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Where You Live Can Negatively Affect Your Health, and U.S. Cities Can Change That

June 1, 2017, 8:33 PM UTC
Mature man running along waterfront, New York, USA
Mature man running along waterfront, New York, USA
Cultura RM Exclusive/Edwin Jimenez Getty Images/Cultura Exclusive

“I will apply, for the benefit of the sick, all of the measures which are required…”

I repeated those words as part of the Hippocratic Oath when I became a physician. It reinforces my commitment to use the best of my ability and judgment when caring for my patients. When I see patients during a routine visit, I know exactly what to do from a clinical perspective to ensure they receive the best possible care I can provide. Yet, when I go home, I am often haunted by those required measures that I can’t apply, and I know that I’m not alone.

For the first time in the United States, middle class, Caucasian children may not live as long as their parents. In 2015, Princeton University released a startling report that showed white, middle-aged women are dying earlier—a decline that has only been seen in the U.S.

A decline in life expectancy is nothing new in some communities. In fact, if you look at communities like the South Side of Chicago or West Baltimore, you can find people living with the same life expectancy as individuals in third-world countries. What’s new is that problems are no longer confined to poor, urban neighborhoods—they’re impacting everyone.

There isn’t a one-size-fits-all solution to this issue. The fact of the matter is that the things that happen to us in our everyday lives are making a profound impact on our health and life expectancy. The things I can’t see during a routine patient visit are the very things that make the biggest impact on a person’s health.

The Journal of the American Medical Association just released a study that found a county where a person resides can make as much an impact on their heath as other factors, like ethnicity and genetics. It’s because where you live, and the people in charge of our communities, determine how easy it is to access healthy foods, your ability to walk and bike safely, and keep you safe from violence and environmental exposures.

Look at the problems facing Flint, Mich. that began in 2014. An estimated 8,000 children under the age of six were exposed to potentially brain-altering levels of lead due to unsafe drinking water. It’s an extreme example that shows how quickly the health of an entire community can be affected by the decisions made about its environment.

Our entire nation is facing a Flint-like crisis when it comes to our life expectancy because of financial instability and crumbling infrastructure around us causing a ripple effect that makes it harder for people to eat healthfully, get more exercise, and spend time outside in a clean, healthy, and safe environment.

As a physician, I’m haunted by these statistics, because I know there is only so much I can do from a clinical perspective. While I’m seeing it firsthand in the exam room, leaders in government, the private sector, and nonprofits should also stand up and recognize the problem. According to the CDC Foundation, about 800,000 people die each year from chronic illness like stroke and heart disease. What’s more, by 2030, yearly direct medical costs for these diseases are projected to rise to more than $800 billion, and lost productivity costs could exceed $275 billion.

These figures are daunting, but we can turn the tide, and some communities are already doing it.

The Live Well San Diego program is a regional initiative used by the San Diego County board bridging a cross-sector group to improve population health by addressing the top 10 factors aimed at improving health and well-being. In Michigan, the Michigan Pathways to Better Health (MPBH) program, implemented by the Michigan Public Health Institute and the Michigan Department of Community Health, is using tablet-based checklists to collect demographic information in communities with the greatest health needs and assess behavioral health, and social service factors impacting each patient to get a fuller picture of social determinants of health.


Here is my prescription: Our leaders must recognize the impact that social determinants of health have on our communities. In the United States in 2017, there should not be one person living with the life expectancy of their ancestors from 1917 due to things we have the power to change.

We all have a role to play when it comes to improving the health of our communities, and those of us on the front lines of care must unite with the resources of the private and nonprofit sectors, while leveraging the power of those in leadership to make a difference.

Dr. Garth Graham is president of the Aetna Foundation.