Digging Deeply To Address Health Inequities At The Local Level

Data are a funny thing. On the surface, data appear to tell you one thing. But if you dig more deeply, you will often find another, more complex truth.

This happens frequently with health data. For example, Northern Virginia is one of the nation’s most prosperous regions, with counties that consistently rank high on measures of health. But if you examine data at the census-tract level, you will see stark health disparities.

Take, for example, Lorton, in Fairfax County, Virginia. Lorton is a locality once known for a District of Columbia prison located there. Between western Lorton and eastern Lorton—a distance of about four miles—life expectancy varies by as much as ten years. In western Lorton, where residents may expect to live to age eighty-nine, median annual household income is $133,413, and African Americans make up 12 percent of the population. In eastern Lorton, where average life expectancy is seventy-nine years, annual median income is $77,901, and 37 percent of residents are African American.

Or look at the Seminary Hill neighborhood of Alexandria, Virginia, where average annual income is $186,705, most (95 percent) of residents have an education beyond high school, and life expectancy is eighty-four years. Just a few miles away, on the other side of Shirley Highway, in Beauregard, life expectancy is only seventy-nine years. There, average annual income is $44,624, and 72 percent of residents have an education beyond high school.

At the 10^th Anniversary Health Summit of the Northern Virginia Health Foundation (NVHF) in June, Virginia’s health commissioner, Marissa Levine, called on community health advocates to take a close look at how they collect and analyze their data.

“If you want to make evidence-based decisions, you have to be careful how you assess health in your communities,” Levine observed. “We have to ensure that we know what every community looks like.”

That means determining not only what the data are telling you—but also what they are not. Are those data “really what we need to know?” Levine said. Are they “providing the picture of health?” Are they “providing the ammunition, so to speak, to do the critical work around [addressing] the other determinants of health?”

Ask those questions, and you will invariably conclude that place matters to health, and it matters a great deal, according to Steven H. Woolf, director of the Center on Society and Health at Virginia Commonwealth University (VCU), in Richmond.

Woolf is also the lead author of a new NVHF-funded report, A Study in Contrasts: Why Life Expectancy Varies in Northern Virginia, which served as the focal point of our 10th Anniversary Health Summit.

Woolf detailed the aspects of community environment that influence health, including polluted air, lead-contaminated water, unsafe streets, and the absence of parks and playgrounds for children to play in, as well as the lack of bike lanes and sidewalks for people to get around on. All of these things have important effects on health, more so even than medical care.

An interactive mapping tool developed by VCU and NVHF allows users to compare neighborhoods in Northern Virginia by census tract on life expectancy, education, income, and racial/ethnic composition. The tool also shows how life expectancy is closely linked with these “upstream” factors that affect health.

The kind of nitty-gritty data underlying Woolf’s report and analysis are key to achieving health equity in Northern Virginia—and, for that matter, everywhere! We cannot address health inequities effectively without having data at the census-tract level that provide a complete picture of community health, so that policy makers and others can make informed choices about how best to allocate resources.

For relatively small and regionally focused foundations like NVHF, it is important to present data that can improve understanding of community health and community health needs.

And for that, we need to dig deep.

Editor’s Note:

Related resource:

“Place Matters: Making the United States The Healthiest Nation, Community By Community,” by Garth Graham of the Aetna Foundation and Georges Benjamin of the American Public Health Association, GrantWatch section of Health Affairs Blog, May 19, 2016.

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