“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)