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.