DECATUR -- A startling trend in health care has emerged in recent years. Americans’ life expectancy is tied to their income.
Those with more money tend to live longer than those without.
According to the American Heart Association, while U.S. deaths from heart attacks, strokes and other heart diseases have been declining, the benefits have not been shared equally across economic, racial and ethnic groups.
According to a study published in the Vital and Health Statistics Journal, Americans earning less than $35,000 are 65 percent more likely to have heart disease and 144 percent more likely to have a stroke than those earning more than $100,000 a year.
Education is a key factor. It affects what kind of job a person has, their access to health care, income and stress, and also what they know about health. Research indicates that people with lower educational levels die younger, largely due to cardiovascular disease, according to Edward P. Havranek, a cardiologist at Denver Health Medical Center and professor of cardiology at the University of Colorado School of Medicine.
The Affordable Care Act increased access to health care, but the poor still have limited access to healthy food and often live in neighborhoods less safe than those with higher incomes. Studies support that the neighborhoods in which people live likely affect their heart disease risk.
“We need to learn more about why that is, but contributing factors could include less access to healthy food, less opportunity for physical activity, higher stress levels with higher crime, noise and traffic,” Havranek said.
There's also evidence that children with low birth weight, often associated with a lack of prenatal care, tend to be predisposed to high blood pressure and diabetes as adults.
Health care facilities are required to commission community needs assessments. In Decatur, which has a poverty level of 18.4 percent according to the Census Bureau, obesity, low access to healthy food and exercise opportunities, low education rates and low birth weights are all problem areas.
“Theoretically you teach doctors to diagnose illnesses and they cure people, but the numbers show us that poverty, poor housing and low education directly impact a person’s health,” said Crossing Healthcare Executive Director Tanya Andricks. “If you truly want to get on top of this problem, you have to teach the medical community how to intervene with the social determinants. It’s understanding you can’t really impact health until you look at the whole picture. Providing access to those basic needs are the first steps to addressing other health needs.”
Crossing, a federally qualified health center, has been on the forefront of attacking the problem of negative social determinants in Decatur.
An article on the World Economic Forum website by Klaus Koenigshausen, founder and CEO of MediQuire -- a medical data analytics company -- suggested health care providers prescribe healthy food to patients with nutrition-related health problems like obesity and diabetes.
Last year, Crossing began growing produce in the open space across from its building at 320 E. Central Ave. and started a pilot program. Twenty patients were hand-selected by Crossing staff based on their social determinants and prescribed fresh produce from the garden.
“If you have someone in what’s known as a food desert, you have to start at the bottom and prescribe produce,” Andricks said. “You have to address that need before you can ever address the diabetes.”
Crossing dietitian Allison Raiha, who administered the produce, said the numbers show prescription produce worked to improve the health of the patients.
“We had weight loss in more than half the participants and lower blood sugar in just under half the participants,” Raiha said.
Raiha said she learned from the experience of the first go-round of prescribing produce.
“They get the produce and it’s delicious, but for a lot of people, the question was, ‘What do I do with this produce,’” Raiha said. “With green tomatoes, they fry them. If that’s all they’ve ever done or seen, it’s hard to go beyond that -- even with tools like the internet.
“This year we’re going to be branching out and doing more cooking demonstrations, cooking classes and video demonstrations that are going to be easy for them to reach, get ahold of and try themselves.”
Andricks said the program would expand to 40 patients this year. Though it will take years to measure the true impact, she said she believes the program will help change the community’s health for the better.
“The trajectory for those people in the program has now changed,” Andricks said. “Over time, we’re hoping they stay healthier longer and have better outcomes with their diabetes and heart health.”
Andricks preaches that a better economy and more education will lead to a healthier community. Havranek agreed.
"Overall population health cannot improve if parts of the population do not benefit from improvements in prevention and treatment,” Havranek said.