In a recently released article in Pediatrics,Anderson et al. contribute to a growing body of literature that suggests health outcomes are intimately and unfortunately, linked to a patient’s address (10.1542/peds.2017-2432). Their study found that children born to families in lower income communities who undergo cardiac surgery have an increased mortality risk, longer hospitalizations and higher hospital costs compared to their counterparts in wealthier neighborhoods. Sadly, these results are hardly surprising and demonstrate that despite over 20 years of substantial research on the social determinants of health, significant disparities still exist between communities.
As pediatricians, we know how far reaching the consequences of growing up in a resource poor setting can be for a child. Research has shown that children living in lower income households are more likely to be delivered prematurely, to experience poor weight gain, to be admitted for an asthma exacerbation, to develop childhood obesity and other chronic medical conditions, and to suffer from higher rates of in-hospital mortality than children in higher income households (Kramer et al. Paediatr Perinat Epidemiol. 2000, Beck et al. J Pediatr. 2013, Alvarado SE Soc Sci Res. 2016, Colvin et al. Pediatrics 2015). Life expectancy has also been linked to the location of their neighborhood: a child’s lifespan may differ by 25 years within a single city, depending on which metro stop is closest to their home (RWJF 2013).
Fortunately, research has started to shine light on potential interventions to tackle such disparities. Yet, after reading studies like Anderson et al, I am left wondering what contribution individuals like myself, who remain primarily in clinical practice and are not focused on public health or policy reform, can make. Often attempting to work out individual solutions on a patient-by-patient basis in clinic frequently feels like detangling a spider web: sticky and futile.
Those of us in clinical practice can take a nod from the Editors of Circulation, who recently published a list of suggestions about how to make a difference in combating health disparities (Chan et al. Circ Cardiovasc Qual Outcomes 2017). The first step is to “engage more” in community events in order to understand the local health disparities in your own community, and to listen carefully to the people in that community. This then allows for movement from “description to action,” in which writing about potential solutions or trialing various interventions becomes the focus. The final step is “getting involved” by sharing success stories or new ideas with surrounding communities to advocate for further change.
The neighborhood effect is large, but perhaps if we are able to work to build relationships within our communities, we may reduce the power that a zip code appears to hold over our patients’ well-being.
References:
- Kramer, M.s., et al. “Socio-Economic Disparities in Pregnancy Outcome: Why Do the Poor Fare so Poorly?” Paediatric and Perinatal Epidemiology, vol. 14, no. 3, July 2000, pp. 194–210.
- Beck, Andrew F., et al. “Inequalities in Neighborhood Child Asthma Admission Rates and Underlying Community Characteristics in One US County.” The Journal of Pediatrics, vol. 163, no. 2, 2013
- Alvarado SE. “Neighborhood disadvantage and obesity across childhood and adolescence: Evidence from the NLSY children and young adults cohort (1986-2010).” Social Science Research, vol. 57, May 2016.
- Colvin, Jeffrey D., et al. “Socioeconomic Status and In-Hospital Pediatric Mortality.” Pediatrics, American Academy of Pediatrics, 1 Jan. 2013
- “Metro Map: New Orleans, LA - Infographic.” RWJF, July 2013, www.rwjf.org/en/library/infographics/new-orleans-map.html.
- Chan, Paul S., et al. “Making a Difference in Disparities.” Circulation: Cardiovascular Quality and Outcomes, American Heart Association, Inc., 1 Oct. 2017
