Zip code, race, class trump genetics and health care as predictors of public health

Anthony Iton

Genetic predisposition and access to quality health care are important predictors of an individual’s health. But throughout the United States, race, class and zip code play a far greater role in determining who is healthy and who isn’t, according to one of the country’s most prominent public health experts. “In this country, where you live predicts a lot about your fate,” said Anthony Iton, MD, JD, MPH, director of public health of Alameda County and the keynote speaker during UCSF’s celebration honoring Martin Luther King Jr. Iton came to that conclusion after several years spent analyzing the stark health disparities that exist throughout Alameda County, which covers much of the East Bay region of the San Francisco Bay Area. In 2008, the Alameda County Public Health Department released a report that merged health, education, transportation, housing and other quality-of-life data into a single, eye-opening document.

Health and Social Disparities in Alameda County*

  • In areas with the lowest poverty rate (7 percent), 49 percent of the population is nonwhite and 90 percent complete high school.
  • In areas with the highest poverty rate (25 percent), 89 percent of the population is nonwhite and only 65 percent complete high school.
  • Life expectancy in the poorest areas is less than 74.3 years.
  • Life expectancy in the wealthiest areas is more than 80 years.
  • Among 11th-graders in Oakland Unified School District, 62 percent of African American students and 60 percent of Latino students have “below basic” reading levels. Among white students, only 17 percent score “below basic.”
  • In 2002, African American households had a median net worth of $5,988; white households had a median net worth of $88,651.
*Source: “Alameda County: What Are We Really Doing to Change the Context of Health?” Alameda County Public Health Department, 2008.

The Report showed that the areas with the lowest income are consistently the areas with the lowest life expectancy and highest incidence of chronic disease. Those areas — which Iton calls “hot spots of death” — also tend to have disproportionately high concentrations of nonwhite residents, though Iton said he believes that “factors related to class are probably more potent than factors related to race.” Overall, there is at least a six-year gap between the areas of Alameda County with the lowest life expectancy and those with the highest life expectancy, the report found. The disparities extend to education as well: In Oakland, African American and Latino seventh-graders read below the level of white third-graders, according to the California Department of Education. This sobering statistic could have major implications for public health, Iton said, noting that numerous studies have linked education to mortality and the incidence of heart disease, certain types of cancer and other illnesses. Closing those gaps will take a multidisciplinary approach — one that focuses on improving not only health and education, but also housing, labor, the environment and all other areas that affect individual well-being, Iton said. “All these things are connected,” he said. “For us to think health is all about whether you smoke or don’t smoke is ignorant at best.” Call to Action
Rather than being depressed by the findings, Iton sees them as a call to action. “The data make it very clear that the root causes of a number of problems facing our community are the same,” he said in a phone interview. “When we recognize that, it galvanizes people to act.” Iton has experience tackling tough challenges. He came to Alameda County after having served as director of health and social services of Stamford, Connecticut, where he developed the local protocol for prophylaxis of postal workers after exposure to anthrax spores. His résumé also includes stints as an HIV disability rights attorney, a health care policy analyst, and a physician and advocate for San Francisco’s homeless population. Since the release of Iton’s report last spring, responses from Alameda County government agencies and advocacy groups have been huge, he said. The public health department is already working with various city planning departments and other organizations to design healthier neighborhoods, he said. Iton said he thinks that local-level changes will ultimately spark change at the state and federal levels. “Most good public health policies tend to trickle up, not down,” he said. “It takes institutions like UCSF taking responsibility for their communities.” For its part, UCSF has made serving its community a top priority over the next decade. The UCSF Strategic Plan calls on the University to “be a force to eliminate the pervasive disparities in health and health care in the local and national environment that are based on race or ethnicity, socioeconomic status and other social vulnerabilities.” UCSF created the University Community Partnerships Program in 2006 to empower the community to partner with the University and vice versa. The program is directed by the 20-member UCSF University Community Partnerships Council, a group of passionate public service advocates consisting of 10 UCSF representatives and 10 members of the community. Iton’s Jan. 22 talk at UCSF was sponsored by the Chancellor’s Diversity Celebration Committee and co-sponsored by the MLK Commemoration Planning Committee and the UCSF Staff Council.

Related Links:

UCSF to Celebrate Martin Luther King’s Vision with Awards, Events
UCSF Diversity Website, Jan. 20, 2009

Alameda County Public Health Department

Alameda County: What Are We Really Doing to Change the Context of Health? (pdf)