By William Dowling, Federal Reserve Bank of San Francisco
The chart below is an excerpt from a recent infographic (pdf, 649 kb) on the connections between health and household income. It compares the average life expectancy of every county in California to the median household income of that county. Although it might be reductive to try to claim a causal relationship between the two variables, the data suggests that a strong correlation exists. Individuals living in the most affluent county of California (Marin) are expected to live an average of 5.6 years longer than those living in the least affluent county (Trinity). With a few exceptions, the wealthier a county is, the longer its inhabitants live.
There are a myriad of aspects that affect life expectancy, but behavioral factors are frequently the most important. According to a 2009 study by the Harvard School of Public Health, over 80 percent of US deaths in 2005 stemmed, at least in part, from behavioral factors. Smoking and high blood pressure alone accounted for approximately 35 percent of deaths. In its annual report on health, the CDC delineates the impact of various behavioral factors based on individual income. While obesity and high cholesterol rates tend to be relatively similar regardless of income level, other behavioral factors, with potentially detrimental effects to health, are more prevalent among low-income individuals. For example, 30 percent of individuals living below the poverty line smoke compared to 13 percent of those at 400 percent or more of the poverty line. Similarly, 61.5 percent of those below the poverty level don’t get enough physical activity compared to 36.4 percent of those at 400 percent or more of the poverty line. Placing these data in a broader social context is an important step towards understanding their significance. For example, individuals living in low-income neighborhoods may smoke more to combat the stress of their environment, or because traditional anti-smoking information has not effectively reached them. Likewise, many low-income individuals don’t have access to fitness facilities, or don’t feel safe walking in their neighborhood which may explain the high percentage who don’t get enough physical activity. Exacerbating these problems is the lack of health care services available to low-income communities. Individuals living below the poverty line are much more likely to not have health insurance than those living at 400 percent or more of the poverty line (32.8 percent to 9.7 percent) and more likely to not get, or delay getting, medical care because of the associated cost (24.1 percent to 5.5 percent). Health care services are useful not only for treating health problems, but for identifying them before they become untreatable. It is hard for individuals living in low-income communities to be informed of risk factors impacting their health when they don’t have access to adequate health care services to begin with.
While not insignificant, violent crime seems to have less of a direct impact on overall county life expectancy than might be expected. In 2010, the National Center for Biology Information ran an adjusted life expectancy model in which they eliminated homicides from Los Angeles County, which only increased the county life expectancy by 0.35 years. That is not to say that homicides are the only metric of a violent community; after all, there are countless mental and behavioral pressures that accompany a dangerous living environment and violence is often more prevalent in impoverished neighborhoods. However, the data suggests that health related issues have a much larger impact on the life expectancy of a county.
Ultimately, the data points to a need for us to rethink our approach to health in low-income communities. Too often, individuals living in low-income neighborhoods don’t have the same opportunities to make healthy choices as those living in more affluent areas. We know socioeconomic disadvantage leads to poor health outcomes, but the question is what can community development do about it? As detailed in the health infographic, several institutions have already begun to recognize this connection and act upon it by developing innovative approaches that weave health promotion into traditional community development activities, such as affordable housing development or community facility financing. Whether building a health care clinic, or a food mart, any project aimed at improving the health and welfare of a community should be cognizant of both disciplines.
Download the infographic (pdf, 649 kb)