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)

 

Toxic Stress

A recent article in thje NY Times discusses the role that Adverse Childhood Experiences (ACEs) plays is determining one's health later in life. It asks us to:

"Imagine if scientists discovered a toxic substance that increased the risks of cancer, diabetes and heart, lung and liver disease for millions of people. Something that also increased one’s risks for smoking, drug abuse, suicide, teen pregnancy, sexually transmitted disease, domestic violence and depression — and simultaneously reduced the chances of succeeding in school, performing well on a job and maintaining stable relationships? It would be comparable to hazards like lead paint, tobacco smoke and mercury. We would do everything in our power to contain it and keep it far away from children. Right?"

This essay is a good introduction to this important, and oft neglected, area.  For full article see "Protecting Children from Toxic Stress.

How Children Succeed

We've been reading Paul Tough's important new book, “How Children Succeed” and find it to be mandatory text for those who are parents or grandparents of young children.  Instead of waxing enthusiastic, please turn to David Brooks' Op=Ed piece devoted to Tough's book in the Friday, September 28 New York Times.

Brooks calls “How Children Succeed” an  "essential book."  "Childhood stress can have long lasting neural effects, making it harder to exercise self-control, focus attention, delay gratification and do many of the other things that contribute to a happy life."  Brooks essay is a great introduction and precis of required reading for many of us.

Rape in America

 

1 in 3 Native American women will be raped in her lifetime.

Read this, weep and rage:  For Native American Women, Scourge of Rape, Rare Justice

 

"In the Navajo Nation, Caroline Antone, 50, an advocate for the reservation’s victims of sexual violence who has herself been raped, said sexual assault was virtually routine in her community. “I know only a couple of people who have not been raped,” she said. “Out of hundreds.”

It is well documented that "Adverse Childhood Experiences" have lasting life-long effects on phycical and emotional health.  Persons who experience these die younger from all causes of mortality.  The article, "The Poverty Clinic: Can a stressful childhood make you a sick adult" by Paul Tough in the March 21, 2011 New Yorker is an excellent companion piece to this riveting and important NY Times article documenting sexual violence in Native Americans.

Paul Tough's article is a "must read" for all care givers and other sentient beings.  You can find a pdf online (too large to upload here) or read an abstract.

From my experience in clinical practice, I see patients every day whose physical and psychiatric health have been forged by ACEs -- Sexual Violence may be the most serious form of abuse and its aftershocks are devastating.