The C2S blog draws on the arts, the social and biological sciences to explore the many meanings of health and "dis-ease." Designed to be a locus where patients, their families and professionals can meet on a level playing field, it is the natural off-shoot of the Cell 2 Soul Online Journal. We encourage the submission of ideas, essays, poems, stories, humor, and timely reviews relating to the humanities and health care.
“Delmar Boulevard in St. Louis, Missouri marks a sharp divide between the poor, predominately African American neighborhood to the north and a more affluent, largely white neighborhood to the south. Education and health also follow the “Delmar Divide,” with residents to the north less likely to have a bachelor’s degree and more likely to have heart disease or cancer.” See: Zip Code Predicts Health.
At a recent health care conference in Hawaii, Dr. Dileep Bal, told a packed auditorium of affluent dermatologists that one’s zip-code is a better predictor of health than any of the questions we routinely pose to patients. This got me thinking about how I have missed what should have been in my face in the five decades since I entered medical school. Zip Codes trump most (maybe all) other determinants of health.
There is not as much literature about this subject as one would anticipate given its importance. Here is a pertinent article: “Poverty, wealth, and health care utilization: a geographic assessment” from The Journal of Urban Health. PubMed Abstract, See Free Full Text Online PMC article.
The paper “demonstrates the strong association between low ZIP code income and both higher percentages of disability and greater hospital utilization. And they suggest that, given the large contribution of the poorest neighborhoods to aggregate utilization, it will be difficult to curb the growth of health care spending without addressing the underlying social determinants of health.”
This Zip Code information runs parallel to the effects Adverse Childhood Experiences (ACEs) have on a child’s subsequent physical and mental health and ultimately longevity. They are both significant determinants of one’s health, well-being and success in life.
Note: In researching this topic I came across this quote: Our public health practices ignore this fundamental truth. In America, when it comes to your health, your zip code is more important than your genetic code. Anthony Iton, M.D. J.D., M.P.H. (Commencement address UC Berkeley 2014)
Andy Tanji from Honolulu alerted us to this: The most competent individuals tend to underestimate their relative ability, but most people increasingly overestimate their ability, and everyone thinks they are above average. As you can see from the graph, self-estimates decrease with decreasing knowledge, but the gap between performance and self-assessment increases as you decrease in performance.
It is no secret that primary care physicians and specialists in large numbers deny care to Medicaid patients. They claim that they cannot afford to see this group. Insurers, patients, and the medical societies tolerate this situation.
It’s just as bad in the Big Apple as it is in the aina of Hawaii. A recent article in the NY Times put the situation in perspective for me. “The taxi lurched away from the curb in Midtown Manhattan, leaving behind a black family of three who had flagged it down. The driver told them he was off duty and then picked up two white women 25 feet away and drove away.
“The judge ruled that the driver refused to transport the family on the basis of their race and color violating a section of city human rights law that protects equal access to public accommodations and fined the cabbie $25,000.”
This ruling made a splash in the NY Times on August 8, 2015. At the same time, most private dermatologists in New York City do not see Medicaid patients. How is this not discrimination too? Yet, the complicated Medicaid credentialing regulations allow physicians to abandon poor patients with inferior insurance coverage and consign them to emergency rooms, Medicaid mills and public clinics.
It’s strange that a family being denied transport in a taxicab can outrage us, but we turn a blind eye to a large segment of our society that is refused competent caring health care. It is also ironic that a cabdriver can be fined for this act of discrimination; while sanctimonious physicians get a pass.
"Oh, my gosh, welcome! So great to meet you! I’m Margot. This is my boyfriend, Claudio. Claudio doesn’t talk much. He mostly speaks with his body. We’re superexcited to have you here for the weekend."
Anyone who has stayed at an Airbnb will appreciate this spoof that appeared in the Sunday, August 2nd, 2015 NY Times.You will nod your head sagely and smile wryly when you read it. Read: Welcome to Airbnb!
ON BEAUTY (2014), from award-winning filmmaker Joanna Rudnick, is a documentary looks at beauty through the lens of fashion photographer Rick Guidotti. It highlights vibrant individuals with genetic conditions. Guidotti's photographs are a stark contrast to the sad, isolated figures seen in medical textbooks and they inspire many to change their perceptions of what it means to be beautiful.
“Are you not giving me any medicine?” her patient asked?
Ms. Shahab was silent for a moment, and then said with a sympathetic gaze, “Medicine for you will not cure your abusive husband.”
"The therapist was born in the isolated Afghan village she still lives in, in 1987 or 1988 — she is not sure. Her father was shot and killed at his mosque shortly before she was born. The reasons for the killing remain unclear, but it shattered their family and forever changed life for Ms. Shahab and her two siblings.
Ms. Shahab and Client (NY Times)
"A marriage was arranged to a man almost 20 years her senior when she was only 13. But the marriage did not stop her from completing her education. She took two of her youngest children with her to school, placing them at the kindergarten as she attended classes."
She is now a therapist in the village, caring for women battered by family and war.