Addressing Health Disparities by Zip Code: Key Factors Explored

The theme of our recent Institute for Value-Based Medicine^® event hosted with NYU Langone Health was “Enhancing Community Cancer Programs With Academic Excellence Through Strategic Partnerships.” As part of the program, Brita Roy, MD, MPH, MHS, spoke on improving cancer health outcomes through community-clinical partnerships.

Roy is an associate professor in the Department of Population Health and the Department of Medicine at NYU Grossman School of Medicine. She also serves as the director of community health and clinical outcomes for Beyond Bridges, a population health initiative in the southwest part of Brooklyn, New York. A highlight of her talk was the influence of zip code on health outcomes and the stark disparities that can exist between neighboring zip codes. Here she discusses contributing factors of these health disparities, the hard questions to ask, and why academic medicines needs to meet people where they are at.

This transcript has been lightly edited.

Transcript

What are key factors driving disparities between neighboring zip codes?

So zip codes, or really places or neighborhoods that people live in, by and large in the United States are segregated in that we have some communities or some neighborhoods that house people with lower incomes. Unfortunately, that also ties in very closely with race. And so in neighborhoods that have lower incomes, we see a number of things. Because of our tax mechanisms, those areas have less investment in their schools, in local job opportunities, transportation—all of the things that people need to be able to make a living wage. And so a lot of the key factors really have to do with income and economic disparity, in addition to the time with education that also ties in closely with access to health care.

So whether that is having or not having access to health insurance, as well as literally places to receive health care. This is even more pronounced in rural areas that have really critical shortages of access to physicians and tertiary care centers and other really high-quality medical care.

Maybe another thing, thinking about the places that people live and how it affects health outcomes is health behaviors. There's a number of different types of behaviors we can think about that link to health outcomes. Certainly there are things like tobacco use, levels of physical activity, and the foods that we eat. All of those are linked to cancer outcomes, as well as cardiovascular disease outcomes or other things related, like diabetes.

Other things, though, like cancer screening and medication adherence. If you're on a medication, are you able to actually get it? Do you take it every day? That also has place-based factors associated with it as well, both in regard to, again, access to health care itself. Do you have access to a place to get your mammogram? Do you have access to a pharmacy to be able to get your medications? But also, who's around you? Who's in your social network? And do those people get cancer screening or not? Do those people engage in physical activity or not? That also has an impact on individuals' engagement in those behaviors, and then therefore subsequent health outcomes.

So partnerships with community, community members, community-based organizations that can then help us link people into health care, make it more accessible, also shape health behaviors—again, from a place that's more comfortable for people and it's a place that people go. So really meeting people where they're at to get them engaged, but also socializing different healthier behaviors and making that more of a cultural norm is a way that we can work together to shift some of those behaviors.