Life expectancy in the U.S. is solidly linked to a person's ZIP code, but communities can take meaningful steps to improve the health of their residents, according to a new report from the Robert Wood Johnson Foundation.
The foundation compiled a report on health gaps using its County Health Rankings and Roadmaps, a joint project with the University of Wisconsin Population Health Institute. The analysis ranks the health of each state's county against the healthiest county in the state and provides strategies for improvement. It doesn't compare counties from different states.
“Americans love rankings,” said Bridget Catlin, who directs the program at the Population Health Institute in Madison. “But we wanted to identify opportunities toward providing everybody a fair chance to be their healthiest and how many deaths could be avoided if every county could be as healthy as the healthiest.”
Individual counties are judged on social and economic factors (40%) such as education, employment and income; health behaviors (30%) such as smoking, diet and alcohol consumption; access to and quality of local clinical care (20%); and physical environment factors (10%) such as air quality, housing and transit.
Catlin said there isn't much point in highlighting what people already know—that residents in states like Colorado are healthier than those in Mississippi. Rather, the Health Gaps report is intended to spark statewide conversations about investing resources where they could best improve the health of residents in bottom-performing counties.
Most of that attention, the foundation says, has come from local communities rather than state lawmakers and agencies.
Marquette County was ranked 71st out 72 Wisconsin counties when its health department decided to create the post of “health educator (PDF)” and used the analysis from its annual ranking to prioritize the duties of the new post.
To promote similar actions, the program instituted the RWJF Culture of Health Prize. The 2015 prize winners were announced last month and included Kansas City, Mo.
A community activist from Kansas City's Douglass-Sumner community told the foundation that neighborhood residents have “been told for so long, through words and actions, that they don't matter—and so they believe it.” But neighborhood advocates were able to persuade voters to approve a "health levy" in 2013.
Structured as a property tax, the new revenue stream provides about $50 million a year to pay for hospital and public health initiatives. A plan for Truman Medical Center to open a grocery store in a community designated as a “food desert” has been set aside, but the hospital continues to operate its Health Harvest Mobile Market, which brings healthy food options into areas where few were previously available.
“ZIP codes matter” has become a recent mantra in healthcare, and the RWJF has worked with the Virginia Commonwealth University Center on Society and Health to illustrate some sharp contrasts in life expectancy within relatively small geographic areas. One map they developed shows how life expectancy for babies born within five miles of downtown Richmond, Va., can vary by up to 20 years. Those born in the southwest Westover Hills community can expect to live to 83 while those born in the northeast Gilpin area are only expected to reach 63.