JSNMA SUMMER 2019 Sneak Preview

60 Commentary
A
2002 study published in
Health Affairs – a journal of
public health policy, thought,
and research – identified
that healthcare only plays a 10%
role in premature death, while 60%
is comprised of the following manmade
factors: behavioral patterns
(40%), social circumstances (15%),
and environmental exposures (5%).
The remaining 30% is due to genetic
predisposition. 1 This is a humbling
study for a physician because it
makes him or her aware that their
delivery of healthcare only plays a
small part in the overall health of a
patient. It is that patient’s behaviors
and the community he or she lives
in that play the largest roles in a
patient’s survivability and mortality.
In 2016, a study which assessed
the association between income
and life expectancy in the United
States found, unsurprisingly,
that life expectancy increases
incrementally with income. More
interestingly, however, was the
J o u r n a l o f t h e S t u d e n t N a t i o n a l M e d i c a l A s s o c i a t i o n
THE INTERSECTION
BETWEEN COMMUNITY
AND HEALTH
LAMAR K. JOHNSON, MD
PGY5 MEDICINE-PEDIATRICS RESIDENT AND CHIEF RESIDENT
WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
DETROIT MEDICAL CENTER PROGRAM
great variation in life expectancy
across geographic areas, which
the study attributed to differences in
health behaviors such as smoking,
obesity, and exercise. The study
also showed that individuals of the
lowest income percentiles who lived
in areas with higher overall levels
of education and wealth, like New
York City and San Francisco, lived
approximately five years longer
than those of comparable income
percentiles living in less affluent
communities, such as Detroit. The
more affluent communities were
also found to have higher immigrant
...healthcare only plays a 10% role in premature
death…[physicians] only play a small part in
the overall health of a patient...behaviors and
the community...play the largest roles…
populations, higher home prices,
and more college graduates. 2
Together, these findings highlight
the direct effect that a community
can have upon health.
Despite the aforementioned
statistics, population health and
disease prevention have been a low
priority with expenditures for public
health only accounting for 3% of
the total spending on healthcare. 3
This is a problem now, more than
ever, as younger people currently
have an increasing prevalence
of non-communicable diseases
(e.g. hypertension, diabetes, and
cardiovascular disease), which were
previously associated primarily with
middle age and lifestyle factors .4
Necessary Changes
What must be done to improve the
health of a community involves
change at multiple levels. At the
national level, public health policies
must be enacted. They should
focus upstream on the regulation of
the food supply and food chain
both nationally and locally, as
well as on the food choices or
the lack thereof. These policies
are vital because evidence
shows that while people may
have the knowledge of how to
eat healthily, they often lack
the necessary resources to put
their intentions into action. 4
Other governmental agencies that
could positively affect community
health include the Department of
Parks and Recreation as well as
Law Enforcement. Per the former,
prioritizing “place-making” can help
create urban parks and spaces
where people can and want to
exercise and be active. By fostering
safer neighborhoods, the latter