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 enjoy easy access to Central Park, a host of top restaurants and markets, as well as some of the country’s most famous museums and cultural sites. But the real advantage of calling home on the Upper East Side is measured in years.
Upper East Side residents have an average life expectancy of 86.4 years, a number equal to the most peaceful and prosperous countries in the world. For a population to enjoy so many precious years is a historic achievement in education, infrastructure and health care. However, these hard-won achievements were not evenly distributed. Just 15 miles away in the Brooklyn neighborhood of Brownsville, the average life expectancy is a decade shorter.
Just 25 miles from Brownsville, Brooklyn, Manhattan’s Upper East Side residents have an average life expectancy of 86.4 years.
Source: NYC DOHMH; Bureau of Vital Statistics, 2006-2015
Such life expectancy gaps are common in the United States. Residents of Chicago’s Streeterville neighborhood can rest assured that they will live to be 90 years old. However, the Englewood neighborhood of Chicago maintains a life expectancy of about 60 years. It is ten years lower than the world average – in the richest country in the world. The phenomenon is not just an urban suffering. Overall, members of the rural community have lower life expectancies as they become more likely to die from these five leading causes than their city counterparts. While it can be tempting to eliminate these lifestyle gaps as a result of lifestyle choices or bad luck, they are not. These are the consequences of a complex intersection between social, environmental and cultural conditions that fall under the “social determinants of health”.
You can have the best treatments, the best doctors, the best facilities, but if a patient’s non-clinical needs are not addressed, none of them will make a difference.
Health rule 80/20
The social determinants of health are those conditions in a person’s life and environment that can help or degrade their health. These include employment, education, food availability, living conditions, community support, neighborhood quality, socio-economic status and the wider systems surrounding these conditions. When such determinants are unhealthy, they erode health long before someone enters a hospital – at which point health professionals may only have a few minutes to change the wave of years of eroded health.
As Udai Tambar, vice president of community health at Northwell Health, said, “You can’t make medicines for social problems, and that’s kind of the system we developed. We try to medicate for social risks and social factors You can have the best treatments, the best doctors, the best facilities, but if the non-clinical needs of a patient are not addressed, none of them will make a difference. “
Today, experts generally agree that 20 percent of health outcomes come from care received in medical facilities, 80 percent from non-clinical care attributed to lifestyle, environment and social circumstances.
The data show this. US spending on health care has almost quadrupled since 1980, and the country has invested heavily in hospitals, health care facilities, the development of prescription drugs and the training of health professionals. Each is valuable in itself, however, as a systematic whole, this massive investment, for decades, has not generated proportional health dividends. In addition to nationwide life gaps, the United States has one of the lowest life expectancies, the highest suicide rate, the highest chronic disease burden, and the highest obesity rate compared to other major nations in the world. OECD.
These other OECD countries do not spend more on health than the United States. In terms of absolute dollars, the US easily surpasses these countries. Instead, these countries spend a larger share of their GDP on social services, helping to alleviate harmful social factors long before a hospital visit. According to an estimate, other major OECD countries allocate, on average, $ 1.70 for social spending per dollar for health. The US system is almost the opposite, spending 0.56 cents on social services for every dollar on health.
“You need social equity to get health equity,” Tambar added.
There is no pill to cure poverty
This pattern of spending is one of the reasons for the division between health and wealth in the United States, a pernicious and destructive social determinant of health. We have seen the manual work of this division on the differences in life expectancy between the Upper East Side and Brownsville, but these are samples of a whole. According to a paper from 2017 in Lancet, “The life expectancy of the richest Americans now exceeds that of the poorest by 10-15 years.” And these values of the life gap signal the final consequences of countless unmet social needs.
Consider common health barriers in poor areas where residents do not have access to healthy and affordable food. Limited funds make it impossible to update or maintain the safe housing without paint or water pipes contaminated with lead or mold. Narrow or non-existent transportation options deprive residents of employment or access to health care opportunities. And being surrounded by street crime, unsafe public spaces or the absence of greenways generates sustained high stress, which research shows spoils our physical health as badly as our mental well-being.
Each of these conditions is bitter in itself, but these social determinants often come packaged as part of a social circuit that magnifies the effects of each.
Unfortunately, the US dietary fads and harsh individualism have loudly argued that health will be the culmination of lifestyle choices (for some, even moral rectitude). While lifestyle and choice certainly have their role to play, an understanding of these social determinants shows how inextricably linked our choices are to our social conditions. As Tambar points out, a person may be well versed in nutrition, but if their neighborhood is a food desert, his choices are limited. Social circumstances can limit or negatively influence health in hostile ways.
As Dr. Mary Travis Bassett, director of the FXB Center for Health and Human Rights at Harvard University, said. Big Think: “No one chooses an inappropriate building to live with terrible rodent infestation problems and internal allergens that trigger asthma. This is not a lifestyle choice. […] It’s not about choice; it’s about people having no choice. “
Going to the source
Credit: Getty Images
Negative social determinants of health pose a massive challenge to the medical community, but medical experts and professionals are not powerless to do so. As Michael Dowling, CEO of Northwell Health, writes in his book Health Care Reboot: This trend toward greater awareness of the social determinants of health is one of the most encouraging developments in health because it creates greater awareness. among providers of the entire patient, including all the various elements – most except those that could be considered strictly medical problems – that affect the health and general well-being of an individual. An increase in this upward trend is called “upstreamism”. Upstream practitioners do not focus only on the patient’s downstream symptoms; instead, it turns its attention upstream to incorporate the social determinants of the patient’s health into their diagnosis. Dowling illustrates this paradigm with an example of a patient with a chronic, interrupting headache. Her upstream doctor offered her the usual medicine, 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 infested with high levels of mold. The doctor and the health worker told the patient that her owner would solve the problem and provided the number of a public interest lawyer in case the owner did not comply. , not only those found in the hospital walls. Sometimes, Dowling notes, this will require medical professionals to take the lead. But sometimes, when there are extra-symptomatic health factors, it will mean partnering or supporting social service workers, law enforcement or legal minds to provide a combination of services to heal the whole person. -care organizations are initiatives and awareness programs to directly address the social determinants of health before they become medical problems. Examples include Northwell’s first gun violence screening program and the American Academy of Pediatrics’ fight for child food safety in the United States. As Tambar points out, this holistic perspective means changing our approach more than just medicine. It will take many aspects of our society to adopt a multi-objective approach, one that adds interdisciplinary depth to social issues beyond the expertise of a solitary profession. He concluded: “What people realize is that you serve someone holistically, it’s not about doing everything. It’s about partnering with the best person who can do something you can’t do. “