It’s no secret that city dwellers sometimes play a guessing game to break up an otherwise boring commute: If you guess that Nice Loafers will exit near the nice waterfront condos, he might live up to the stereotype, or surprise you and get off in a low-rent neighborhood. Meanwhile, Chest Tattoo with a Harmonica could live near the artist squats, or pop off for an $11 wheatgrass smoothie in the heart of the city’s fashion district. But unlike shoes or tattoos, the subway stop itself is a powerful and accurate indicator about populations of people, and the awful, underlying issue is that there’s actually little guesswork in it.
Public health researchers have been mapping severe life expectancy disparities across cities for years, but nowhere is that more apparent than on a map of the subway. Upon the second meeting of its Commission to Build a Healthier America, the Robert Wood Johnson Foundation released maps of health disparities across metro maps of Washington, D.C., New Orleans, Minneapolis, Kansas City, and the San Joaquin Valley in early July. In some places, like New Orleans, a difference of just a mile could mean a difference of 20 years off an expected lifespan.
"The maps are meant to show that this is a pervasive problem," says director of the Virginia Commonwealth University Center on Society and Health, Steve Woolf, whose research has produced a number of similar maps independently. "You can do this in any American city—and many cities have done this and found the same pattern."
The pattern mimics much of the disparities we see across social and economic inequalities—in areas with less access to educational resources, or decreased availability of safe areas to play or work out, lifespans tend to be shorter. Poverty, the proximity of highways and air filled with diesel fumes, and food deserts are also linked to poor health. Woolf points out that the maps are meant to demonstrate that environmental factors can have a bigger impact on our health outcomes than what happens inside a doctor’s office.
"The point here is that these big differences in life expectancy aren’t going to be made up by adding a new wing to a hospital," Woolf says. "The solution involves jobs, education, strengthening our neighborhoods, community development. These aren’t issues we normally think of as close to medicine, but they’re probably more important than what we as doctors could do."
One of the factors the commission has chosen to focus on in 2013 is early childhood development. "Early brain development has really evolved, the impact of stress on health," says Robert Wood Johnson senior program officer Abbey Cofsky. As a result, the commission, which will be publishing its second list of recommendations this fall, has engaged federal reserve banks in tailoring their community development strategies to help neighborhoods with the number of child care centers, for example, along with clinics, charter schools, and grocery stores.