Viewpoints

Daniel Weintraub: Our good health shouldn’t depend on income

Lucia Jimenez has her prescription filled by pharmacist at AltaMed clinic in March in east Los Angeles. California’s overall health ranking is lowered by disparities based on income.
Lucia Jimenez has her prescription filled by pharmacist at AltaMed clinic in March in east Los Angeles. California’s overall health ranking is lowered by disparities based on income. Los Angeles Times/TNS

Californians eat more fruits and vegetables than other Americans, refrain from smoking, keep their blood pressure under control and do a decent amount of physical activity. But our health, overall, is still worse than the residents of 21 other states, according to a recent report.

Why?

A big reason might be a category in which California ranks at the bottom of all 50 states – health disparities, according to an annual report published by the United Health Foundation.

Health disparities are a measure of the differences among different demographic groups. In this case, the ranking reflects the gap between the health of those who have graduated from high school and residents without a high school diploma.

California’s gap – 38 percentage points between the number of high school graduates and non-graduates who report being in good or excellent health – is a stain on what in many ways is a positive story, for California and the country.

The nation is getting better at preventing unnecessary hospitalizations, increasing immunizations, reducing cigarette smoking, preventing heart disease and lowering infant death rates. In some cases the numbers are striking.

Preventable hospitalizations, a major focus of the federal Affordable Care Act, have declined by 11 percent in the past two years. Deaths from heart disease have fallen by 23 percent in the past decade. And since 1990, infant mortality has dropped by 41 percent.

California ranks third in the nation in “health behaviors” – which measures such things as diet, smoking, drinking, physical activity and preventive care visits to doctors and dentists. Not surprisingly, perhaps, we eat more servings of fruits and vegetables than residents of any other state.

But overall our health outcomes rank only 22nd in the nation. We are no better than the middle of the pack in cardiovascular deaths and diabetes, among other problems.

And that no doubt reflects the disparities the report highlighted. Education levels are correlated with incomes, and California has about the most unequal income distribution in the country. Income, in turn, is linked to health.

We have plenty of wealthy and affluent people, and for the most part, their health is great. But we also have more poor people than any other state, and their health is generally a lot worse.

California ranks near the bottom in unemployment, under-employment and income inequality, and among the bottom third of the states in our rate of child poverty. We also have the worst air pollution in the country, based on the level of tiny toxic particles in the air we breathe. And air pollution, of course, is worse in places away from the coast – in other words, where most poor people live.

The takeaway from all of this is that efforts to spread the word about healthy living are bearing fruit, literally. On average, Californians are eating better and taking better care of their bodies than people in other states.

But those behaviors and the benefits they bring are not universal. We need to do more to ensure that everyone knows that their lives depend on healthy behaviors. And we need to make it easier for everyone – not just the wealthy – to make the choices that will keep them healthy.

Good health should not be a luxury.

Daniel Weintraub is editor of The California Health Report. He can be contacted at daniel.weintraub@gmail.com.

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