It Takes a Village

CHW LogoMy older son spent the first year and a half of his life in Falls Church, VA.  Based on data from the Robert Wood Johnson Foundation, his life expectancy is 83 years. (Don’t worry, buddy – they go fast but you have plenty left.)  But if he had been born three Metro stops away, in Washington, DC, his life expectancy would be 7 years shorter.  The situation is even more striking in New Orleans, where the difference in life expectancy across the metro area is 25 years.  As an article in Health Affairs put it, Zip code is more important than genetic code when it comes to health.

It’s easy to write this off.  Different communities, different people.  While there are undoubtedly differences in population between neighborhoods – including racial and ethnic differences that may include a genetic component – the strongest association is with poverty.  Poor people have worse health regardless of their race or culture.  Moreover, a 2011 study published in the New England Journal of Medicine showed that when people who began in a poor neighborhood were randomly assigned to receive housing vouchers allowing them to relocate, those who moved to low-poverty areas subsequently had lower rates of obesity (19% lower) and diabetes (22% lower) than those who either stayed or moved to another high-poverty area.  It appears the real estate people are right: it’s all about location, location, location.

The exact factors about a neighborhood that lead to adverse health impacts are unclear.  Possibilities include: physical infrastructure (e.g., parks, sidewalks, safe streets) that allows and promotes physical activity; access to healthy food; low crime and attractive environment that decrease chronically elevated levels of stress hormones.

As an organization committed to making the children in Wisconsin the healthiest in the nation, Children’s Hospital recognizes that we can’t simply provide excellent health care.  We must partner to influence all the other determinants of a child’s health, including the state of their community.   A recent article in the New York Times highlighted a Philadelphia program of community health workers: individuals from target communities, hired by a health system and trained to work with other families in those communities to address health needs and connect with needed resources.  This is very similar to Children’s’ own community health navigator program in three neighborhoods in central Milwaukee.  Health Partners, an integrated health system in the Twin Cities, has adopted what it calls a “community business model,” whereby they invest in activities and partnerships that are designed to improve all of the modifiable determinants of health, not just medical care.

Kids on the near north side of Milwaukee deserve to have the same life expectancy as those in Wauwatosa.  To get there, it truly takes a village.

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