New York City is a vibrant, vibrant city. No one knows this better than the people who live on the Upper East Side. Residents of this Manhattan neighborhood have easy access to Central Park, an array of top-notch restaurants and markets, and some of the country’s most famous museums and cultural sites. But the real benefit of calling home in the Upper East Side is measured in years.
Inhabitants of the Upper East Side maintain an average life expectancy of 86.4 years, a number comparable to the most peaceful, prosperous countries in the world. That a population can enjoy so many precious years represents historical achievements in education, infrastructure and health care. Yet these hard-won achievements are not evenly distributed. Just 25 miles away, in the Brooklyn neighborhood of Brownsville, the average life expectancy is a full decade shorter.
Just 15 miles from Brownsville, Brooklyn, residents of Manhattan’s Upper East Side have an average life expectancy of 86.4 years.
Source: NYC DOHMH; Bureau of Vital Statistics, 2006-2015
Such differences in life expectancy are common in the United States. Residents of Chicago’s Streeterville neighborhood can rest easy knowing that they will live an average of 90 years old. However, the Englewood neighborhood of Chicago has a life expectancy of about 60 years. That’s ten years lower than the world average – in the world’s most prosperous country. The phenomenon is not just an urban disorder. In general, members of the rural community have a lower life expectancy because they are more likely to die from these top five causes than their urban peers. While it may be tempting to write off these gaps in life as a result of lifestyle choices or bad luck, they are not. They are the consequences of a complex intersection of social, ecological and cultural conditions that fall under ‘social determinants of health’.
You can get the best treatments, the best doctors, the best facilities, but unless a patient’s non-clinical needs are met, none of this will make a difference.
The 80/20 rule of health
Social health determinants are those conditions in a person’s life and environment that can promote or worsen their health. They include employment, education, food availability, living conditions, community support, quality of the neighborhood, socio-economic status and the wider systems surrounding these conditions. If such determinants are not healthy, they affect health long before a person enters the hospital. At that point, health workers may only have minutes to turn the tide of years of eroded health.
As Udai Tambar, vice president of community health at Northwell Health, said, “You can’t give drugs for social problems, and in a sense that’s the system we’ve developed. We try to give drugs for social risks and social factors. You can get the best treatments, the best doctors, the best facilities, but unless a patient’s non-clinical needs are met, none of it will make any difference. “
Today, experts generally agree that 20 percent of health outcomes come from the care received in medical settings, and 80 percent of non-clinical care is attributed to a person’s lifestyle, environment, and social conditions.
The data confirms this. Health care spending in the US has nearly quadrupled since 1980, and the country has invested that money heavily in hospitals, nursing facilities, prescription drug development, and training medical specialists. Each is valuable in its own right, but as a systematic whole, this huge, decades-long investment has failed to deliver commensurate health dividends. In addition to life inequalities across the country, the US has one of the lowest life expectancy, highest suicide rate, highest chronic disease burden, and highest obesity rate compared to other major OECD countries.
These other OECD countries don’t spend more on health than the United States. In terms of absolute dollars, the US handily issues these countries. Instead, these countries spend a higher proportion of their GDP on social services, mitigating harmful social determinants long before a hospital visit. According to one estimate, other major OECD countries allocate an average of $ 1.70 in social spending for every dollar of health. The American system is almost the opposite: it spends 0.56 cents on social services for every dollar of health.
“You need social justice to achieve health equality,” Tambar added.
There is no pill to cure poverty
This spending pattern is one of the reasons for the health-wealth gap in the US, a harmful and destructive social determinant of health. We’ve seen the handiwork of this gap in the life expectancy differences between the Upper East Side and Brownsville, but those are examples of a whole. According to a 2017 paper in The Lancetthe “life expectancy of the richest Americans is now 10-15 years higher than that of the poorest”. And these life-gap statistics indicate the ultimate consequences of many unmet social needs.
Consider the health barriers common in poor areas, where residents don’t have access to healthy, affordable food. Limited resources make it impossible to update or maintain safe housing without mold or lead contaminated paint or water pipes. Close or non-existent transport options foreclose residents from employment or access to healthcare. And being surrounded by street crime, unsafe public spaces, or the lack of greenways creates persistent high stress, which research shows that our physical health declines just as much as our mental well-being.
Each of these conditions is bitter in itself, but these social determinants are often packaged as part of a social circuit that amplifies the effects of each.
Sadly, diet fads and the US’s rugged individualism have loudly embraced health as the culmination of lifestyle choices (even moral righteousness for some). While lifestyle and choice certainly play their part, an understanding of these social determinants shows how inextricably linked our choices are to our social circumstances. As Tambar points out, a person can be well versed in nutrition, but if their neighborhood is a food desert, their choices are limited. Social conditions can adversely affect or adversely affect health.
As Dr. Mary Travis Bassett, director of the FXB Center for Health and Human Rights at Harvard University, said Think big: “No one chooses a substandard building to live in with such terrible problems as rodent pests and indoor allergens that cause asthma. That’s not a lifestyle choice. […] It’s not about choice; it’s about people not having enough choice. “
Go to the source
Credit: Getty Images
Negative social determinants of health pose a huge challenge to healthcare, but experts and medical professionals are not powerless to meet them. As Michael Dowling, CEO of Northwell Health, writes in his book “Health Care Reboot”, this trend towards greater awareness of the social determinants of health is one of the most encouraging developments in healthcare as it creates greater awareness among providers. of health care. entire patient, including all the different elements – most outside of what could be considered strictly medical issues – that affect an individual’s overall health and well-being. An outgrowth of this growing trend is called ‘upstreamism’. Upstream practitioners don’t just focus on the patient’s downstream symptoms; instead, they also turn their attention upstream to include the patient’s social determinants of health in their diagnosis. Dowling illustrates this paradigm with an example of a patient with chronic, life-interrupting headaches. Her upstream doctor gave her the usual medication, but added the unusual prescription of a visit from a community health worker. The health worker found that the walls of the patient’s apartment were contaminated with a lot of mold. The doctor and health worker told the patient that her landlord needed to resolve the issue and gave a public interest attorney number in case the landlord broke. , not just those found within hospital walls. Sometimes, Dowling notes, medical professionals will have to take the lead. But other times, when there are extra-symptomatic drivers of health, it means working with or supporting social workers, law enforcement or legal minds to ensure a combination of services to heal the whole person. health care organizations are at the forefront of initiatives and outreach programs to directly address social health determinants before they become medical problems. Examples include Northwell’s first gun violence screening program and the American Academy of Pediatrics’ struggle for food security for American children. As Tambar points out, this holistic view means changing our approach to more than just medicine. It takes many aspects of our society to adopt a multi-lens approach, one that adds an interdisciplinary depth to social problems beyond the expertise of a solitary profession. He concluded, “What people realize is serving someone holistically, it’s not about you doing everything. It’s about working with the best person who can do something you can’t.”