The minute you sit down in the exam room, your doctor jumps into a checklist of questions, all designed to help draw a picture of your health.
But Dr. Garth Graham, M.D., cardiologist, president of the Aetna Foundation and former deputy assistant secretary in the U.S. Department of Health and Human Services, says that despite gathering your family history and medical records, it’s impossible to get a complete understanding of your overall health while you’re sitting in his office.
“One thing that a lot of people don’t know is that your doctor can only see part of the picture during a routine visit. It’s the things that individuals experience in their everyday lives outside of the doctor’s office that really tell their full story and influence their health,” he says. “Things like genetics and family history are important, but often, the factors like where you live, your access to healthy food options and community safety, known as social determinants of health, make the biggest impact. They can vary drastically from state to state, city to city and even community to community.”
Things like access to healthy food options and the ability to safely walk and play outside can greatly impact not only an individual’s overall health, but also their life expectancy.
And studies support this link between where we live and how healthy we are. A study published in the Journal of Public Health suggests that children who live near fast food outlets are more likely to gain weight than those who live farther away. And researchers at the Harvard School of Public Health found that women who lived in or near green spaces had a longer lifespan.
“Social determinants of health are the things that individuals experience in their everyday lives that can’t be seen in the doctor’s office,” says Dr. Graham. “It’s things like their access to healthy food options, education and transportation, the ability to safely walk and play outside. These factors can greatly impact not only an individual’s overall health, but also their life expectancy.”
And you may be surprised how widely these factors can vary between communities and even between neighborhoods in the same city. A study published in the Journal of the American Medical Association found a 20-year difference in life expectancy between counties in the U.S. A majority of those differences, Graham says, were due to social determinants of health.
Because of social determinants of health, your zip code can have a bigger impact on your health than your genetic code.
“We know that because of social determinants of health, your zip code can have a bigger impact on your health than your genetic code,” he says. “This particular study shows a difference in life expectancy between two communities in Boston: Roxbury and Back Bay. Residents in Roxbury face different challenges to their health than individuals who live in Back Bay. Community members in Roxbury don’t have access to grocery stores with healthy food options and rely on public transportation to get around. In Back Bay, residents can walk to their local grocery store for healthy foods on wide sidewalks, feel safe playing and exercising outside and have better access to education and employment opportunities.”
How healthy is your neighborhood?
You may be wondering how your neighborhood stacks up. While some issues might jump out at you — like your access to public transit or how far you must travel to get to a grocery store — other factors may be less obvious. As people evaluate their communities, Graham encourages them to ask themselves these questions:
- How often do I spend time outside? Do I feel safe walking around my neighborhood alone?
- Where do I go grocery shopping in my area? Is it easy for me to get to a store with an abundance of fresh produce?
- Is public transportation affordable and accessible in my community? How do my neighbors get around throughout the day?
- What is the air quality like in my community? Is my neighborhood smoke-free, or do I live in an area with frequent smokers? Is there air pollution from cars in my community?
If your neighborhood is playing a bigger role in your health than you thought, here are some ways to begin to reverse that trend, and make your zip code a healthier place to live.
Access to healthy, whole foods is one of the biggest obstacles that our neighborhoods can pose to our health.
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“In urban communities often located in the heart of cities, fast food chains and small convenience stores dominate with unhealthy food options,” says Graham. “Many rural communities are far away from a grocery store with fresh, healthy food. Known as food deserts, these area lack access to affordable fruits, vegetables and other foods that make up a healthy diet.”
If you’re living in an urban area with tons of food options, there’s a chance that the most accessible aren’t the healthiest. Think about the closest options to your home: How many fast-food restaurants or convenience stores do you pass on your way to the grocery store?
“In these large urban communities, grocery stores that offer healthier food options can be inconveniently located or far away from neighborhoods that lack transportation options or means to get to the grocery store,” says Graham. “Oftentimes, the fast food restaurants or convenience stores are more easily accessible and offer affordable meals that are closer to these neighborhoods, which makes it difficult to make healthy choices.”
Even if you do have easy access to a grocery store with healthy offerings, it’s all too easy to be tempted by the drive-thru window on busy weeknights when you haven’t prepared ahead of time. So we can all benefit from heeding Graham’s advice:
- Find your local farmer’s market. “If healthy food options are not readily accessible in your community, take advantage of your community farmer’s market, where locally sourced, fresh produce is available,” suggests Graham. “With spring just around the corner, this could be an easy way to get your produce for the week.” Many farmer's markets also accept SNAP/EBT, WIC and FMNP coupons. You can visit the website of your local market for instructions on how to use them.
- Prepare your meals ahead of time. “If you can only get to a grocery store on occasion, try meal prepping to ensure you have healthy meals ready to go throughout the week,” says Graham. “Head to the grocery store with your week’s meals planned in order to prepare them ahead for the busy workdays that would normally have you headed to the nearby fast food restaurant.” While the upfront cost may seem higher, preparing your own food at home ends up being cheaper per meal than relying on takeout and fast-food.
We all know that when it comes to fitting exercise into our schedule, the struggle is real. And when communities lack accessible parks and walkways it becomes even harder.
Not being able to head outdoors to be active can be a hindrance to your mental and physical health. The research conducted at the Harvard School of Public Health found that the women who lived in greener spaces were more physically active. And being active outdoors comes with an additional set of benefits: A 2010 study published in Environmental Health and Preventive Medicine found that participants who walked in a forest had lower blood pressure and levels of cortisol (a.k.a. the stress hormone) afterwards than those who strolled through a city environment.
We’d all love to have a lush park outside our front door, but that isn’t always the reality. If your neighborhood doesn’t have a green space, or lacks safe sidewalks or walking paths, it may be harder (or less appealing) to stay active — but it’s not impossible.
- Get creative with your exercise. “The American Heart Association recommends that adults participate in moderate physical activity for at least 30 minutes, five days a week,” he says. “You don’t have to leave your house to get some cardio in — download an at-home workout video you can complete in your living room while the kids take a nap or while dinner is in the oven.” There are also tons of apps that bring trainers right into your home, leading you through everything from a strength training routine to a yoga session.
- Stay safe and accountable. “If you feel don’t feel comfortable walking or running outside alone, join a local workout group or invite some friends to tag along,” suggests Graham. “Not only will this help you feel safer while exercising, but it will also hold you accountable to completing a daily workout.” Working out in a group may even be a better option than going solo: A 2016 study published in the journal Obesity found that overweight people tend to lose more weight if they spend time with their fit friends — the more time they spend together, the more weight they lose. So rallying the troops to catch up over a weekend walk may prove beneficial for your mental health and your waistline.
In addition to your access to food and outdoor space for exercise, there are a few other environmental factors that can have a big impact on your health:
- Access to transportation and ways to commute around the city. “Some cities, like New York and D.C., have affordable public transportation options that can help residents get to and from work, the store or other activities,” says Graham. “There is a plethora of buses, you can take the subway, there are bike and ride share options. But even in these cities, there are neighborhoods where it is not easy to access these options – making it harder to live healthfully and make healthy choices.”
- Sleep. Does that police station across the street have sirens disrupting your shut eye? “The amount of sleep you get can play a big role in your heart health,” says Graham. “Ongoing sleep deficiency is linked to an increased risk of problems like heart disease, high blood pressure and stroke.”
Take Action and Get Involved
You may be thinking, “I can relate to these issues, but what can I do? Moving isn’t an option.” But now that you know how your neighborhood is affecting your health, you can take actions to start improving your environment. We all have the power to make our neighborhoods healthier, says Graham: “In order to make a difference or an improvement in your local neighborhood, it is important to get involved and be heard.”
- Join or build an online community. “Community message boards, listservs and social media groups are a great way to find or create community activities for good health and learn more about organizations in your community that are working to better local health,” says Graham. “Find others in your neighborhood to start a walking group, look for ways to set up play dates where both the parents and children can be active.”
- Make your voice heard. “Join local community organizations or attend a townhall meeting to learn about new or ongoing projects, voice your opinion on what needs to be changed and to identify which elected leaders could help you address these concerns,” says Graham.
It may seem daunting, but it is possible for one person to enact real change in their community.
“We have seen communities taking charge through our Healthiest Cities & Counties Challenge to improve health for their neighbors by identifying their unique health problems and creating partnerships and programs to address these challenges,” says Graham.
He sites one community, in Mecklenburg County, North Carolina, as an example. “The Village HeartBEAT (VHB) program works to reduce heart disease and obesity, offering services screenings and exercise regimens to local community members,” he says. “The organization identified churches as a place to address and best serve residents. One community member there, AJ, weighed more than 400 pounds before getting involved with VHB. Through one of their free vitals screenings, he discovered just how high his blood pressure is and, with physician approval, began exercising regularly. Using resources and support offered by VHB, AJ has since lost 180 pounds. That’s just one example of a personal story coming from a community program like this, but it’s inspiring to see what can happen when people get more involved.”
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