In one area of Baltimore, the average life expectancy is 85.
But across town, a person might expect to live to only 65, said Leana Wen, M.D., now a visiting professor of health policy and management at the George Washington University Milken Institute School of Public Health.
The city is just one example of how much a patient’s life expectancy depends on what neighborhood they are born in and live in, said Wen, who spoke of the need to rebalance health outcomes as part of The Hill’s Diversity Matters Summit this week.
Wen, a former CEO of Planned Parenthood and a former Baltimore health commissioner, said it is important to delineate between healthcare and health when talking about disparities that can mean 20 years added to or subtracted from a person’s life.
“Improving health is not enough. We must also focus specifically on reducing disparities and achieving health equity,” she said, pointing to factors from the quality of food and education to the level of poverty,
“Choice is predicated by privilege. How can we even the playing field of equality? We need to get to a point where a child is born does not indicate how long they will live,” she said.
Also speaking at the panel, Georges C. Benjamin, M.D., executive director of the American Public Health Association, said a similar disparity exists in Washington, D.C. Life expectancy in the downtown area of the nation’s capital is 72 years. At the end of the red line on the Metro rail system, it’s 84 years.
“A year of life expectancy is a big deal,” agreed Benjamin.
While access to healthcare is important, other behavioral and social factors—so-called social determinants of health—play a role. For instance, if you want to get someone to walk regularly to improve their health, you need level sidewalks that aren’t cracked and falling apart and streets that are lighted so they are safe, he said.
Getting to solutions
At some point, health leaders need to stop simply talking about disparities in healthcare and tackle the problem, Wen said. For instance, Baltimore was able to reduce its infant mortality rate by 38% over five years by using data to assess risk factors and distribute maternal and infant care more effectively, she said.
The city was able to allocate interventions, such as home visits, to the most vulnerable pregnant women and focus services on dangers to infants such as educating new parents about sleep-related death.
It’s important to focus on solutions, she said. For instance, as a physician, she can tell a patient that they’ve got to eat healthier foods. But if that patient has to take a bus and walk two blocks to a grocery store, it will be difficult to eat healthier.
Everyone knows where health disparity is, Benjamin said. “It’s called the other side of the tracks. Every city has that.”
To solve the problem, the country needs an adequately funded public health system, he said. For example, the use of tobacco is linked to the five leading diseases in the U.S. from heart disease to cancer. Yet the country spends little on prevention and wellness.
“We know how to fix these problems,” he said, as health leaders go to foreign countries to address issues, such as the need for vaccines. Yet the country doesn’t take these same solutions and implement them here, he said.
Asked about whether he supports "Medicare for All," Benjamin said he wants to see “Prevention for All.”
“We need to pay for it,” he said, suggesting if he was given the federal budget, he could find the money.
It can be hard to measure the effects of efforts that prevent people from getting sick, said Wen. “Public health ends up being the first thing on the chopping block.”
Wen quoted late Congressman Elijah Cummings, who represented Baltimore. “The cost of doing nothing isn’t nothing. What is the face of public health? Public health has saved your life today. You just don’t know it and we need to talk about the cost of inaction in public health,” she said.
Both Wen and Benjamin also said there needs to be diversity in the health professions. Wen again quoted Cummings. “Diversity is not our problem. It is our promise,” she said.
When he graduated from medical school in 1978, the number of black medical students was at its peak, Benjamin said. At that time, 9% of physicians were African American. Now, only 4% of practicing physicians are African American. Patients need to be treated by providers they trust, and having someone who looks like you can be important, he said.
Wen said patients also need providers who understand their cultural background.
She recalled how long it took before her mother’s metastatic breast cancer was diagnosed. Doctors first told her she had a cold and then one told her she was suffering from depression. “She knew she didn’t have depression. But was so scared to speak up,” said Wen, whose mother died 10 years ago and left her wondering whether the outcome would have been different if her cancer were discovered earlier.
Doctors are also more likely to go back into the community where they are from, Benjamin said. They can also help counter stereotypes, such as some physicians who still believe that African Americans can tolerate more pain or assume people of color must be on Medicaid or be uninsured. Numerous physicians have had that experience when they have taken their own family members to the emergency room for treatment, he said.
Wen, who was the leader of Planned Parenthood until she was ousted last July, had urged the organization to take the position that abortion was not a political issue, but a healthcare one. Wen said it is unfortunate some issues such as women’s reproductive rights and abortion have become political.
“I come to this work as a physician,” she said. When a patient comes to a doctor for reproductive care or abortion care or hypertension, “people are not trying to make a political statement” but want to be cared for.
“That’s my north star,” she said. “I still think, though, it’s important to stay grounded. It’s not just what we’re fighting about, but we need to stay focused on who we’re fighting for.”