New York City is a lively and vibrant city. No one knows this better than the people who live on their Upper East Side. Residents of this Manhattan neighborhood enjoy easy access to Central Park, a host of top-notch restaurants and markets, and some of the country’s most renowned museums and cultural sites. But the real advantage of calling the Upper East Side home is measured in years.
Residents of the Upper East Side maintain an average life expectancy of 86.4 years, a number on the same level as the most peaceful and prosperous countries in the world. That a population enjoys so many precious years represents historic achievements in education, infrastructure and health care. However, these hard-earned successes have not been evenly distributed. Just 15 miles away, in the Brooklyn neighborhood of Brownsville, average life expectancy is a full decade lower.
Just 15 miles from Brownsville, Brooklyn, Upper East Side residents in Manhattan have an average life expectancy of 86.4 years.
Source: NYC DOHMH; Office of Vital Statistics, 2006-2015
These life expectancy gaps are common in the United States. Residents in Chicago’s Streeterville neighborhood can rest assured knowing they will live to be 90 years old on average. Chicago’s Englewood neighborhood, however, maintains a life expectancy of about 60 years. This is ten years lower than the world average, in the richest country in the world. The phenomenon is not just an urban affliction. In general, members of rural communities have lower life expectancies as they are more likely to die from these five leading causes than their peers living in the city. While it can be tempting to eliminate these vital shortcomings as a result of lifestyle decisions or bad luck. , they are not. They are the consequences of a complex intersection between social, environmental, and cultural conditions that fall into the “social determinants of health”.
You may have the best treatments, the best doctors, and the best facilities, but unless a patient’s non-clinical needs are addressed, none of them will make a difference.
The 80/20 health rule
The social determinants of health are those conditions in a person’s life and environment that can help or degrade their health. They include employment, education, food availability, living conditions, community support, neighborhood quality, socioeconomic status, and the broader systems surrounding these conditions. When these determinants are unhealthy, they erode health long before someone is admitted to a hospital, at which point health professionals may have only a few minutes to change the tide of years of eroded health.
As Udai Tambar, vice president of community health at Northwell Health, said, “You can’t be medicated for social issues and that’s, in a way, the system we’ve developed. best treatments, best doctors and best facilities, but unless a patient’s non-clinical needs are addressed, none of them will make a difference. ”
Today, experts generally agree that 20 percent of health outcomes are derived from care received in medical facilities, 80 percent from non-clinical care attributed to one’s own lifestyle, environment, and social circumstances.
The data prove it. U.S. health care spending has quadrupled almost since 1980, and the country has invested heavily in this fund in hospitals, nursing centers, prescription drug development, and training in medical specialists. Each is valuable in itself, but as a systematic whole, this massive investment of decades has not allowed for proportional health dividends. In addition to life shortages across the country, 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 OECD countries.
These other OECD countries do not spend more on health than the United States. In terms of absolute dollars, the United States easily outperforms these countries. Instead, these countries devote a larger portion of their GDP to social services, helping to mitigate harmful social determinants long before the hospital visit. According to one estimate, other major OECD countries spend, on average, $ 1.70 on social spending for every dollar in health. The US system is almost reversed, spending 0.56 cents on social services for every dollar in health.
“You need social equity to get equity in health,” Tambar added.
There is no pill to cure poverty
This pattern of spending is one of the reasons for the divide between health and wealth in the U.S., 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 they are samples of a whole. According to a 2017 paper published in He Lancet, “The life expectancy of the richest Americans now exceeds that of the poorest in 10-15 years.” And these life gap metrics indicate the ultimate consequences of a myriad of unmet social needs.
Think of the common health barriers in impoverished areas, where residents do not have access to healthy and affordable food. Limited funds make it impossible to upgrade or maintain safe housing without water pipes or mold or lead paint. Narrow or non-existent transportation options cut residents off from job opportunities or access to health care. And being surrounded by crime on the street, unsafe public spaces or no greenways generates high sustained stress, which research shows shows that it affects our physical health as fiercely as our mental well-being.
Each of these conditions is bitter in itself, but these social determinants often come together as part of a social circuit that magnifies its effects.
Unfortunately, the dietary fashions and harsh individualism of the United States have loudly advocated health as the culmination of lifestyle choices (for some, even moral rectitude). While lifestyle and choice certainly play a role, understanding these social determinants demonstrates how our decisions are inextricably linked to our social conditions. As Tambar points out, a person may have good nutrition, but if their neighborhood is a food desert, their options are limited. Social circumstances can limit or negatively influence health in opposite 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 a quality building to live with terrible rodent infestation problems and internal allergens that trigger asthma. This is not a life choice. […] This is not a choice; it’s about the fact that people don’t have enough choice. “
Go to the source
Credit: Getty Images
Negative social determinants of health pose a massive challenge to the healthcare community, but medical experts and professionals are incapable of doing so. As Northwell Health CEO Michael Dowling 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 care as it creates greater awareness. among providers of the entire patient, including all the various items (most outside of what could be considered strictly medical), that affect the health and general well-being of the individual. A growth of this growing trend is called “upstreamism.” Ascendant professionals not only focus on the patient’s subsequent symptoms; instead, they also turn their attention upward to incorporate the social determinants of the patient’s health into their diagnosis. Dowling illustrates this paradigm with an example of a patient with chronic headaches that interrupt life. Her ascendant doctor provided her with the usual medication, but added the unusual prescription of a visit from a community health worker. The health worker found that the patient’s floor walls were infested with high levels of mold. The doctor and health worker told the patient that their landlord would fix the problem and provided the number of a public interest attorney in case the landlord failed to comply. , not just those on the walls of the hospital. Sometimes, Dowling points out, this will require medical professionals to take the initiative. But other times, when there are extra-symptomatic health factors, it would mean collaborating or helping social service workers, law enforcement, or legal minds to ensure a combination of services to cure the whole person. Healthcare organizations are outreach initiatives and programs aimed directly at the social determinants of health before they become medical problems. Some examples are Northwell’s first gun violence screening program and the American Academy of Pediatrics ’fight for the food safety of American children. It will need many aspects of our society to adopt a multiline approach, one that adds interdisciplinary depth to social problems beyond the experience of a solitary profession. He concluded, “What people are realizing is serving holistically someone, it’s not about doing everything. It’s about partnering with the best person who can do something that can’t be done.”