Positioning El Paso as a major center for medical care is an admirable goal and yet is only part of the solution to create a healthy community. What has not received much attention from our policymakers and funders is a comprehensive plan to address the social limitations of health.
Many health problems can either be eliminated or their impact markedly diminished through addressing the root cause of many of these challenges.
The proportional importance of factors shaping health is determined 40 percent on behavior, 20 percent related to environment, 20 percent on genes, and 10 percent on health care.
Proximity to health care does not mean that our community will have improvement in their health status.
The strongest predictor of health is where we stand as individuals in our social structure. Those at the top have the most power and on average live longer and healthier. Those at the low end of the social pyramid are unhealthier and die younger.
According to the Public Broadcast Service series, “Unnatural Causes,” those in the middle class have a 50 percent higher chance of dying sooner then those on the top. Furthermore, those in the lower economic sector are 400 percent more likely to die sooner than the upper economic sector. This is true despite unhealthy behaviors such as smoking and obesity.
The choices that we make are based on what is available to us. For example, does our zoning regulations require parks, walking paths, playgrounds and grocery stores located within walking distance of residential areas. Or do we see more fast food outlets, liquor stores and lack access to affordable fresh foods? Public transportation that is inconsistent, has limited routes and runs at inconvenient times can mean many are unable to access healthier options.
Are our schools held accountable for educating graduates who can compete in our modern world? Are extracurricular activities, such as after school programs, music, art and gym, made available to all students? If we improve access to preschools, community college and universities, and create jobs that are “green friendly” we can enhance the health of our community.
As “Unnatural Causes” illustrates it is not the CEOs that are dying of stress-induced illnesses, it those with low paying jobs who have limited access for housing, food, health care, inadequate public transportation and unsafe living conditions who are suffering the most.
When we do not have money, a sense of control in our lives and an education to allow access to greater economic security then no health insurance, poor health and premature death are the norm. It is this kind of stress that kills!
Social policies such as minimum wages, improved working conditions, mandatory schooling, civil rights laws and improved housing have contributed to an increase in our life expectancy. But more must be done.
We are paying the price by our lack of commitment to address the social determinates of health. Many of us are obese, have cardiovascular diseases and diabetes. In many cases these conditions can be directly related to the limitation of our social status.
The cost of treating our health problems is the highest in the world and will continue to escalate if we do not address these other factors that contribute to disease.
We must also provide resources to tackle these issues. Continuing to educate more nurses, physicians and other members of the health care team—while urgently needed—must also be done in tandem with developing community-based solutions to address these social determinates. We need to invest now or our health disparities and inequities will continue to grow.
Martin Luther King once said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” This statement is still true 40 years after this death.
