by Noble A-W Maseru, PhD, MPH
In 2008, the World Health Organization’s (WHO) Commission on Social Determinants of Health released a report. In it, the commission examined reasons for differences in people having good and bad health—in essence, a long or short life. The commission’s principal finding for the differences in people’s health was the social conditions in which people are born, live and work. For this article, we see the place where one lives as tantamount to social conditions. These social conditions are largely determined by what are commonly called “bread and butter” issues. Researchers call them social determinants of health.
So how do bread and butter issues like food, transportation, housing, education and a living wage affect life expectancy? In the United States in 1900, life expectancy averaged 47 years. In 2000, life expectancy increased to 77 years. The Centers for Disease Control and Prevention (CDC) determined 25 of the 30-year improvement was attributed to bread and butter factors. The other five years were due to health care. Native Pittsburgher Andre Perry of the Brookings Institute determined that obtaining a high school diploma added 10 years to life expectancy. Education is a bread and butter issue.
In June 2019, Pitt Public Health Center for Health Equity, in collaboration with the Community Empowerment Association, launched the project Live Longer: Empowering and Engaging Pittsburgh Communities. The project’s overarching goal was to use the Robert Wood Johnson Foundation’s USALEEP database to determine whether there was evidence of disparities in life expectancy within its base community of Homewood (zip codes 15208 and 15209). Using USALEEP data, the Live Longer project has calculated the life expectancy in 63 Pittsburgh-area neighborhoods and determined longevity ranged from 62-84 years. That is a difference of 22 years in some neighborhoods.
The Live Longer project’s Pittsburgh life expectancy findings affirmed the WHO report—that where people live and, more sobering, their zip code can be an indicator of how long they will live. Zip codes draw attention to the social environment. We know from our research and practice in public health the effect that bread and butter issues have on population health (which, for this article, we will call zip code neighborhood health).
Today, Allegheny County and the City of Pittsburgh, not unlike the nation, are experiencing unprecedented health and human services crises caused by the COVID-19 pandemic. The pandemic is affecting local zip code neighborhoods differently. Communities and populations currently experiencing economic, environmental, social and public health challenges are suffering the most. Just as the county and city declared racism a public health crisis, it is anticipated that Black, Brown and low-income communities will experience disproportionate COVID-19 mortality and morbidity.
The Live Longer project analyzed COVID-19’s effect on the life expectancy of residents in the majority-African American Homewood and other distressed and marginalized zip code neighborhoods. Researchers determined that the life expectancy in these neighborhoods were 11-15 years shorter than the median select neighborhood in USALEEP data—and are worsened by the COVID-19 pandemic. Using CDC data, Lisa Cooper MD, MPH, Johns Hopkins Center for Health Equity, found that COVID-19 has lowered life expectancy 1.2 years and 3.2 years for whites and African Americans, respectively. Data below further shows the effect COVID-19 has on the Homewood zip code (African Americans in Pittsburgh are located in zip codes that Jerry Dickinson describes in his essay “Pittsburgh Is America’s Apartheid City.” https://www.publicsource.org/commentary-jerry-dickinson-pittsburgh-is-americas-apartheid-city/)
Homewood Zip Codes Full and Partial Vaccination Percentages as of June 23 and July 7
AA White Total
15206 30% 73% 66% June 23
31% 73% 67%
15208 29% 73 % 56% July 7
30% 73% 56%
Source: Allegheny County Health DepartmentThe Allegheny County Health Department also reports that 3 out of 5 African American residents are eligible for the vaccine: In African Americans, 35% are fully vaccinated, and 58% of Whites are fully vaccinated.
What Action or Actions Can Improve Life Expectancy
When inequality is too great, the idea of community cannot be realized. When linking decision making to the resources that flow from policies formulated, we must ask: Do those decisions lead to better health and advancing health equity or to worse health and greater health inequity? This article affirms that until mechanisms are in place to hold public decision makers accountable for policy that both advances and achieves social equity, organizations like the Black Equity Coalition, Urban Kind, the Human Rights Working Group, The Pittsburgh Study and The Pittsburgh Neighborhood Project are essential to assure social justice is advanced.
Pittsburghers in zip code neighborhoods plagued by poor social conditions (economic, environmental, social, education and health) live shorter lives and have greater illness than people in more affluent zip code neighborhoods. The marked differences in these neighborhoods will remain until we have social justice and institutional racism is eradicated.
Join in realizing a Just Pittsburgh and Allegheny for All.
Even further, Dr. Gianaros and colleagues are trying to better understand what census measures are actually indicating about communities. Census data like median house or property values do not provide a complete picture of a neighborhood. So they are digging into the measures to determine whether they reflect information about green space, pollution, proximity to highways, easy access to health care or overall safety. More research may eventually provide evidence to help support policy changes that could break the link between zip code and unwanted health outcomes.
If where we live causes stress, that can affect health, too.
“Stress is not just in your head,” says Dr. Gianaros. “It’s in your body—an actual physical effect we can measure. It can powerfully shape physical health and how well we grow and age. We are learning more every day about how stress can ‘rewire’ the brain to affect how it functions. Our biggest challenge is to better understand all the factors that might contribute to stress, as well as how we can change them for the better. We’re learning that many of these factors are more or less present across different neighborhoods.”
This scientific understanding about the connection between our neighborhoods and our health may also lead to preventative health measures that people and policy makers could act on in the future.
To learn more about research by Dr. Gianaros and his colleagues, visit https://www.healthyheart.pitt.edu.