Geography plays role in health disparity
By Doug Boyd
ECU News Services
Dr. Brian Smedley. Photos by Cliff Hollis
(Feb. 3, 2012)
Health disparities among demographic groups are a well-researched topic, but disparities among geographic groups may be just as significant.
That was the message of Dr. Brian Smedley, the keynote speaker at the eighth annual Jean Mills Health Symposium, held Friday, Feb. 3, at the Greenville Hilton.
"Often, when it comes to health, your ZIP code is a better predictor than your genetic code," said Smedley, vice president and director of the Health Policy Institute at the Joint Center for Political and Economic Studies
in Washington, D.C.
While health efforts often focus on individuals, Smedley said more work should be done to create healthy communities and create a "geography of opportunity." He described that as places where people of color may live in an environment that is as supportive of good health as in places where whites live.
Smedley cited statistics from his organization saying that from 2003-2006, 30.6 percent of medical expenses for blacks, Asians and Hispanics in the United States were due to disparities. Those disparities cost the nation $1.24 trillion, he said.
"If you're paying an insurance premium, you're helping pay these costs, because the costs are shifted," he said.
Numerous factors contribute to the disparities, including residential segregation, environmental risks, occupational risks and a lack of insurance.
Though studies show residential segregation has decreased from the mid-20th century – many fewer neighborhoods consist of only one race today – the percentage of minorities who live in predominately poor neighborhoods is greater than the percentage of whites who live in poor neighborhoods, Smedley said.
"It is literally toxic to the health of children particularly," he said. Poor communities concentrate poverty and limit opportunity, he said. In such neighborhoods fast food, liquor and convenience stores outnumber supermarkets that offer fresh food, contributing to poor health, he said.
The N.C. Racial and Ethnic Health Disparities Report Card 2010 (http://www.schs.state.nc.us/SCHS/pdf/MinRptCard_WEB_062210.pdf) showed more than a third of black children live below the poverty level in the state, compared to fewer than 12 percent of white children. Black children are also more likely to live in poor neighborhoods than white children.
Smedley said some programs being tried around the country are alleviating disparities. The Moving to Opportunity program of the federal Department of Housing and Urban Development helps low-income families move from poverty-stricken urban areas to low-poverty neighborhoods. Adolescent girls in particular benefit by getting away from areas of risky health behavior, he said.
Another program, Pennsylvania's Fresh Food Financing Initiative
is a public-private partnership to create incentives for supermarkets to locate in urban areas, providing healthful food choices and jobs to local people while also helping the stores earn a profit so they can remain in business.
Other topics discussed at Friday's symposium included discussions of teen health disparities in Greene, Lenoir and Jones counties and a study of periodontal disease in diabetic and obese children in eastern North Carolina.
The event was sponsored by the ECU College of Allied Health Sciences in collaboration with the ECU Medical & Health Sciences Foundation, the Vidant Medical Center Foundation and the Eastern Area Health Education Center.
Mills earned her bachelor's degree from the University of North Carolina at Chapel Hill in 1977 and a master's degree in public administration with a concentration in community health from ECU in 1984. She died of breast cancer in 2000.
Her brother, Amos T. Mills III, created the symposium in an effort to keep her spirit of discovery and community outreach alive.