Why zip codes matter more than genetics

Environmental and socioeconomic conditions may have a greater impact on a patient's health than their genetic disposition, according to research presented at the American Medical Associations recent consortium on health equity.

Anthony Iton, MD, JD, is the senior vice president of healthy communities at the Los Angeles-based California Endowment, a foundation dedicated to raising awareness about health and health equity. Dr. Iton said his interest in the paradox stemmed from one of his first visits to Johns Hopkins School of Medicine, where he earned his doctorate degree.

"East Baltimore looked to me like Beirut, with bombed out buildings and cars up on their axels and little mangy dogs running around and babies playing in and amongst all of this," said Dr. Iton. "We end up seeing devastating disease in clinics because of the social policies that leave people essentially bereft of the resources that they need to be able to manage and navigate a healthy life."

After becoming the health director for Alameda County in California, Dr. Iton examined the county's database of death certificates to look for patterns. He found that less-affluent individuals face significantly more stress than wealthier individuals. Stress, he found, may lead to cardiovascular disease, glucose intolerances, insulin resistance and a variety of other health issues.

"The things that we make difficult for people in life — getting health insurance, getting access to primary care — these are stressors that are unnecessary that actually change our physiology," said Dr. Iton. "When you walk into a low income community, cortisol levels are high. People are constantly being threatened. Most of these threats are policy-mediated threats. They're not somebody with a gun or a hammer, although that happens. It's often the inability to meet your basic needs with the resources you have at your disposal."

His frustration with the current care delivery model and its inability to address systemic healthcare disparities is what led Dr. Iton and his colleagues to start the Oakland, Calif.-based Bay Area Regional Health Inequities initiative.

"We know if you don't have access to healthy food it's much less likely that you're going to eat healthy food. We know that if you don't have access to parks and recreation it's much less likely that you're going to exercise and do the things that we tell people to do all the time," said Dr. Iton. "The solutions are about enlisting the very people who are experiencing those inequities, building their social, political and economic power, so that they can participate in reshaping these policies."

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