The jigsaw puzzle of U.S. counties fits neatly together into a pleasing whole, displaying America as a land of many parts.
Within those parts, people in adjacent communities may have similar lifestyles and incomes. They may eat similar foods, enjoy the same music, picnic in the same parks and vacation at the same campgrounds or beaches.
But look more closely and you’ll find people living in neighboring communities often live very different lives. Residents in one county may suffer many more days of poor physical or mental health – or both – than those in the county next door. People in many communities even live longer than those in communities nearby, a pattern that extends nationwide.
Which is why community health assessments – including a new U.S. News ranking of the nation’s Healthiest Communities, to debut in March – are so valuable for identifying trouble spots and targeting remedies to where they’ll do the most good.
Think of them as diagnostic scans of what ails America, from soaring rates of obesity, hypertension, and diabetes to pervasive mental health problems and opioid abuse. The overlapping epidemics are having a profound impact nationwide. For the first time in nearly a century, life expectancy has begun to decline in major population groups, and not just in poor underprivileged neighborhoods. Death rates rose for white men, white women, and black men, and remained essentially unchanged for black women and Hispanic men and women.
“This is the first time we’ve really seen fairly marked decreases in life expectancy in key groups and not simply the socially disadvantaged,” says Dr. William Stead, chief strategy officer at Vanderbilt University Medical Center and McKesson Foundation professor of biomedical informatics.
In most measures of population health, the world’s richest country lags behind other developed countries, despite trillions spent each year on medical care.
“Waves of chronic disease are reaching historic rates,” says Tyler Norris, chief executive of the Well Being Trust, a $100-million nonprofit funded by Providence St. Joseph Health to help improve the nation’s mental and physical health. Chronic diseases not only reduce productivity, he says, they have driven health care costs so high that they are “unaffordable no matter who you are.”
Eighty percent of the growth in Medicare spending – now totaling nearly $650 billion a year – is due to chronic disease, says Kenneth Thorpe, of the Rollins School of Public Health at Emory University and chairman of the Partnership for Chronic Disease.
Tragically, this chronic-disease epidemic of diabetes, hypertension, heart disease, stroke, arthritis and other ailments is occurring against the backdrop of a revolution in medical care, one that ushered in countless innovations including antibiotics, blockbuster drugs, high-tech surgery and genetic medicine.
The roots of the problem run deep, anchored in national neglect of festering social problems and each community’s history, culture, economy, schools, hospitals, neighborhoods and sense of place. These so-called social determinants offer a way of assessing community health. They show that poor health and other social problems are more heavily concentrated in some neighborhoods than others, variations that may not be apparent when examined at the national or state levels.
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