Where we live can determine how long we live
This article first appeared in the St. Louis Beacon, Oct. 11, 2010 - Larry Chavis, George Banks, Tracy Blue and Carolyn Dickerson are from different neighborhoods in north St. Louis, but all four have at least one thing in common. They have health problems that are largely preventable and far more prevalent among African Americans than the rest of the city's population.
Coping with lead poisoning has turned Larry into an unusually quiet 4-year-old. His mother hopes treatment will help him ward off any long-term consequences.
Banks, meanwhile, is trying to beat a different set of health-related odds stemming from his battle against diabetes as he approaches old age.
Blue is an energetic college-educated woman who uses bursts of laughter and self-deprecating humor to cope with diabetes, weight problems and occasional bouts of depression.
And Dickerson is an example of the city's premature birth problem. But hers is a success story, thanks to the intervention of a highly regarded maternal and child health program. It gave her the means to rise from poverty and become self-sufficient for herself and her child, Isaac, now 4. Isaac had faced a high risk of being among the 12 out of 1,000 city infants who don't make it to their first birthday.
Larry Chavis, George Banks, Tracy Blue and Carolyn Dickerson are among the St. Louisans featured in this Beacon series about how and why some health and social conditions afflict African Americans in certain zip codes at a much higher rate than whites. They are known as health disparities or inequities. And, for the most part, they have been accepted as perplexing but unsolvable facts of black and white life in St. Louis and the nation.
Public Health As Prevention
Until now, that is. One aim of the new health-reform law is to reverse the notion that health disparities are inexplicable and inevitable. The new law is expected to address the issue in part by re-energizing the public health movement.
While medical doctors treat disease, public health workers identify trends, explain why people get sick and address conditions that trigger illnesses. Public health work includes screening children for lead poisoning, offering nutrition programs for diabetics, and setting up sex education classes to try to prevent the spread of sexually transmitted diseases, or STDs. Over the years, this work has faltered from a lack of manpower and money. That has allowed some diseases to move way beyond the prevention stage. Traditional medicine has been left to fill the void with a case-by-case approach to treating disease. It as if we had responded to the massive BP oil spill by dealing with one oil-soaked fish at a time.
Still, the news in some poor St. Louis neighborhoods isn't all bad. Examples include the city Health Department's sustained attack on lead poisoning and a similar effort planned for childhood asthma. Another is the Maternal and Child Health Coalition's push to reduce infant mortality. These challenges have prompted providers to be more imaginative in the ways they view and tackle health problems.
We can trace the roots of such efforts all the way back to the 19th century and the work of Dr. John Snow. He's credited with looking beyond conventional thinking during a cholera outbreak in London. Snow eventually traced the epidemic to a contaminated public water pump. Removing the pump is said to have helped end an epidemic that claimed 600 lives. Fast forward to 2010, and the moral might be that high-tech medicine isn't always the answer and certainly not the cheapest solution to some diseases in St. Louis.
"The public fails to realize that some illnesses have an environmental influence and are preventable," says Dr. William Kincaid, former head of the St. Louis Health Department and now head of the local Asthma Coalition. "We develop systems to treat them after they happen, but we don't look upstream to see why we are having these problems. And we lose an opportunity to make some of them go away. Lead is a classic example. So is asthma."
Location Influences Wellness
Hope and despair run on parallel tracks in some of the worst neighborhoods on the north side. Hope surfaces unexpectedly as a motorist takes in street after street of gloomy sights, then turns a corner and finds a suburban-like setting of a block or two of stately, market-rate brick homes, trimmed lawns, fenced-in backyards and newly poured concrete sidewalks out front. These neighborhoods still include many working-class and middle-class families, some of who can't afford to leave. Others stay out of a sense of pride in a part of town that is rich in black history.
But the north side's decay is never far away. Some neighborhoods have been reduced to a treeless landscape with crumbling houses, weedy sidewalks, cracked storefront windows and closed factories. The higher than average concentration of health problems in this part of town mirrors the conditions of many of its residents. You find many here with stooping bodies, burned out by cancer and respiratory conditions, heart disease and other illnesses that are the results of inhaling too much nicotine and bad air and consuming food high in fat and low in fiber.
The stress of living in what amounts to a racially isolated, crime-ridden wasteland also takes its toll. Many residents have no choice except to settle for substandard housing, unreliable public transportation, limited access to grocery stores and the trauma of hearing gunshots and witnessing occasional fights and other forms of violence. It is a community where Larry Chavis' mom might be more likely to happen upon a crack house than a store that sells WIC-approved fresh fruits and vegetables essential to the health of her lead-poisoned son.
Just as location affects the value of property, it influences wellness. In other words, where people live and how they live matter. Last February, that point was brought into sharp focus with a study from the University of Wisconsin's Population Institute. The institute ranked the quality of life of communities within states, the first such study of its kind.
Stable St. Charles County ranked at the top. St. Louis, despite its world-class health facilities and providers, ranked at or near the bottom for most indicators, ranging from smoking to STDs. The survey showed that where people live, rather than access to clinical care, can make a big difference in health outcomes, according to Julie Willems Van Dijk, an associate scientist at the University of Wisconsin's Population Institute.
"St. Louis is a perfect example of what we're trying to show," she says. "You have very good access to care and pretty good quality of care for those who get the care. But that alone is not enough to produce good health. It's not just having a doctor. We're saying it's all of those factors working together to determine health outcomes."
The Value Proposition
Though the problems afflict primarily African Americans in the city's impoverished neighborhoods, Van Dijk says more affluent residents can ignore the issues only at their peril. Health disparities mean everyone is paying higher taxes to treat disease that's preventable, she says.
Matt Krueter, director of the Health Communication Research Laboratory at Washington University's Institute of Public Health, agrees.
"When you have a population of poverty experiencing all the consequences, it makes us weaker as a society and a community," he said "They are going to be less competitive in the job market. There are not just lost human consequences but financial consequences for everybody. It boils down to a value proposition and a question of what do we want our society and community to look like."
This article is the first in a series that examines health-care disparities that persist in the St. Louis area, despite the fact that the region is blessed with some of the finest medical facilities in the world.
This story was written with the assistance of the Dennis A. Hunt Fund for Health Journalism, which is administered by the California Endowment Health Journalism Fellowships, a program of USC's Annenberg School for Communication and Journalism. Funding for health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization whose vision is to improve the health of the people in the communities it serves.