New York City is a vibrant, vibrant city. No one knows this better than the people who live on the Upper East Side. Residents of this Manhattan neighborhood have easy access to Central Park, a large variety of restaurants and markets, and some of the country’s most famous museums and cultural venues. But the real benefit of naming the Upper East Side House is measured in years.
Residents of the Upper East Side maintain an average life expectancy of 86.4 years, which is equivalent to the most peaceful, prosperous countries in the world. For a population to enjoy so many precious years, these are historic achievements in education, infrastructure and healthcare. Yet these much-desired achievements were not evenly distributed. Just 20 miles away, in the Brooklyn area of Brownsville, the average life expectancy is a full decade shorter.
Just 20 miles from Brownsville, Brooklyn, Upper East Side residents in Manhattan have an average life expectancy of 86.4 years.
Source: NYC DOHMH; Bureau of Vital Statistics, 2006-2015
Such shortcomings in life expectancy are common in the United States. Residents of Streeterville in Chicago can rest assured that they will turn 90 on average. However, the Englewood area of Chicago maintains a life expectancy of about 60 years. It is ten years lower than the world average – in the richest country in the world. The phenomenon is not just an urban distress. In general, members of the rural community have a lower life expectancy, as they are more likely to die from these five major causes than their peers in the city. While it may be tempting to write off these life gaps due to lifestyle choices or bad luck, it is not. These are the consequences of a complex intersection between social, environmental and cultural conditions that fall under ‘social determinants of health’.
You can have the best treatments, the best doctors, and the best facilities, but unless the non-clinical needs of a patient are addressed, none of them will make a difference.
The 80/20 rule of health
Social determinants of health are the conditions in a person’s life and environment that can help or degrade their health. These include employment, education, food availability, living conditions, communal support, environmental quality, socio-economic status and the broader systems surrounding these conditions. If such determinants are not beneficial, it deteriorates health long before someone enters a hospital – at that point, health workers may only have a few minutes to reverse the tide of years of deteriorating health.
As Udai Tambar, Vice President for Community Health at Northwell Health, put it: ‘You can not do medicine for social issues, and in a way this is the system we have developed. We try to give medicine for social risks and social factors. . You can have the best treatments, the best doctors, the best facilities, but unless a patient’s non-clinical needs are met, none of them will make a difference. ‘
Today, experts generally agree that 20 percent of the health outcomes are obtained from the care received at medical facilities, and 80 percent from the non-clinical care attributed to one’s lifestyle, environment, and social circumstances.
The data confirms this. U.S. spending on health care has nearly quadrupled since 1980, and the country has invested heavily in hospitals, nursing homes, medical development and medical specialist training. Each is valuable in its own right, but as a systematic whole, this massive, decades-long investment has not yielded a proportionate health dividend. In addition to the nationwide life gaps, the US has one of the lowest life expectancies, the highest suicide rate, the highest chronic disease burden and the highest obesity rate compared to other major OECD countries.
These other OECD countries do not spend more on health than the United States. In terms of absolute dollars, the US spends these countries handy. Instead, these countries spend a larger portion of their GDP on social services, which help mitigate harmful social determinants long before a hospital visit. According to one estimate, other large OECD countries spend an average of $ 1.70 on social spending for every dollar spent on health. The American system is almost the reverse and spends .56 cents on social services for every dollar of health.
“You need social equity to get health equality,” Tambar added.
There is no pill to cure poverty
This spending pattern is one of the reasons for the separation between health and prosperity in the US, a harmful and destructive social determinant of health. We’ve seen the handiwork of this gorge in the differences in life between the Upper East Side and Brownsville, but these are examples of a whole. According to an article in 2017 in The Lancet, the “life expectancy of the richest Americans now exceeds that of the poorest by 10-15 years.” And these life gap measurements indicate the end consequences of a myriad of unmet social needs.
Think of the health barriers that are common in impoverished areas, where residents do not have access to healthy, affordable food. Limited funds make it impossible to update or maintain secure housing without mold- or lead-contaminated paint or water pipes. Narrow or non-existent transportation options deprive residents of jobs or access to health care. And because we are surrounded by street crime, unsafe public spaces or no green roads, it causes constant stress, which research shows shows that our physical health is just as fierce as our mental well-being does.
Each of these conditions is bitter in itself, but these social determinants are often packaged as part of a social circle that magnifies the consequences of each.
Unfortunately, dieting greed and the robust individualism of the US have loudly cited health as the culmination of lifestyle choices (for some even moral corrections). Although lifestyle and choice certainly play their part, an understanding of these social determinants shows how inextricably our choices are linked to our social conditions. As Tambar points out, someone can have a good knowledge of nutrition, but if their environment is a food desert, their choice is limited. Social circumstances can limit or adversely affect health in intimate ways.
As Dr Mary Travis Bassett, Director of the FXB Center for Health and Human Rights at Harvard University, said Great Think: “No one chooses a substandard building to live in with terrible problems with rodent infestation and indoor allergens that cause asthma. It is not a lifestyle choice. […] It’s not about choice; it’s about people not having enough choice. ‘
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Credit: Getty Images
Negative social determinants of health pose a major challenge to the healthcare community, but experts and medical professionals are not powerless to deal with them. As Michael Dowling, CEO of Northwell Health, writes in his book “Health Care Reboot”: This trend towards greater awareness of the social determinants of health is one of the most encouraging developments in healthcare, as it creates greater awareness among providers across the board patient, including all the various elements – most of which can be counted outside the strict medical issues – that affect the general health and well-being of the individual. Upstream practitioners do not just focus on the downstream symptoms of the patient; instead, they also draw their attention upstream to include the patient’s social health determinants in their diagnosis. Dowling illustrates this paradigm with an example of a patient with chronic, life-threatening headaches. Her upstream doctor gave her the usual medication, but added the unusual prescription of a visit by a community health worker. The health worker found that the patient’s apartment walls were infected with high levels of mold. The doctor and health worker told the patient to solve the problem with her landlord and provide the number to a public interest lawyer if the landlord does not comply. The Dowling story shows the holistic approach of upstreamism: to consider all the determinants of health. , not just those found within hospital walls. About, says Dowling, it is necessary for professionals to take the lead. But other times, when there are outside symptomatic health drivers, it means partnering with or supporting social workers, law enforcement or legal thinkers to ensure a combination of services to cure the whole person. It is for these reasons that many health care organizations are at the forefront of initiatives and outreach programs to directly address social determinants of health before they become medical problems. Examples include Northwell’s first selection program for gun violence and the fight against the American Academy of Food Safety for American children. As Tambar points out, this holistic view means that we need to change our approach to more than just medicine. Many aspects of our society will be needed to pursue a multi-lens approach, one that adds an interdisciplinary depth to social issues beyond the expertise of a single person. He concluded: “What people realize is to serve someone holistically, it’s not about you doing it all. It’s about partnering with the best person who can do something you can not do.”