Detroit, Michigan has been the deadliest large city in America for decades. The city’s rate of violent crime is five times higher than the national average. The child mortality rate rivals third-world countries with 120 deaths in children under the age of 18 per 100,000. In the neighboring suburbs, a drastically different story is told: child mortality occurs at a much lower rate of 45.4 per 100,000 and violent crimes are rare. A difference of a few miles can mean the difference between a relatively safe and healthy life and one of child mortality and high crime rates.
(Image Source: LBS)
Where you live matters.
Detroit and its environs are just one example of many cities across the nation that are facing an uphill battle to address health disparities. In New Orleans, a child's life expectancy varies up to 25 years between neighborhoods. The average life expectancy of a resident in Boston’s Roxbury neighborhood is 33 years less than a denizen of the trendy Back Bay. The reasons for such gaps vary and are based on a number of environmental and social factors, commonly known as social determinants, that make where you live an important factor in your health.
In Detroit’s case, the city suffered major economic and demographic decline coupled with years of political and financial mismanagement. More than one million people moved away from the city in favor of the surrounding suburbs, weakening the tax base that supported vital infrastructure. Moreover, American automobile companies, long headquartered in Detroit, were forced to shift manufacturing away from “Motor City” due to high labor costs, newer manufactoring methods, and stiff global competition. The combination of these events left Detroit a veritable ghost town with the highest unemployment rate and the highest percentage of population living below the poverty level among all 71 major U.S. cities. Many of those living in the city—unemployed and faced with poverty—lack access to the necessary resources that they need to live health lives.
Health inequalities are created by poverty, lack of job opportunities, and limited access to care. Poor education, racial segregation, and pollution within a community can worsen health outcomes. When a neighborhood lacks quality schools or the support of additional educational resources, children are not given the same opportunity to pursue higher paying jobs, become more health literate, and make educated decisions that lead to good health. Segregation limits opportunities for economic advancement. Bad air quality aggravates respitory ailments.
Your zip code is the strongest predictor of overall health. Where you live impacts your access to care and your understanding of appropriate preventative care. By better coordinating care among low-income communities, we can lessen the gaps in health inequality. Where you live shouldn’t matter to your health.