For Your Health, Where You Live Plays a Powerful Role
By Jessica Young
According to a recent report, Alabama, Arkansas, Louisiana, Mississippi and West Virginia have the worst health in the U.S. These states have higher rates of premature deaths, chronic diseases and poor health behaviors year after year.
Why are people in some places in the U.S. consistently less healthy than those in others? If you look to health and fitness magazines, it may seem like poor diet, lack of exercise and other bad behaviors are to blame. Genetics and access to health care are also commonly cited reasons for why some people are healthier than others.
But where a person lives, works and plays also matters. As a public health researcher interested in how society affects our health, my research shows where you live plays a powerful role on your health.
Public health experts often talk about the "social determinants of health": community traits like housing quality, access to nutritious and fresh food, water and air quality, education quality and employment opportunities. These factors are thought to be among the most powerful influences on a person's health.
Alabama, Arkansas, Louisiana, Mississippi and West Virginia also share a similar economic environment. Data from the Economic Innovation Group (EIG), a bipartisan public policy organization in Washington, DC, shows that these states are the top five most economically distressed states in the U.S.
In fact, Alabama and Mississippi have the highest shares of people living in distressed zip codes.
The U.S. has experienced economic prosperity since the end of the Great Recession. But not all states have shared equally in this economic growth. In North Dakota, for example, employment rates increased almost 20 percent between 2010 and 2013. During the same time period, residents in Alabama have seen only about four percent growth in employment.
Local communities in every state across the U.S. face similar poor economic realities: 52.3 million Americans live in economically distressed zip codes. This means that about 17 percent of the U.S. population lives in places with limited opportunities for education, good housing and employment. These factors are essential for good health.
Place and Health
Analysts at the Economic Innovation Group found that people in prosperous counties live, on average, five years longer than those living in distressed counties. In distressed counties, deaths from mental and substance abuse are 64 percent higher compared to prosperous counties.
My own analysis of EIG data and the 2017 County Health Rankings follows this pattern. The more economically distressed a county is, the worse their health outcomes are. This is true across measures of clinical care, quality of life, mortality, chronic conditions, health behaviors and health environments.
I am currently researching a range of health outcomes across the U.S. My unpublished results show that infants are about 20 percent more likely to die before their first birthday in distressed counties. Adults in distressed counties are 18 percent more likely to report poor or fair health than those in prosperous counties.
Those in distressed counties are also more likely to live in places with fewer resources for good health. For example, distressed counties are 26 percent more likely to have limited access to healthy foods and have about 24 percent fewer opportunities for exercise. They also have about 20 percent fewer primary care providers than prosperous counties.
Investing in Solutions
Shared economic prosperity is good for our health and good for the economy.
Improving population health requires more than changing health behaviors or increasing health care access. Similarly, if we want to increase shared economic prosperity among those who need it most, we need to focus on more than employment rates and average incomes.
As public health researcher David Williams and Robert Wood Johnson Foundation Executive Vice President James Marks wrote, "reaching America's full health potential will require that targeted initiatives have a dual focus" on health and community economic development. This means that the health and economic sectors must collaborate, which is often made difficult by separate funding streams and political battles.
Despite challenges, there are successful examples of communities working together to improve health and foster economic opportunity. In Sacramento, California, the Building Healthy Communities program worked with community members to develop bike paths and expand community gardens. This effort was a part of an initiative to transform formerly contaminated land into healthy, livable and usable property.
More investments in the social determinants of health will help close the health gaps we see across the U.S.
Reposted with permission from our media associate The Conversation.
EcoWatch Daily Newsletter
To hear many journalists tell it, the spring of 2020 has brought a series of extraordinary revelations. Look at what the nation has learned: That our health-care system was not remotely up to the challenge of a deadly pandemic. That our economic safety net was largely nonexistent. That our vulnerability to disease and death was directly tied to our race and where we live. That our political leadership sowed misinformation that left people dead. That systemic racism and the killing of Black people by police is undiminished, despite decades of protest and so many Black lives lost.
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After sustained declines in the number of COVID-19 cases over recent months, restrictions are starting to ease across the United States. Numbers of new cases are falling or stable at low numbers in some states, but they are surging in many others. Overall, the U.S. is experiencing a sharp increase in the number of new cases a day, and by late June, had surpassed the peak rate of spread in early April.
Seven day rolling average of number of people confirmed to have COVID-19, per day (not including today). This chart gets updated once per day with data by Johns Hopkins. Johns Hopkins university doesn't provide reliable data for March 12 and March 13. Johns Hopkins CSSE Get the data
To Have a Second Wave, the First Wave Needs to End.<p>A wave of an infection describes a large rise and fall in the number of cases. There isn't a precise epidemiological definition of when a wave begins or ends.</p><p>But with talk of a <a href="https://www.theguardian.com/world/2020/jun/27/new-covid-19-clusters-across-world-spark-fear-of-second-wave" target="_blank">second wave in the news</a>, as an <a href="https://www.american.edu/cas/faculty/mhawkins.cfm" target="_blank">epidemiologist and public health researcher</a>, I think there are two necessary factors that must be met before we can colloquially declare a second wave.</p><p>First, the virus would have to be controlled and transmission brought down to a very low level. That would be the end of the first wave. Then, the virus would need to reappear and result in a large increase in cases and hospitalizations.</p><p>Many countries in <a href="https://doi.org/10.1038/s41562-020-0908-8" target="_blank">Europe and Asia have successfully ended the first wave</a>. <a href="https://www.theguardian.com/world/2020/jun/08/new-zealand-abandons-covid-19-restrictions-after-nation-declared-no-cases" target="_blank">New Zealand</a> and <a href="https://www.newyorker.com/magazine/2020/06/08/how-iceland-beat-the-coronavirus" target="_blank">Iceland</a> have also made it through their first waves and are now essentially coronavirus-free, with very low levels of community transmission and only a handful of active cases currently.</p>
Different States, Different Trends<p>Looking at U.S. numbers as a whole hides what is really going on. Different states are in <a href="https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html" target="_blank">vastly different situations right now</a> and when you look at states individually, four major categories emerge.</p><ol><li>Places where the first wave is ending: States in the Northeast and a few scattered elsewhere experienced large initial spikes but were able to mostly contain the virus and substantially brought down new infections. <a href="https://www.nytimes.com/interactive/2020/us/new-york-coronavirus-cases.html" target="_blank">New York</a> is a good example of this.</li><li>Places still in the first wave: Several states in the South and West – see <a href="https://www.nytimes.com/interactive/2020/us/texas-coronavirus-cases.html" target="_blank">Texas</a> and <a href="https://www.nytimes.com/interactive/2020/us/california-coronavirus-cases.html" target="_blank">California</a> – had some cases early on, but are now seeing massive surges with no sign of slowing down.</li><li>Places in between: Many states were hit early in the first wave, managed to slow it down, but are either at a plateau – like <a href="https://www.nytimes.com/interactive/2020/us/north-dakota-coronavirus-cases.html" target="_blank">North Dakota</a> – or are now seeing steep increases – like <a href="https://www.nytimes.com/interactive/2020/us/oklahoma-coronavirus-cases.html" target="_blank">Oklahoma</a>.</li><li>Places experiencing local second waves: Looking only at a state level, <a href="https://www.nytimes.com/interactive/2020/us/hawaii-coronavirus-cases.html" target="_blank">Hawaii</a>, <a href="https://www.nytimes.com/interactive/2020/us/montana-coronavirus-cases.html" target="_blank">Montana</a> and <a href="https://www.nytimes.com/interactive/2020/us/alaska-coronavirus-cases.html" target="_blank">Alaska</a> could be said to be experiencing second waves. Each state experienced relatively small initial outbreaks and was able to reduce spread to single digits of daily new confirmed cases, but are now all seeing spikes again.</li></ol><p>The trends aren't surprising based on how states have been dealing with reopening. The virus will go wherever there are susceptible people and until the U.S. stops community spread across the entire country, the first wave isn't over.</p>
What Could a Second Wave Look Like?<p>It is possible – though at this point it seems unlikely – that the U.S. could control the virus before a vaccine is developed. If that happens, it would be time to start thinking about a second wave. The question of what it might look like depends in large part on everyone's actions.</p><p>The <a href="https://dx.doi.org/10.1086%2F592454" target="_blank">1918 flu pandemic</a> was characterized by a mild first wave in the winter of 1917-1918 that went away in summer. After restrictions were lifted, people very quickly went back to pre-pandemic life. But a second, deadlier strain came back in fall of 1918 and third in spring of 1919. In total, <a href="https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/1918-pandemic-history.htm" target="_blank">more than 500 million people were infected</a> worldwide and upwards of <a href="https://theconversation.com/compare-the-flu-pandemic-of-1918-and-covid-19-with-caution-the-past-is-not-a-prediction-138895" target="_blank">50 million died</a> over the course of three waves.</p><p>It was the combination of a quick return to normal life and a mutation in the flu's genome that made it more deadly that led to the horrific second and third waves.</p><p>Thankfully, the coronavirus appears to be much more <a href="https://doi.org/10.1016/j.meegid.2020.104351" target="_blank">genetically stable</a> than the influenza virus, and thus less likely to mutate into a more deadly variant. That leaves human behavior as the main risk factor.</p><p>Until a <a href="https://theconversation.com/what-needs-to-go-right-to-get-a-coronavirus-vaccine-in-12-18-months-136816" target="_blank">vaccine or effective treatment is developed</a>, the tried-and-true public health measures of the last months – <a href="https://theconversation.com/this-simple-model-shows-the-importance-of-wearing-masks-and-social-distancing-140423" target="_blank">social distancing,</a> <a href="https://theconversation.com/masks-help-stop-the-spread-of-coronavirus-the-science-is-simple-and-im-one-of-100-experts-urging-governors-to-require-public-mask-wearing-138507" target="_blank">universal mask wearing</a>, frequent hand-washing and avoiding crowded indoor spaces – are the ways to stop the first wave and thwart a second one. And when there are surges like what is happening now in the U.S., further reopening plans need to be put on hold.</p>
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