.
The good news, however, is that none of this is in any way inevitable. As much as place of address and life expectancy correlate with one another in the United States today, they do so less than in many other countries. Also, historically, the correlations in the United States used to be much lower.
The conditions that we witness in low-income neighborhoods are man-made, the result of flawed policies. They can be “unmade” through the actions of an informed and motivated citizenry.
A deep and sustained investment in policies that focus on early childhood experiences (e.g. high-quality preschool), heighten educational attainment, improve access to health care, promote more mixed-income neighborhoods and encourage living wages will help de-couple the tight relationship between address and life expectancy.
Growing up in a low-income neighborhood need not produce such dramatic health problems. In 21st-century America, our charge is to create the political will to undo some of the legacy of our 20th-century mistakes.
I look forward to the day when you can tell me your address and I, looking at the numbers, will have nothing special to predict.
(Anthony Iton is senior vice president for healthy communities at The California Endowment. He participated in a Zócalo panel on health inequality. This article appeared first at zocalopublicsquare.org) Photo courtesy of Dottie Mae. -cw
Tags: neighborhood, death, health, where you live, genetic code, life expectancy, Japan
Vol 9 Issue 54
Pub: July 8, 2011