Cancer Communication Research Center

Health Happens Here


Did you know that your zip code has a greater effect on your health and longevity than your genetic code?

Anthony Iton, the Senior Vice President of the California Endowment's Healthy Communities Program, has the data to prove it.  Speaking at National Jewish's Center for Health Promotion this morning, Dr. Iton presented "Developing a 21st Century Public Health Practice: Tackling the Root Causes of Health Inequity."  His message is that there are causal relationships between where you live and how long you live, and his mission is to enable individuals and communities to take action to change that. 

The reasons for disparities in health are not all about access to health care.  They're broader and more fundamental than that, and are rooted in the social, economic, and environmental inequities that pervade our country.  In almost every city (and many rural areas) there are neighborhoods characterized by poor schools, degraded buildings, a lack of supermarkets and parks or other recreation areas, and high rates of crime and other violence.  Unsurprisingly these are areas in which resident poverty levels are extremely high, and Dr. Iton's data showed in case after case, city after city, that these economic, educational, environmental and social inequities are linked to stark disparities in health - manifesting ultimately in decades long differences in life expectancy.  A 2011 article in the New England Journal of Medicine came to the same conclusions[1], and as Robert Ross of the Endowment stresses, "health happens in communities. If you live in a disinvested, low-income community of concentrated poverty you are going to live sicker and die younger. If you're lucky enough to get out of those challenging circumstances and are able to move to a neighborhood with a grocery store, safe parks and good schools, your health will improve."[2]

So rather than paying attention solely to the downstream, medical model of the links between behaviors, disease, and death, Dr. Iton and the Healthy Communities Program are emphasizing the importance of the upstream, socio-ecological model of the inequities that create the disparities.  In that model the important linked factors are Place, Policy, and Narrative.  Narrative is the complex social, historical, political, economic story that describes the people living in an area, the "isms" that get applied to a population and its history.  These narratives ineluctibly influence the overarching political, economic and social policies that create and perpetuate inequities that characterize and differentiate neighborhoods.  And Place is the neighborhood, and the particular levels of access to good, safe housing, food, schools, and places to exercise.  Iton likened the inequities -> disparities link to a fire that pops up every day in the same place.  You put it out once, then come back and find it burning again.  You put it out again, but it pops up again.  At some point, in addition to continuing to put out the fire, you have to start looking for the cause of the fire.  What's needed here, argues Iton, are more interventions to disrupt these upstream causal inequities, and more people and more communities working together to develop new narratives, influence policy, and improve place.  Eventually, the fire goes out and stays out.

To learn more about the work of the Healthy Communities Program and the California Endowment, visit

Written by CCRC at 15:32




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