90210: Does ZIP code Affect Health?

Perhaps it is obvious to non-physicians that medical care accounts for a small proportion of peoples' overall health. Education and income are two of the strongest predictors of good health. As James Marks writes in a blog for the Huffington Post:

"College graduates can expect to live five years longer than those who do not complete high school...and people who are poor are 3x more likely to suffer physical limitations from a chronic illness."

These findings extend to other diseases such as diabetes, heart disease, and cancer.

So why is there still such emphasis on personal responsibility for poor health? Where we work, our social networks, and the communities we live in have more to do with our health (physical and mental) than the two hours a year that we spend in the doctor's office.

I applaud Marks for being bold and stating the obvious (for those of us social determinants folks out there...)

"As we consider health reform in 2009 let's think about the neighborhoods and towns in which we all live and ask ourselves: What are the barriers standing in the way to better health?"

We've learned our lesson from crash-diets and "good intention" gimmicks. It is not enough to try and be healthy (...I tried really hard to not eat that other half of the chocolate chip cookie this afternoon). We need to create environments where healthy living is normative, where it is expensive and cumbersome to buy unhealthy snacks and to sit on the couch or in a chair all day long. These changes involve community changes. It involves caring for the collective rather than blaming the individual. 

For example, it took compromise to create smoke-free public spaces that now exist all around the country. Now, we should slowly, but surely, look to create healthy environments in other ways. Those who oppose these efforts often don't realize that healthy environments create opportunities, they don't diminish them. The green movement hasn't stifled industry, it has given it a chance to innovate and progress into a new era. 

Let's take a cue from history and move forward with health reform. Rather than relying on medical-model and health-care driven solutions, let us first consider community and environment. Then we may find ourselves on the path to population-based health and wellness.