http://www.contracostatimes.com/life-expectancy

OVERVIEW OF MAJOR FINDINGS• There’s a 16-year life expectancy difference between rich and impoverished neighborhoods 12

miles apart in Contra Costa and Alameda counties.• Health disparities correlate to one’s place on the socioeconomic ladder, with higher disease rates

and shorter life expectancy affecting the poor the most. And the middle-class, while faring better than those lower on socioeconomic rungs, nonetheless live shorter, sicker lives than the more affluent.

• 15 percent of health disparities are linked to a lack of access to medical care.• Lifestyle accounts for about half of the variations in health, although lifestyle choices are strongly

influenced by the available options.• Chronic stress also plays a key role in explaining the higher rates of disease and lower life

expectancies along the socioeconomic gradient. • Numerous initiatives nationwide are now addressing health disparities by leveraging the inherent

strengths of communities, and through social policy changes such as zoning laws and “health impact assessments” to protect and improve residents’ health.

Julie Rettig, center, and her husband and daughter live in ZIP code 94546 in Castro Valley, Calif. Life expectancy in this middle-class suburb is 79 years.

Richard Angelis lives in Walnut Creek, Calif. on a tree-lined street in ZIP code 94597, where life expectancy is 87.4 years.

The Orantes family lives in ZIP code 94603 in Oakland, Calif. Life expectancy in this high-crime, resource-poor neighborhood is 71.2 years.

A seven-part series on the “social determinants of health,” or SDOH.

Outcomes so far: • Sobrante Park Time Bank – This program has received nationwide attention. It allows neighbors to

swap services, like gardening, babysitting, or car repair. • More than 100 residents completed leadership courses.• New neighborhood councils tackled neighborhood blight, crime prevention, disaster preparedness

and strategic planning.• The public health department funds an annual health fair. • Half the people surveyed in 2007 said the neighborhood was cleaner than in the previous year. Calls

complaining about such blight dropped 25 percent from 2004 to 2007. • More people attended neighborhood barbecues or block parties and more felt prepared for a

disaster. Survey will be repeated this year.

SOBRANTE PARK COMMUNITY CAPACITY BUILDING PROGRAMIn Sobrante Park in Oakland, residents live on average 71.2 years, nearly seven years below the California average of 78.4 years. In 2004, the Alameda County Public Health Department chose Sobrante Park as a laboratory for testing how social cohesion and civic leadership improves health by bringing neighbors together to advocate for resources like better parks, better bus service or more police patrols.

In a separate initiative, The California Endowment this year began funding its Building Healthy Communities initiative. It intends to spend hundreds of millions of dollars from 2010 to 2020 building up resource-poor neighborhoods.

• The health reform law sets aside $15.4 billion over five years for a Prevention and Wellness Trust to fund neighborhood initiatives to improve health, like keeping a school open after hours or hiring a guard for a park.

• Seven in 10 Americans support the prevention provisions in the health care reform bill. • Secretary of Labor Hilda Solis, as a House member from Southern California, tried four times to

introduce legislation for reducing health disparities with her Health Equity and Accountability Act. The bill never moved beyond introduction.

• The Congressional TriCaucus, formed of the African-American, Hispanic and Asian caucuses,

infused language from Solis’ bill into the health reform legislation.

HOW TO OVERCOME PROJECT CHALLENGES TIME CONSTRAINTS• In early stages, squeeze in time for project amidst daily beat reporting.• Near the end, request dedicated time to complete series.• Meet regularly with project team including photographer, graphics, online and multimedia to keep

everyone on track.• Create meeting agendas and set deadlines.• Use fellowship commitment. FINDING PEOPLE TO PROFILE• Be creative. Try community organizations, churches, hospitals, clinics, friends and co-workers.• Be sensitive. Understand that people may be reluctant to have you in their homes, or to open up

their lives to media coverage.• Develop rapport. The first interview may not yield the best results.• Be picky. Find the right people. Don’t be afraid to reject recommendations, even after interviews. PERSUADING EDITORS• Be ready to address role of ‘personal responsibility’ versus socioeconomic factors. • If your local health officials and other experts are onboard, make sure your editors know.• Welcome editors’ questions and address those in story. Readers may have the same reaction.• Show editors other coverage, such as:

Unnatural Causes documentary at www.unnaturalcauses.orgOur series at www.contracostatimes.com/life-expectancy.

• Point out that this is an emerging issue that’s getting more attention as a way to address problems like diabetes, obesity and escalating health costs.

HOW TO GET HEALTH INEQUITIES DATA IN YOUR COMMUNITY

DO I HAVE TO DO MY OWN NUMBER-CRUNCHING?No. You can do a strong story by finding people to profile and “humanizing” numbers prepared by

others.Places to look for data include:• Your local and state health departments. • The National Neighborhood Indicators Partnership at http://www.urban.org.NNIP.• To compare your county with others throughout the nation, go to www.countyhealthrankings.org.• In California, try Healthy City at www.healthycity.org or First 5 California at

http://www.ccfc.ca.gov/• Nearby universities, which may have researchers examining health disparities.• Local nonprofits focused on health disparities. Visit the Joint Center’s site for a list of such groups

nationwide: www.jointcenter.org/hpi/pages/health-equity-community.• The CDC’s Health Disparities page at www.cdc.gov/nchhstp/healthdisparities. HOW TO BEGIN YOUR OWN ANALYSIS• Start with your local and state health departments. Many have units devoted to health inequities.• Do they use an electronic death registration system? If so, it may be possible to get a database

with geo-coded death certificate info, including cause of death.• See if they have hospital records that include unnamed patients’ ZIP codes. This can be used to

determine child asthma hospitalization rates, for example.• In California, our hospital reports came from the Office of Statewide Health Planning and

Development at www.oshpd.ca.gov.

MAKE SURE YOUR ANALYSIS IS VALID• If possible, find an epidemiologist to do the number-crunching. Try your local health department or

university researchers.• It is crucial to “age adjust” the numbers. Otherwise, areas with a large percentage of seniors or

young people will skew the results.• Be sure to compute the rate of heart disease deaths per 100,000 population, instead of using raw

numbers. Some ZIP codes have more people than others.

HOW TO GET POPULATION INFO BY ZIP CODE, INCLUDING AGE BREAKDOWNS• The best source is the U.S. Census Bureau at www.census.gov.• For more up-to-date info, we used estimates by Nielsen Claritas at www.claritas.com. This can be

pricey, but:• Your news organization’s marketing department may have already purchased the Nielsen Claritas

estimates. It may also have a wealth of demographic data, including mapping software and ZIP code maps for your circulation area.

STORY IDEAS ON HEALTH INEQUITIES

• Examine how life expectancy varies in your area.• Map disease rates or child asthma hospitalizations by ZIP codes. What patterns emerge?• Does life expectancy or disease prevalence vary by race and ethnicity in your area? If so, dig deeper

to explore the causes for these disparities.• What role does poor air quality play in a neighborhood’s health? Do you have areas where people

are routinely exposed to large amounts of diesel particulates or industrial pollution? What impact does this have?

• How do local land use and zoning laws affect people’s health? Do governmental policies lead to safe, walkable neighborhoods with well-maintained parks?

• How does the level of violence in a neighborhood affect people’s health?• Map fast food outlets, liquor stores, or grocery stores with fresh fruits and vegetables. Then

compare this to diabetes and heart disease rates. Do patterns emerge?• Look at the health of foreign-born immigrants in your area. Does life expectancy and disease

prevalence worsen for the second and third generation of immigrants? Why?• Look into initiatives by local health agencies or nonprofits that seek to reduce health disparities,

such as through “neighborhood interventions” or “health impact assessments” for new projects. • Profile someone taking a leading role in addressing health disparities.• Track the Community Transformation grants in the health reform bill. These address health

disparities, and many local groups are gearing up to apply for them.

LIST OF RESOURCES

UNDERSTANDING SOCIAL DETERMINANTS OF HEALTH

• Unnatural Causes: Is inequality making us sick? - A seven-part documentary series exploring racial and socioeconomic inequalities in health. www.unnaturalcauses.org

• World Health Organization: Social Determinants of Health program - A compilation of news, research and WHO activities related to social determinants of health www.who.int/social_determinants/en

• University of California - San Francisco Center for Health and Community - An academic center linking social and behavioral sciences, epidemiology and health policy. www.chc.ucsf.edu/index.htm

PUBLIC POLICY • National Institutes for Health National Center on Minority Health and Health Disparities

The Institutes’ program for promoting minority health and reducing health disparities. http://ncmhd.nih.gov

• Centers for Disease Control and Prevention: Designing and Building Healthy PlacesInformation and resources on designing and building healthier communities. www.cdc.gov/healthyplaces

STUDIES AND STATISTICS

• Human Impact Partners - This Oakland-based organization provides extensive list of studies related to social determinants of health.www.humanimpact.org

• The Joint Center for Political and Economic Studies - This think tank for minority issues has

launched a national initiative called “Place Matters” to eliminate health disparities. Its website offers a repository of reports, statistics and studies.http://jointcenter.org/hpi/pages/place-matters

• U.S. Census Bureau - Offers free demographic data for media coverage of social determinants of

health issues. Our primary source for getting age breakdowns by ZIP code was the 2000 U.S. Census.www.census.gov

• Nielsen Claritas - Demographic research firm offers detailed, fee-based demographic data used

by journalists and marketers.http://en-us.nielsen.com/content/nielsen/en_us.html

ADVOCACY AND PHILANTHROPY • The California Endowment: Building Healthy Communities - Philanthropic community development

initiative to improve health of 14 California communities, which began this year. www.calendow.org/healthycommunities

• Policy Link - National organization advocating for public policies to reduce health disparities and

other social inequities.www.policylink.org

• The Bay Area Regional Health Inequities Initiative - Coalition of California local health departments

working on health inequity issues.www.barhii.org

• Prevention Institute - www.preventioninstitute.org

"Shortened Lives" won the 2010 White House Correspondents' Association Edgar A. Poe award for print or broadcast coverage of national significance. President Obama congratulated award winners at the association's annual dinner in Washington, D.C.

http://www.contracostatimes.com/life-expectancy