What are some of the strongest factors that affect your health and life span? Contrary to what you might think, your interactions with the health care system have less effect on how long you live than socioeconomic factors.
“No scientific doubt exists that, mostly, circumstances outside health care either nurture or impair health,” Dr. Donald Berwick of the Institute for Healthcare Improvement in Boston says.
He cites the “subway map” view of life expectancy. For example, the life expectancy of someone living in mid-town Manhattan is on average 10 years longer than someone who lives in South Bronx (a 20-minute subway ride away). In Chicago, the difference between someone living in the “Loop” and the west side of the city is 16 years.
To put this in perspective, if all heart disease in the U.S. were eliminated, the average life expectancy would be 4 years longer. In essence, where one can afford to live potentially has about 2 to 4 times the impact on one’s life expectancy compared to the theoretical elimination of the leading cause of death.
In 2018, the average life expectancy in West Virginia was 75.4 years. In Hawaii, it was 81 years, which was the longest. West Virginia’s life expectancy was second-to-last in the country, barely edging out... Mississippi.
All of the states in the U.S. where the average life expectancy was less than 76 years were in the South. The U.S. overall average was 78.6 years.
So, what are the causes of this disparity? These factors, called the “social determinants of health” include- conditions of birth and early childhood, education, employment, “community resilience” (which includes transportation, housing, security and a sense of self efficacy). These social determinants have a larger impact on community longevity than what we docs do in our offices and operating rooms.
How is our country as a community doing? Forty million people are hungry, 600,000 are homeless, 2.3 million are in prisons and jails with minimal health services (70 percent of whom experience mental illness or substance abuse).
Oh, and 40 million live in poverty. And, oh yeah, 30 million Americans do not have health insurance.
Berwick opines that despite acknowledgement that these social determinants of health are the main source of our national health status, our response has been to get better at fixing up the damage rather than pouring resources into preventing the damage in the first place.
As the pitch man on the old Fram Oil Filter commercials said, “You can pay me now, or pay me later” (Spoiler alert- paying later, for cars and populations, is more expensive). A perfect example is the misappropriation of the tobacco settlement funds, of which 0 percent was used in our state for tobacco cessation education in the past year.
Dr. Berwick, whose comments appeared in an opinion piece in the July 21, 2020, issue of JAMA, argues that the U.S does not spend nearly enough on public health services and on these social factors that influence our longevity.
He has several thoughts on the solution. Among them (and this is not a complete list): confirm by law that health care is a human right: re-enter the Paris agreement on climate change (the U.S. is the sole country to withdraw from the accord); reform of the criminal justice system, and increase efforts to end hunger and homelessness in the US.
The devil is obviously in the details, but the current pandemic has shown that we need more investment in our public health infrastructure to deal not only with these disease outbreaks as well as the day to day societal ills that contribute to worsening health and premature death.
Speaking of things that worsen our health, the CDC recently conducted a survey on how people utilized products that are designed to disinfect non-living surfaces. Sixty percent of people who participated in the survey said they disinfected their homes more frequently since the onset of Covid 19.
However, the survey discovered alarming percentages of people who used disinfectants inappropriately. Nineteen percent used bleach on food such as fruits and vegetables. Eighteen percent used household cleaning products on their skin.
Ten percent reported misting their body with a cleaning or disinfectant spray. Six percent reported inhaling vapors from disinfectants and 4 percent said they drank or gargled with diluted bleach, soapy water or other disinfectant products.
The writer is a member of the primary care team that treats patients at the Valley Health Hampshire Memorial Hospital’s Multispecialty Clinic. As befitting its name, the clinic provides specialty care services in the fields of cardiology, general surgery, gastroenterology, gynecology, podiatry, pulmonary medicine, and wound care.