What is your best guess for the average life expectancy of homeless individuals?
Without using Wikipedia, Google, or Bing, what is your best guess for the average life expectancy in your home county?
(I’ll give you a hint; the average for the U.S. is 78 years old).
To make your prediction, some of you might start analyzing the amount of respected doctors or hospitals in the area. Good, you’ve accounted for about 10% of an individual’s health. Others might start looking for your family tree or reaching for your latest genetic testing from 23andMe. This can help attribute another 10% of one’s health status. Now, before you start to consider the percentage of smokers in your town, let me ask another question.
What is your best guess for the average life expectancy of homeless individuals?
Significantly lower you might assume. But why?
Let’s start by answering the first question. The Institute for Health Metrics and Evaluation graph below shows huge disparities between counties across the United States ranging from McDowell, WV, with an average life expectancy of 74.1 years for females and 66.3 years for males to Collier, FL, with a whopping average of 85.8 years for females and 80.7 years for males.
Highest and lowest life expectancy by county and sex (US), 2009
Even more staggering is the answer to the second question. Homeless individuals have an average life expectancy between 42 and 52 years – numbers not even visible on this graph. This data shows people living in some of the healthiest counties in the country have nearly 2 times the life expectancy of homeless individuals. However, even comparing people living within the same region of the United States, there is still more than 10 years of disparity.
These vast differences demonstrate health as a factor dependent on the social and physical environment within a community. This “infrastructure” includes: safe and affordable housing, education, public safety, transportation policy, urban planning, food production and distribution, social support, poverty/stressful conditions accompanied by poverty, the working environment, and exposure to toxic substances.
This combination of elements contributes up to 60% of an individual’s overall health. Yet, these components are often completely under-emphasized in today’s society. Instead, questions to reveal one’s health generally focus around ‘your behaviors’:
- Do you eat 3-5 servings of fruits and vegetables per day?
- Do you get enough sleep?
- Do you exercise moderately for at least 30 minutes a day 5 times a week?
- Are you taking any medications?
All these questions assume that the appropriate infrastructure is in place to be able to make these individual decisions. The first questions we should be asking concern the physical and social environment at the community level:
- Is there sufficient affordable housing in the area?
- Are the housing units contaminated with mold or lead?
- Is there access to foods providing adequate vitamins and minerals?
- Are the streets safe for walking?
If the largest contributing factor to an individual’s overall health is his/her social and physical environment, these are the critical questions which should be on the forefront of our healthcare discussion. These are the components which will greatly improve our ability to predict an individual or a community’s overall health.
Therefore, as we jump into many changes stemming from health care reform, we should be reflecting on what healthcare really means. And to start, let’s begin thinking of housing as healthcare.
Katie McKillen is an intern for the Pacific Northwest Team. She is currently receiving her Master’s degree in Health Policy & Management at Harvard’s School of Public Health.
This blog originally appeared on the Gates Foundation’s Impatient Optimists Blog.