“Your zip code is a stronger predictor of your health than your genetic code,” said David R. Williams, a professor of public health at the Harvard School of Public Health and professor of African and African-American studies and of sociology at Harvard University.
Williams visited St. Louis on MLK Day to deliver the annual MLK lecture for the Office of Diversity Programs at Washington University School of Medicine, organized by Will Ross, M.D., associate dean for diversity at the medical school.
“Socioeconomic status is one of the most powerful predictors of variations of health from one society to another,” Williams said, citing an index of variations of health by the Robert Wood Johnson Foundation. “It is more powerful than genetics, exposure to carcinogens or even cigarette smoking.”
Yet Williams said health outcomes in this country are seldom reported by socioeconomic status.
“Socioeconomic status literally patterns exposures to the opportunities to be healthy from the cradle to the grave,” Williams said.
“It determines the quality of employment opportunities and the quality of jobs and how hazardous those jobs are. It determines the neighborhood in which you live and the quality of housing. It determines your ability to provide for your family and determines the quality of life.”
Race plays a factor, because African Americans and Hispanics with higher educational attainment on average have lower incomes, purchasing power and live in areas where goods cost more and services are of poorer quality than whites. All of this affects health outcomes, he said.
Williams noted that U.S.-born Hispanics have the same overall health profile as African Americans. When new immigrants arrive in the U.S., they have a healthier state and unfortunately get “Americanized” with this country’s poorer health habits and outcomes.
“What we find in national health data is that immigrants of all racial ethnic groups have better health than their native-born counterparts,” Williams said. “The bad news is, with increasing length of stay and generational status, the health of immigrants declines. There is something about the American way of life that is dangerous to your health.”
Williams is a national health policy developer and has served on the U.S. Department of Health and Human Services National Committee on Vital and Health Statistics and seven Institutes of Medicine committees. He serves on the Centers for Disease Control and Preventions Health Disparities Committee and was a key collaborator on the award-winning PBS series Unnatural Causes: Is Inequality Making Us Sick?
National data show that education helps, though a staggering racial disparity exists on many health outcomes even factoring in higher education.
“For African Americans, as mothers’ education increases from less than 12 years of education to a college degree or more, infant mortality declines,” Williams said.
“But this group of black women still have an infant mortality rate that is almost three times higher than women of other racial groups. And strikingly, African-American women with a college degree or more education have a higher rate of infant mortality than white, Latino and Asian women who have not graduated from high school.”
We can reduce health disparities, Williams said, by providing high quality care to all patients. That means treating people equally as individuals. He said addressing unconscious discrimination caused by negative stereotypes will help health care professionals improve patient care.
“Let me remind you this is not just about race,” Williams said. “If you hold negative stereotypes about gay people, about fat people, about old people – as long as you hold negative stereotypes, you will treat that person differently.”
Williams said we can build a healthier America, but it will take much more than health reform.
“Health care system reform is critical but insufficient to improve America’s health. Social factors – education, housing, transportation, environment – have decisive impacts,” Williams said.
“Health professionals need to work with other sectors to bring resources together for a concerted focus to modify the way and how we live, learn, work and play.”
