Main Library
When I was 14 years old, my parents moved our family home within Miami Dade County. We shifted from zip code 33157 to 33183, and as I’ve recently learned, this increased our life expectancy from ~79 years to ~86 years. My parents didn’t have a college education or any access to this type of data, but instinctively they moved toward what we all want and should have — safer neighborhoods, good schools, grocery stores with fresh foods, and job opportunities.
Zip code determines up to 60% of health, and life expectancy can vary up to 30 years within a 10-mile span. Yet over 50 million Americans live in economically distressed zip codes, and we’re a far cry from all Americans having “the fair and just opportunity for every person to attain their highest level of health,” per the CDC.
We’ve made little progress on health equity because we haven’t been able to frame the issue around business cases that employers and payers can fully embrace. Capitation and advanced payment frameworks, particularly in Medicare, have enabled care models where community healthcare providers take care of transportation, food, air conditioners, pest control, and other socioeconomic needs that stand in the way of health. However, 80% of the aggregated US healthcare spend is still essentially fee-for-service, and health equity can’t wait for value-based payments to become the norm. This means that employers and payers, who still directly own the substantial financial risk, need to pave the way through population health initiatives in the fee-for-service population.