Cell 2 Soul: The Humane Health Care Blog

It All Depends on Zip Codes

“Delmar Boulevard in St. Louis, Missouri marks a sharp divide between the poor, predominately African American neighborhood to the north and a more affluent, largely white neighborhood to the south. Education and health also follow the “Delmar Divide,” with residents to the north less likely to have a bachelor’s degree and more likely to have heart disease or cancer.”  See: Zip Code Predicts Health.

At a recent health care conference in Hawaii, Dr. Dileep Bal, told a packed auditorium of affluent dermatologists that one’s zip-code is a better predictor of health than any of the questions we routinely pose to patients.  This got me thinking about how I have missed what should have been in my face in the five decades since I entered medical school.  Zip Codes trump most (maybe all) other determinants of health.

There is not as much literature about this subject as one would anticipate given its importance.  Here is a pertinent article: “Poverty, wealth, and health care utilization: a geographic assessment” from The Journal of Urban Health.  PubMed Abstract, See Free Full Text Online PMC article.

The paper “demonstrates the strong association between low ZIP code income and both higher percentages of disability and greater hospital utilization. And they suggest that, given the large contribution of the poorest neighborhoods to aggregate utilization, it will be difficult to curb the growth of health care spending without addressing the underlying social determinants of health.”

This Zip Code information runs parallel to the effects Adverse Childhood Experiences  (ACEs) have on a child’s subsequent physical and mental health and ultimately longevity.  They are both significant determinants of one’s health, well-being and success in life.

Note:  In researching this topic I came across this quote: Our public health practices ignore this fundamental truth. In America, when it comes to your health, your zip code is more important than your genetic code.  Anthony Iton, M.D. J.D., M.P.H.  (Commencement address UC Berkeley 2014)

 

Poor Lives Matter

The Rich Live Longer Everywhere.
For the Poor, Geography Matters.

By Neil Irwin and and Quoctrung Bui
NY Times April 11, 2016

Here are some excerpts from the Times article:

For poor Americans, the place they call home can be a matter of life or death. New research, has an optimistic message: The right mix of steps to improve habits and public health could help people live longer, regardless of how much money they make.

The top 1 percent in income among American men live 15 years longer than the poorest 1 percent; for women, the gap is 10 years. These rich Americans have gained three years of longevity just in this century. They live longer almost without regard to where they live. Poor Americans had very little gain as a whole, with big differences among different places.

It has long recognized that health care interventions have a much smaller effect on life span than behavioral factors like smoking and exercise. “There remains this misconception in our society that health is determined by health care,” A common thread among many of the places with a smaller longevity gap was population density, with wealthy cities like New York leading the way.

It may be good to know that poor Americans are living a lot longer in some places than in others, but it would be better to know — in terms of specific policy prescriptions — how the places with better results are doing it.

The Times article is based on a report in JAMA (April 10, 2016):

The Association Between Income and Life Expectancy in the United States, 2001-2014 FREE ONLINE FIRST

Raj Chetty, PhD et.al.

Modern Medicine

Dunning-Kruger Effect

Andy Tanji from Honolulu alerted us to this:
The most competent individuals tend to underestimate their relative ability, but most people increasingly overestimate their ability, and everyone thinks they are above average. As you can see from the graph, self-estimates decrease with decreasing knowledge, but the gap between performance and self-assessment increases as you decrease in performance.

For more: Download Lessons from Dunning Kruger

Cell Phone Addiction

It keeps me from looking at my cell phone every two seconds.

On Cabbies and Kahunas

It is no secret that primary care physicians and specialists in large numbers deny care to Medicaid patients.  They claim that they cannot afford to see this group.  Insurers, patients, and the medical societies tolerate this situation.

It’s just as bad in the Big Apple as it is in the aina of Hawaii.  A recent article in the NY Times put the situation in perspective for me.

“The taxi lurched away from the curb in Midtown Manhattan, leaving behind a black family of three who had flagged it down. The driver told them he was off duty and then picked up two white women 25 feet away and drove away.

“The judge ruled that the driver refused to transport the family on the basis of their race and color violating a section of city human rights law that protects equal access to public accommodations and fined the cabbie $25,000.”

This ruling made a splash in the NY Times on August 8, 2015.  At the same time, most private dermatologists in New York City do not see Medicaid patients.  How is this not discrimination too?  Yet, the complicated Medicaid credentialing regulations allow physicians to abandon poor patients with inferior insurance coverage and consign them to emergency rooms, Medicaid mills and public clinics.

It’s strange that a family being denied transport in a taxicab can outrage us, but we turn a blind eye to a large segment of our society that is refused competent caring health care.  It is also ironic that a cabdriver can be fined for this act of discrimination; while sanctimonious physicians get a pass.

See:  Cherry Picking in the ‘Aina: Inequalities of Access to Dermatologic Care in Hawai‘i

 

 

 

Welcome to AirbnB

 

Image from Times article

"Oh, my gosh, welcome! So great to meet you! I’m Margot. This is my boyfriend, Claudio. Claudio doesn’t talk much. He mostly speaks with his body. We’re superexcited to have you here for the weekend."

Anyone who has stayed at an Airbnb will appreciate this spoof that appeared in the Sunday, August 2nd, 2015 NY Times.You will nod your head sagely and smile wryly when you read it.  Read: Welcome to Airbnb!