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Q&A with Dr. Jeff Duchin: What Our 18 Year Life Expectancy Gap in Neighborhoods Tells Us

On the heels of a Lancet Public Health study that found an 18 year difference in life expectancy for men, and 14 year difference for women, we caught up with our Health Officer, Dr. Jeff Duchin, to talk about neighborhood-level data and how it informs our work.

Q: What does this study tell us about the health of King County?

First, it reinforces how important detailed neighborhood-level data can be to understand the health of a community. The current study tells us that for average life expectancy, King County is a top performer (95th percentile) among all counties in the U.S. But when you drill down to life expectancy at the census tract (neighborhood level)—there are 397 census tracts in King County—you see a very different picture; an 18-year difference in life expectancy for men and 14-year difference for women.

These inequalities or differences in health outcomes found in different sub-groups of the population are known as health disparities. In addition to place of residence or neighborhood, health disparities are found also by social class, wealth and income, education level, race, ethnicity, gender, and, sexual orientation. For example, it’s well described that in the US, people with higher income live longer and healthier lives than people with lower income.

Q: What is it about place that corresponds to health?

For most neighborhoods, place is a proxy for a host of other characteristics. The neighborhood where people live impacts residents’ health both because the physical environment of that neighborhood can influence health directly–for example, safety, access to healthy food and recreation, exposure to pollution, etc.—but perhaps more significantly, because neighborhood is also a marker of other important factors that determine health, such as income, race, and social status.

The poorer a person is, the greater the struggle to meet basic necessities of life—access to healthy food, opportunities for recreation, safe homes in safe neighborhoods, good schools, employment, and transportation options. Additionally, increased barriers in meeting these necessities leads to chronic stress (e.g., having little job security or control over one’s work leads to increased stress levels), which increases the chance of illness and disability. It’s important to understand that racism is a driving force of the social determinants of health (like housing, education, and employment).

We continue to see a disproportionate burden of illness and injury in southern areas of Seattle and southwest King County, where we also see higher levels of poverty, lower levels of educational attainment and other social inequities, driven, in part, by a long history of underinvestment and social injustice.

Q: What else are public health data geeks wondering?

Years of life lost rates from ischemic heart disease by census tract in King County, 2014

This study provides data on causes of death and the contributions they make to health disparities, from ischemic heart disease to drug-use disorders.

A few conditions like cardiovascular disease, if prevented, would make the greatest difference in both improving overall health and reducing disparities.

The study doesn’t provide a complete picture of King County residents or identify which interventions would provide the biggest “bang for the buck.” That’s where public health program staff and evaluators come together to work with communities to design and assess the costs and effectiveness of programs and policies.

To get a more complete picture, we must also consider non-fatal conditions like living with chronic conditions including diabetes, Alzheimer’s disease and depression that affect our quality of life as well as the impact of social determinants (economic stability, education, and housing) and the systems of power such as racism that create disparities.

The study reminds us that it is not one disease, but a complex and interrelated set of individual, health system-related, societal, and environmental factors that contribute to disparities in health and health care.

Q: Do the study findings surprise you?

Public Health routinely assesses differences in health and social outcomes by place within King County. Knowledge of these place-based disparities have long guided public health efforts towards the areas that have the greatest opportunity for improvement.

So while not surprising, the findings reinforce how critical it is to work across many sectors, including healthcare, housing and education, to address unequal health outcomes.

Q: Left with that complexity, how does the health department address the numerous contributors to health disparities?

The complexity requires broadening the concept of health policy to include areas not normally considered when thinking about health: policies regarding education, taxes, recreation, transportation, and housing. Investments in social and economic policy made upstream can pay health dividends downstream.

From a program perspective, we routinely use neighborhood-level data to work upstream, midstream and downstream.

For example:

  • We improve health care access and focus on preventive care; practicing and promoting culturally competent health care.
  • Our programs address immediate risk factors such as poor diet, overweight/obesity, smoking, high blood pressure, and low physical activity. These actions are critical to reducing obesity and tobacco use which are underlying causes of cardiovascular and respiratory diseases. Our Youtube playlist has videos of this work in the community.
  • Moving further upstream, we participate in recent efforts such as Best Starts for Kids and Communities of Opportunity that focus on prevention, early intervention and policy strategies designed with communities experiencing health disparities.

And, within the larger umbrella of King County government, Public Health is part of the critical work to dismantle institutional racism and discrimination through the County’s Equity and Social Justice Initiative.

Q: What’s next in the world of data that could make a difference for community health?

We look forward to continuing to collaborate with IHME & UW to add the burden of non-fatal diseases to our description of health in King County by neighborhood, and to better characterize the impact of social determinants of health by neighborhood. Ultimately, our goal is to apply our public health expertise in a way that will have the greatest impact in reducing disparities and improving health.

The study is a joint project by Institute for Health Metrics and Evaluation at the University of Washington and Public Health—Seattle & King County. This article originally appeared in Public Health Insider on September 5, 2017.