Tag Archives: health

Big differences in life expectancy across American counties due to income differences

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Here is an update on the “longevity gap,” the differences in life expectancy, by county in the United States:

Fairfax County, Va., and McDowell County, W.Va., are separated by 350 miles, about a half-day’s drive. Traveling west from Fairfax County, the gated communities and bland architecture of military contractors give way to exurbs, then to farmland and eventually to McDowell’s coal mines and the forested slopes of the Appalachians. Perhaps the greatest distance between the two counties is this: Fairfax is a place of the haves, and McDowell of the have-nots. Just outside of Washington, fat government contracts and a growing technology sector buoy the median household income in Fairfax County up to $107,000, one of the highest in the nation. McDowell, with the decline of coal, has little in the way of industry. Unemployment is high. Drug abuse is rampant. Median household income is about one-fifth that of Fairfax.

One of the starkest consequences of that divide is seen in the life expectancies of the people there. Residents of Fairfax County are among the longest-lived in the country: Men have an average life expectancy of 82 years and women, 85, about the same as in Sweden. In McDowell, the averages are 64 and 73, about the same as in Iraq…

Since the 1980s, “socioeconomic status has become an even more important indicator of life expectancy.” That was the finding of a 2008 report by the Congressional Budget Office. But dollars in a bank account have never added a day to anyone’s life, researchers stress. Instead, those dollars are at work in a thousand daily-life decisions — about jobs, medical care, housing, food and exercise — with a cumulative effect on longevity.

http://www.nytimes.com/interactive/2014/03/15/business/higher-income-longer-lives.html

This is part of a growing body of research that links demographics and social forces, including social spaces, to different health outcomes. Wealthier counties can offer a wide range of health and social services as well as have more higher class residents while poorer counties have different social structures.

While the county level data is interesting, I would assume there would also be some wide differences in life expectancy within counties. Fairfax County, Virginia is one of the wealthiest U.S. counties but income levels there are not uniform. Cook County, Illinois could include some of the poorest neighborhoods in Chicago as well as Kenilworth, Illinois, one of the wealthiest suburbs with a median household income of over $247,000. Check out these maps from VCU’s Center on Society and Health on life expectancy in metro areas. Here is what they found in Chicago:

So the contrast between a county in Virginia versus one in West Virginia might be notable but one doesn’t have to travel that far to find big differences in life expectancy.

To improve health and cut costs, UnitedHealth spending $150 million on affordable housing

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Having affordable housing is linked to better health outcomes so insurance company UnitedHealth is spending some money on affordable housing units:

The firm is taking an unusual step for an insurance company –investing $150 million to build low-income housing in a dozen states…

UnitedHealth’s big push into housing isn’t charity. The company derives benefits from it, too, including tax credits.

But Kate Rubin, vice president of social responsibility for UnitedHealth Group, says the real payoff is longer term.

“Studies show that without stable homes people are sick more often,” says Rubin. “There’s more undiagnosed illness and people are more likely to seek care in emergency rooms.”

That’s expensive for insurance companies, for patients and for the rest of us, who pay the price in higher premiums and taxes.

It will be interesting to see how many units UnitedHealth is able to construct for that kind of money. It seems like the biggest payoff would be if they are able to have sufficient economies of scale, enough units to see significant long-term returns.

This also hints at the need for affordable housing more broadly in the United States and the inability of others to construct it. Public housing in the United States is limited and has had a variety of issues for decades. Lower levels of government, whether states or metropolitan regions, or local government, have had either a hard time finding the right mix of regulation and incentives or haven’t paid any real attention to affordable housing. If few organizations are stepping up to provide or prompt public housing, perhaps insurance companies are a good bet.

Are micro-apartments bad for your health?

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Micro-apartments might be a popular idea these days but some experts suggest they might be bad for the health of certain groups:

“Sure, these micro-apartments may be fantastic for young professionals in their 20’s,” says Dak Kopec, director of design for human health at Boston Architectural College and author of Environmental Psychology for Design. “But they definitely can be unhealthy for older people , say in their 30’s and 40’s, who face different stress factors that can make tight living conditions a problem.”

Home is supposed to be a safe haven, and a resident with a demanding job may feel trapped in a claustrophobic apartment at night—forced to choose between the physical crowding of furniture and belongings in his unit, and social crowding, caused by other residents, in the building’s common spaces. Research, Kopec says, has shown that crowding-related stress can increase rates of domestic violence and substance abuse…

Susan Saegert, professor of environmental psychology at the CUNY Graduate Center and director of the Housing Environments Research Group, agrees that the micro-apartments will likely be a welcome choice for young New Yorkers who would probably otherwise share cramped space with friends. But she warns that tiny living conditions can be terrible for other residents—particularly if a couple or a parent and child squeeze into 300 square feet for the long term, no matter how well a unit is designed…

“When we think about micro-living, we have a tendency to focus on functional things, like is there enough room for the fridge,” explained University of Texas psychology professor Samuel Gosling, who studies the connection between people and their possessions “But an apartment has to fill other psychological needs as well, such as self-expression and relaxation, that might not be as easily met in a highly cramped space.”

While this is largely framed in terms of negative consequences for mental health, it strikes me that a lot of these concerns are built around social expectations about private space. In modern America, people expect a certain amount of space, whether in public or at home. This reminds me of the findings in Going Solo where more and more Americans want home spaces where they can get away from relationships. But, just how much space do they need? Is the ability to handle small spaces proportional to the space in an average new house (around 2,500 square feet in the United States) or to the large living spaces usually portrayed on TV?

It seems like there should be comparative data from other countries. For examples, some European countries as well as Japan have had smaller spaces for decades. Do they have higher rates of stress and other negative outcomes?

Architecture to improve your health and increase your happiness

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Check out this guide from the American Institute of Architects on how certain designs can improve your health. A few examples:

Serenity Now: The spaces architects create can have a soothing and calming effect that reduces stress through mitigation of excessive noise, allowing visual connections beyond the building or within it, and providing access to natural daylight. Research indicates that short-term exposure to noise may negatively affect mental  well-being; prolonged exposures may exacerbate other issues, including aggression…
Stairs Can Save Lives: Well-integrated and -designed staircases can increase physical activity and cardiovascular health. A Harvard study found that men who climbed at least 20 floors per week had a 20 percent lower risk of stroke or death from all causes. New York City’s Active Design Guidelines recommends stair-design strategies that may increase physical activity.
Toxic Gas: Off-gassing from high VOC (volatile organic compound) materials can trigger respiratory health problems such as asthma or allergies in both users of buildings and the people who build them. A child that sleeps in a bedroom with fumes from water-based paints and solvents is two to four times likely to develop allergies or asthma…
Eyes on the Street: Street-level doors and windows encourage walkability and foster a strong sense of community, which aids people’s sense of environmental safety and broader community health. In a Bronx, N.Y., neighborhood where crime is prevalent, the Betances Community Center, designed by Stephen Yablon, AIA, illuminates a central staircase and gymnasium in natural light, wrapping its ground-level façade in windows as well. These transparencies give the building a welcoming presence and offer views to a public park across the street.

A lot to have to consider when designing and constructing a building. It is interesting that a number of these suggestions cross multiple areas of need. For example, stairs are necessary for safety if elevators stop operating. Toxic gas from VOC materials is a green issue. Eyes on the street is a classic phrase from Jane Jacobs to describe the kind of vibrant street life that helps social control without the need for formal policing. But, to also pitch these as health issues is likely a nice marketing tool. Not only can architects design a well-functioning building, they can improve people’s health outcomes.

In pointing to this story, Curbed provides a quote that architects can even do more: they “are often the architects of our happiness and unhappiness as well.” What can’t architects do?

Health includes social and behavioral dimensions

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There may be privacy concerns about the government having behavioral and social data as part of medical records but that doesn’t necessarily mean they aren’t important factors when looking at health:

The Centers for Medicare and Medicaid Services (CMS) wants to require health care providers to include “social and behavioral” data in Electronic Health Records (EHR) and to link patient’s records to public health departments, it was announced last week.

Health care experts say the proposal raises additional privacy concerns over Americans’ personal health information, on top of worries that the Obamacare “data hub” could lead to abuse by bureaucrats and identify theft…

The “meaningful use” program already requires doctors and hospitals to report the demographics of a patient and if he smokes to qualify for its first step. The second stage, planned for 2014, will require recording a patient’s family health history.

The National Academy of Sciences will make recommendations for adding social and behavioral data for stage three, which will be unveiled in 2016.

Maybe these are separate concerns: one might argue such data is worthwhile but they don’t trust he government with it. But, I suspect there are some who don’t like the collection of social and behavioral data at all. They would argue it is too intrusive. People have made similar complaints about the Census: why exactly does the government need this data anyway?

However, we know that health is not just a physical outcome. You can’t separate health from behavior and social interactions. There is a lot of potential here for new understandings of health and its multidimensionality. Take something like stress. There are physical reactions to it but this is an issue strongly influenced by context. Solutions to it could include pills or medicine but that is only dealing with the physical outcomes rather than limiting or addressing stressful situations.

We’ll see how this plays out. I suspect, federal government involvement or not, medical professionals will be looking more at the whole person when addressing physical concerns.

Can you name “America’s 50 Healthiest Counties for Kids” when you only account for 38% of US counties?

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US News & World Report recently released a list of “America’s 50 Healthiest Counties for Kids.” However, there is a problem with the rankings: more than half of American counties aren’t included in the data.

About 1,200 of the nation’s 3,143 counties (a total that takes in county equivalents such as Louisiana’s parishes) were evaluated for the rankings. Many states don’t collect county-level information on residents’ health, whereas populous states, such as California, Florida and New York, tend to gather and report more data. In some counties, the population is so small that the numbers are unreliable, or the few events fall below state or federal reporting thresholds. And because states don’t collect county-level information on childhood smoking and obesity, the rankings incorporated percentages for adults. Catlin says this is justified because more adult smokers mean more children are exposed to secondhand smoke, a demonstrated health risk. Studies have also shown a moderately strong correlation between adult and childhood obesity, she says.

The experts who study community health yearn for more and better data. “We don’t have county-level data on kids with diabetes, controlled or uncontrolled, or on childhood obesity rates,” says Ali Mokdad of the Institute for Health Metrics and Evaluation at the University of Washington. “Almost every kid in this country goes to school. We could measure height and weight, but nobody’s connecting the dots.”

This won’t stop counties high on the list from touting their position. See this Daily Herald article about DuPage County coming in at #20. But, there should be some disclaimer or something on this list if a majority of US counties aren’t even considered. Or, perhaps such a list shouldn’t be too together at all.

Claim: a McMansion might kill you

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I’ve seen lots of critiques of McMansions but I can’t recall seeing one that suggests they are bad for your health:

https://i0.wp.com/homeinsurance.com/images/McMansion.v2.png

Quite the infographic but I think it (perhaps intentionally) invokes McMansions to introduce some negative connotations and avoids the bigger context: these are problems across American society, whether you live in a big house or not. Some of these are tied to sprawl more broadly with its dependence on cars, on a shift toward eating out and more sedentary jobs, building homes in general, and a growing emphasis on media. This could fit with a common critique of McMansions: they are part of larger patterns of excessive consumption.

In the end, your McMansion is not killing you much more than “average” American contexts are.

ProCure proton therapy: you are not “close to downtown Chicago”

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I’ve heard plenty of radio commercials for the ProCure proton therapy facility in Warrenville, Illinois and one thing gets me every time: the ad claims the center is “close to downtown Chicago.” A few thoughts about this:

1. The actual distance from Chicago to the facility is 30 miles. While the drive is relatively simple (Eisenhower to I-88 and then about 0.6 miles off the Winfield Road exit), this is not “close.” It probably wouldn’t even qualify as nearby. In no traffic, this drive would take at least 35-40 minutes and during the day would be longer. In my world, 10 miles or less would be close to downtown Chicago.

2. I’m not sure why the facility was built in Warrenville: the land is conveniently located near an interstate, close to Central DuPage Hospital (CDH), I assume the land was cheaper than in or near Chicago, and was able to be put up in “record time.” And there was competition: Northern Illinois University wanted to build a proton therapy facility in West Chicago and CDH filed a lawsuit against NIU that was withdrawn when a regulatory board gave the go ahead to the Warrenville facility.

3. One reason they might make this claim is because not too many people have heard of Warrenville. Going to Warrenville, a small community, doesn’t sound as good as going to somewhere “close to Chicago.”

4. Another reason they may have made this claim is that they want to win market share in the Chicago region. The ProCure facility has teamed with CDH which provides care to western DuPage County and has designs on a larger healthcare footprint (with a recent merger with Delnor Hospital) but may not be familiar to all of Chicagoland. Perhaps the claim of being close to Chicago is more about winning the PR battle against Chicago hospitals such as University of Chicago, Northwestern, Rush, and Loyola.

Philadelphia fighting food deserts through fresh fruits and vegetables at corner stores

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Philadelphia is launching a new initiative to fight food deserts through existing corner stores:

The $900,000 investment in better health depends on apples and oranges, chips and candy, $1,200 fridges and green plastic baskets. The results could steer the course of American food policy.

Philadelphia is trying to turn corner stores into greengrocers. For a small shop, it’s a risky business proposition. Vegetables have a limited shelf life, so a store owner must know how much will sell quickly — or watch profits rot away. He also lacks the buying power of large supermarkets and is often unable to meet the minimum orders required by the cheaper wholesalers that grocery stores use.

With shelf space at a premium, shop owners must pick and choose the products they think will sell best. Chips and candy and soda are a sure bet. Eggplant? It’s hard to know…

The city has recruited 632 corner stores — of 2,500 overall — to its Get Healthy Philly initiative. Of those, 122 have gotten more intensive support, been supplied with new fridges to store produce and connected with wholesalers from whom they can buy at lower prices. It is also working with schools to improve nutrition and helping neighborhoods launch farmers markets, a multifaceted approach officials hope will improve public health.

As the article suggests, there is a lot riding on this project. It will be interesting to see if this could (1) substantively help improve health and (2) be profitable.

The advantage here seems to be that the stores are already established in neighborhoods and probably already have an established clientele. This program then puts healthier food in front of people who may already be visiting these stores. Working with existing infrastructure sounds like it would be more effective as well as cheaper in the long run.

Participating in culturally elite activities related to lower BMI?

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A new sociological study suggests there is a relationship between participating in certain cultural activities and having a lower BMI:

The study uses survey data from 17 nations, most of which are in Europe. In each country, a representative sample of the population was asked not only about height and weight, but also about time spent in a variety of activities. These included reading, going to cultural events, socializing with family and friends, attending sporting events, watching TV, going shopping, and exercising.A scale that measures interest in ideas, art, and knowledge—by surveying the amount of time spent reading, attending cultural events, going to movies, and using the Internet—is associated as strongly as exercise with a lower body-mass index, or BMI (a measure of weight relative to height). In other words, reading and exercise appear similarly beneficial in terms of BMI.

In contrast, people participating in other activities such as watching TV, socializing, playing cards, attending sporting events, and shopping have higher average BMI. Although time spent reading and time spent watching TV both expend few calories, one is associated with lower weight, and the other with higher weight…

So why might reading and related cultural activities be associated with thinness? The social meaning of the activity rather than the activity itself must be important for weight control. Leisure-time activities involve more than the calories burned; they also reflect differences across social groups in motives and means for good health.

These sound like interesting findings but I wonder if this is a classic example of “correlation does not imply causation.” Since these cultural activities might be related to social class, how do these findings line up with current statistics about weight (and health) by social class?