Posted December 19, 2018 in Articles
Author: Julie Washington, The Plain Dealer
CLEVELAND, Ohio -- On the East side of Cleveland, there are a few blocks surrounding a water plant where a little under 1,200 people live. It’s just across the street from the Cleveland Clinic. A Clevelander living in that part of the Fairfax neighborhood is likely to die before they turn 66, about 20 years sooner than someone residing in Southerly Park less than five miles away.
Fairfax was once a prosperous neighborhood, said Dr. Margaret Larkins-Pettigrew, head of the office of community impact, equity, diversity and inclusion at UH.
“Now it is a depressed area,” Larkins-Pettigrew said. Problems that are social determinants of health care shorten lives, such as lack of access to healthy food, housing and education, are rife in Fairfax.
This illustration of an extreme health disparity was one of many contained in an Associated Press analysis of life expectancy and demographic data for 65,662 census tracts. Tracts are small geographic areas that encompass roughly 4,000 residents each.
Health disparities persist in Northeast Ohio despite its nationally recognized health care systems, which spend millions annually on community health outreach and caring for the county’s poorest.
But even if a person lives across the street from a major hospital, he or she may not seek health care there, Larkins-Pettigrew said. It’s not always a question of health insurance. If patients feel they aren’t treated with dignity, or doubt they are getting good care, they won’t return for follow-up visits or take their medication.
“We can’t give good health care at UH unless we take on social determinant of health,” Larkins-Pettigrew said. In an effort to tackle root causes of poor health near its campus, UH has opened a small grocery store, called the Food for Life Market, where patients who don’t have access to healthy food can get one week’s worth of food without charge, following a referral from their doctor. The market is located in the UH Otis Moss Jr. Health Center in Fairfax.
The AP found that certain demographic qualities — high rates of unemployment, low household income, a concentration of black or Native American residents and low rates of high school education — affected life expectancy in most neighborhoods. Their findings support the idea that many people experience bigger obstacles to good health because of their race or ethnic group, gender, age, geographic location and other social factors.
An increase of 10 percentage points in the unemployment rate in a neighborhood translated to a loss of roughly a year and a half of life expectancy, the AP found. A neighborhood where more adults failed to graduate high school had shorter predicted longevity.
A health disparity is defined as a health difference linked with socioeconomic or environmental disadvantage.
Factors that influence a population’s health include access to good education, nutritious food, safe housing, reliable public transportation, health insurance, clean water and air, and health care providers who understand and respect their culture, according to Healthy People 2020, a government-sponsored push to improve Americans’ health.
For tracts with few social and economic resources, achieving better health and longer lives is an uphill struggle. Social disparities in health care are slow to improve, even with better access to health care, Dr. Adam Myers, chief of population health at the Cleveland Clinic, said in a statement.
“Only 20% of health outcomes are directly attributable to traditional healthcare delivery as we know it. The remaining 80% are strongly impacted by the social realities of people’s lives,” Myers said. He listed, homelessness, substance abuse, smoking, obesity and emotional/physical trauma as social issues that affect health.
The Clinic tries to improve access to healthcare through its health and education centers that provide care for diabetes, smoking cessation, obesity and other health risks. The hospital system’s Stephanie Tubbs Jones Health Center is a Medicaid provider that also offers free transportation to patients.
The Clinic offers prevention and screening programs, such as its Minority Men’s Health Fair. The fair attracts about 1,000 people each year. The hospital system also seeks to boost Cleveland’s economic growth through workforce development initiatives, employer housing subsidies and other initiatives.
The data showed glaring health disparities affecting Cuyahoga County.
The lowest life expectancy in Cuyahoga County was 65.4 years in the part of Fairfax near the Baldwin Water Plant, where average median income was $18,000 annually and about 10% were uninsured. Unemployment there is 7.5%.
Life expectancy also was low in a Census tract in Hough (age 65), a tract east of the Magnolia wade park historic district (age 66), and streets west of Cudell Avenue between Detroit and Lorain avenues (66.7).
The highest life expectancy, 88.6 years, was found in a triangular census tract in Shaker Heights. Residents of this area had median incomes of about $95,600. About 4% were unemployed and the same percentage were uninsured.
Data showed that Cuyahoga County residents also enjoy longevity on the eastern edge of Shaker Heights (age 86) and in a Census tract located north of Solon and outlined by Miles, SOM Center, Harper and Bainbridge roads (age 84). These two areas had median incomes of more than $100,000 and unemployment under 3%.
That’s much higher than the national median household income of $61,372 in 2017, according to the U.S. Census Bureau. The nation’s unemployment rate was 3.7% in October 2018, and 5.9 % in Cuyahoga County in 2017. The percentage of U.S. adults without health insurance was essentially unchanged in the fourth quarter of 2017, according to Gallup. The U.S. uninsured rate among working-age Americans was 15.5 percent in May 2018.
The AP analyzed 88.7 percent of all U.S. census tracts. Maine and Wisconsin were excluded because some of their death records lacked home addresses of the deceased.
New York state had the largest range for life expectancy among its neighborhoods, spanning 34.5 years. The places with the highest and lowest estimates are both in New York City.
Children born between 2010 and 2015 in part of the northern half of Roosevelt Island have an estimated life expectancy of 59 years; a child born 6 miles away in Chinatown in lower Manhattan can expect to live 93.6 years.
In one North Carolina neighborhood, a child born between 2010 and 2015 can expect to live 97.5 years, the highest estimated lifespan for any neighborhood in the United States. A child in part of Stilwell in Adair County, Oklahoma, can expect 59 years on average, the nation’s lowest.
The AP analysis also found discrepancies among states. Life expectancy in Hawaii topped all other states at 82 years. Mississippi's estimate of 74.9 was the lowest, followed closely by West Virginia, Alabama, Oklahoma and Kentucky.
The data is part of a new partnership between the National Center for Health Statistics, The Robert Wood Johnson Foundation, The National Association for Public Health Statistics and Information Systems (NAPHSIS), and the National Center for Health Statistics (NCHS). Through the collaboration, researchers used six years of death records and demographic data to create a longevity estimate for nearly every census tract in the country.