ZIP code vs. genetic code: How to cover health inequality #ahcj15

About Kris Hickman

Kris Hickman (@the_index_case) is a graduate research assistant for AHCJ, pursuing a master’s degree in public health. She has a bachelor's degree in anthropology, with a minor in journalism, from the University of Missouri. She spent two years in Zambia as an HIV/AIDS community education volunteer in the Peace Corps. She aspires to be an epidemiologist and science writer.

Poverty is a poignant reality – and an overwhelming one. If you’re a reporter, you might struggle to find the story in health inequality.  But at Health Journalism 2015 in Santa Clara, Calif., panelists shed some light on the health disparity between high and low incomes – and who it hurts.

Nearby Silicon Valley has massive income inequality, and panelists from Northern California gave attendees some local perspective. The panel, moderated by independent journalist Sheree Crute, explored how wealth influences health, as well as how to provide – and cover – health care in an impoverished community.

Luisa Buada, R.N., M.P.H., chief executive officer, Ravenswood Family Health Center, said the top earners in Silicon Valley can make $3,500 a week and the mean cost of a home is $855,000, but 86 percent of patients in her clinic are at or below 100 percent of the federal poverty level (FPL).

“We’re living in a place of extraordinary poverty surrounded by extraordinary wealth,” Buada said at the April 25 panel. She described “another kind of homelessness,” in which low-income families are priced out of the astronomically expensive Silicon Valley. This creates a barrier to health care for those people, she said.

According to panelist Sarah Reyes, regional program manager of The California Endowment’s Building Healthy Communities, the problem goes further than lack of access – environment trumps biology when it comes to health.

“Does your ZIP code matter more than your genetic code?” Reyes asked. “The answer is, quite frankly, yes it does.”

So how can health journalists parse meaningful stories from such a complicated situation? Here are a few tips from the panelists (or inspired by them) on understanding the impact of ZIP code on the genetic code.

Life expectancy: See how life expectancy differs by ZIP code in certain areas of the U.S. and a nationwide data visualization of life expectancy by area and gender (scroll down for maps).

Income disparity:  What do the highest and lowest earners make, and what is the income gradient? In other words, are there many low earners and only a few high ones? Reyes said every additional $12,500 in household income buys one year of life expectancy, but benefit plateaus at $150,000.

Daily commute: How long do people in your community travel to get to work? Buada said one of her clinic employees had to travel four hours one way to get to work. “I had a staff person who was living in her car two months were her 4-year-old son,” she said. “She was seven months pregnant when she started doing that.”

Health care providers: Tracy Seipel,a reporter for the San Jose Mercury News, stressed the importance of talking to doctors and nurses. Make a visit to the local clinic to see what they do and what challenges they face, Seipel suggested

Insurance and the ACA: Has the ACA truly improved the health status of extremely low-income families and individuals? How many are still uninsured? Buada says many can’t afford the premiums, even with the subsidies, so they go without. “Unless the penalty becomes more than what they have to pay per month, they won’t pay for marketplace insurance,” she said. Also, Buada said the ACA’s audits and increased compliance regulations can hurt local clinics and providers.

“Communities of opportunity:” Functional communities make for healthy people. “We know when you have parks, access to healthy food, clean air, good jobs, strong local business … that you do have a good health status,” Reyes said. These features foster opportunity within a community, she told attendees. Check out the Food Access Research Atlas and the Food Environment Atlas for a place to start in your community.

Homelessness in high income areas: Are there homeless elderly individuals who can no longer afford their communities? Yes, according to Buada. Seipel emphasized eyewitness experience as the key to understanding homelessness and health inequality. “Go to the homeless camps and there you’ll find great stories,” she said. “Find the poor.”

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