Is Geography Your Health Destiny?

Dr. Lavizzo-Mourney is the President and CEO of the Robert Wood Johnson Foundation.  Before joining Robert Wood Johnson she taught at the University of Pennsylvania, where she was the Sylvan Eisman Professor of medicine and health care systems and director of Penn’s Institute on Aging. In Washington, D.C., she was deputy administrator of what is now the Agency for Health Care Research and Quality.

Thanks to a new set of reports, we now know that where you live matters to your health.  People who call Prince George’s County Maryland home are twice as likely to die prematurely from disease as their neighbors just across the line in Montgomery County.  The data cut both ways.  People who live in the healthiest counties, such as Montgomery or Howard County Maryland have a two-to-three times better chance of living longer than people who live in less healthy counties such as Prince Georges or Baltimore.

These important new facts aren’t just for the Washington area, because the same disparities are happening across the country. This story unfolds in 50 state reports – The County Health Rankings (www.countyhealthrankings.org) – that the Robert Wood Johnson Foundation just released with the University of Wisconsin Population Health Institute.

The data tell a story of our health that doesn’t take place in the doctor’s office, but where we live, learn, work and play.  This story reveals multiple factors— beyond access to health insurance and medical care – that influence how healthy we are and how long we live.  Factors like whether we have access to healthy foods, safe places to be active, our level of education, the number of children living in poverty, and even the number of liquor stores on our block.

These reports are the first to rank each county in the United States, 3,000 in total, on overall health and show the effect that health behaviors, clinical care, social and economic factors, and physical environment collectively have on health and longevity. The snapshot they provide is vivid.  Low-ranking counties tend to be places where it’s harder to stay healthy because of fewer places to walk, lower high-school graduation rates, lack of healthy food stores, higher rates of obesity, and higher rates of smoking.

As a physician, I have seen first hand that much of what influences the health of my patients happens before they arrive in the clinic where I practice.  Many are from neighborhoods that are not healthy places; others have low education or health literacy and face other barriers that make it difficult to make healthy decisions.

The good news is that it doesn’t have to be this way. Many of the problems highlighted in these reports are things all members of a community, working together – the public health sector, the business sector, policy leaders and educators – can improve on.  Even better, many of these problems can be addressed with simple, often low-cost efforts. For example, we can make workplaces and restaurants smoke-free, we can find ways to bring farmer’s markets to food deserts so people can buy healthier foods, we can encourage residents to be physically active by building safer walking paths, we can encourage schools to stop selling unhealthy foods in vending machines, or we can work to improve transportation so people can access services they need to lead healthier lives.

Leaders in Prince George’s County have already started this process.  The county is ranked 17th of 24 counties on overall health.  Nearly one-third of adults who live in the county are obese, well above the state average and significantly higher than nearby Montgomery County.

Prince Georges County residents live in neighborhoods peppered with fast-food outlets and convenience stores selling unhealthy foods. That’s why State Senator David Harrington, public health advocates, and others are seeking to give residents healthier food options.

Other counties have taken similar steps to improve health. Stakeholders in Kansas City are looking at why Wyandotte County is one of the least healthy counties in Kansas. They’re advocating for better public transportation to help residents access healthier foods at grocery stores, visit the doctor, or do other things to lead healthier lives.  Community and public health leaders in Juneau County, one of the lowest ranking counties in Wisconsin, are working to boost health literacy, physical activity, and access to dental care.

Even the healthiest counties can use the Rankings to identify where they need to improve.  Fairfax County Virginia ranks low on air quality–traffic congestion may be a contributing factor.  Measures to reduce air pollution could go a long way to improving overall health.

What these Rankings show us is that health is everyone’s responsibility, that it can be improved, and that we all have a role to play: From First Lady Michelle Obama who has taken on the national epidemic of childhood obesity, to local business leaders, to transportation leaders, to legislators, to health officials, to residents – all of whom must come to the table and together create policies and programs that will help transform America into a place where everyone, not just those in certain zip codes, can lead longer, healthier lives.

Risa Lavizzo-Mourey, MD, is president and CEO of the Robert Wood Johnson Foundation.

8 replies »

  1. Swimming is considered to be one of the wonderful workouts for maintaining a healthy body. It not only helps to keep the body fit but also relaxes mind. During summer time, swimming helps to keep the body cool. For obese people, swimming could help a lot to cut down weight. Thus, swimming is very helpful in reducing weight and to achieve a good physical condition. Swimming is considered as effective as any cardio exercises such as running, and it also helps to strengthen muscles, which is beneficial while carrying out weight training exercises. Besides, there is a multitude of health benefits due to swimming which are as follows:
    •To control blood pressure and cholesterol, swimming is considered as one of the best exercises as it helps blood circulation and improves functioning of heart.
    •Swimming benefits lungs in many ways. Besides, it reduces the risk of stroke, heart attack and diabetes.
    •For the people suffering from bone or joint pain, swimming helps a lot. In fact, it is one of the effective exercises for the people suffering from joint pain as water exerts less pressure on joints. It also improves scope for boosting physical activity. More importantly, it improves the flexibility of joints and helps a great deal to cut down weight.
    •It is also considered as one of the best exercises for the people who are unable carry out weight-lifting and land-based physical activities. One of reasons for the same being weight of the body in water is about 1/10 of weight on land.

  2. Moving from microscope to macroscope is a great move.I think it’s everbody’s duty to take care of himself or herself.If everyone will think like caring of himself or herself then these rankings may improve

  3. It is about time someone pointed all of this out…as far as I am concerned, it is basic sociological thinking. The computer doesn’t make magic…what people do with the computer is what counts. Geography IS critical and just imposing technology on a school is pointless unless there is a support system to absorb the technology into the everyday life of the users. I also believe the cell phone is the real democratize…easier to use, open for everyone, and not a geographical obstruction. Doesn’t everyone get it?

  4. Thank you for pointing out some of the important things we can do to address the glaring geographic variations seen even between adjacent communities.
    Until we can realize the benefits of these initiatives among our community bretheren, sometimes to change the place we are in, we need to change the place we are in.
    Please see the recent report from Urban Institute on the significant and largely unmeasured effect of mobility on community intervention efforts and policy: http://www.urban.org/publications/411973.html http://www.urban.org/publications/901329.html And, my recent view: http://blog.altarum.org/happiness-on-location-when-health-matters-so-does-place/

  5. This is a very important report.
    As a nation, we need to realize that a commitment to public health for the population as a whole is as important as medical care for individuals.
    Even if we pass health care reform legislation (toes crossed), it won’t roll out until 2014.
    In the meantime, we should begin to focus on public health.
    Start with public schools (they need gyms, gym teachers, nutritious lunches and breakfasts. Public schools in poor areas also need smaller classes and dentists visiting the schools–doing checkups, cleaning teeth, doing fillings, etc. We also should clean up the environment in our inner city ghettos. And provide public transportation in poor rural areas.
    I could go on, but these are not new ideas. I think that many people know what we need to do.
    Now, we should do it.

  6. Thank you so much for moving us from the microscope to the “macroscope” and for your leadership at RWJ.
    I am sure you are aware of the series entitled Unnatural Causes at http://www.unnaturalcauses.org
    Let us hope that our US physician colleagues enbrace a bio-psycho-social-spiritual(BPSS) model of health care going forward.
    It is long overdue.
    Dr. Rick Lippin