Winter 2013
LEGISLATIVE SCOOP

Zip Codes: Where You Live, How You Live, Whether You Live

By Ajenai Clemmons, MPP, NBCSL Policy Director serves as NBSCL’s policy director. She was formerly the ombudsman for Denver’s Office of the Independent Monitor, where she helped establish a civilian agency that monitors police and sheriff internal affairs investigations. She has worked in the Iowa State Legislature as well as non-profit and private sectors. Ms. Clemmons holds a Master of Public Policy and B.A. in International Relations, Spanish, and Latin American History.
Zip Codes: Where You Live, How You Live, Whether You Live

A veteran African-American lawmaker recently joked that he checked the obituaries every Sunday to make sure he wasn’t in there. Then he reflected on a pattern he had noticed over the years looking at the ages of Whites and Blacks at the time of their passing, noting that Whites seemed to well outlive Blacks.  The scientific research now confirms this but goes a bit deeper. In recent years, a mountain of evidence across the country has pointed to this devastating truth: it is actually our zip codes that are predictive of life expectancy.

Humans are remarkably sensitive to their environment. First, they are directly affected by environmental conditions such as pollution, mold, or isolation. Second, people who juggle the multiple, constant stressors of very difficult surroundings—such as prevalent crime and insufficient earnings to cover basic necessities—often experience a host of physiological reactions that lead to weakened immune systems, damaged organs, accelerated aging, chronic disease, and ultimately premature death. The final result of these difficult environments is that they often constrain behavior and lead to a very different set of choices than an individual might otherwise make.1  Intuitively, this makes sense. People who live in industrial districts without sidewalks, for instance, tend to avoid recreational walking in ways they would not if they had access to safe and attractive walkways and parks.

In 2008, the Alameda County Public Health Department, located in California’s Bay Area, released a report of its groundbreaking study to examine the root causes of chronic illnesses plaguing its residents. In examining 400,000 death certificates over a 40-year period, the department found such a high correlation between zip code and life expectancy, that zip code could actually be used to predict life expectancy—in Alameda’s case, an 8-year gap between Blacks and Whites.2  Furthermore, filtering out violence and HIV/AIDS made virtually no difference, as those explained less than 6% of the difference.  Another startling find was that the difference, while non-existent between Blacks and Whites in the 1960s, had worsened over time and was at its greatest disparity at the time of the study.3  Similar studies have confirmed this predictive power of zip code, revealing that even within the same county, life expectancy can vary by as much as 30 years. These extreme examples in the areas of New Orleans, LA (18 years); South Delta, MS (20 years); Baltimore, MD (24 years); and Albuquerque, NM (30 years) showed life expectancies surpassed by several developing nations.4 

A widely cited 1993 article, “Actual Causes of Death in the United States,” attributes 51% of health to lifestyle, 20% to biology/genetics, 19% to environment, and 10% to medical care.5  Within the 51% of health attributed to lifestyle, only 30-40% falls under behaviors, and those choices are more constrained for people living in poverty-stricken, dilapidated, dangerous, and geographically/socially isolated environments. Yet, most of our societal messaging around being healthy assumes that simply becoming educated about better choices and then changing behavior, is the key to improving health status. 

In fact, there are, what a growing global movement of health practitioners, community advocates, researchers, and policymakers are calling, social determinants of health. These are factors that substantially impact one’s health, including economic opportunities/income, well-maintained and affordable housing, high-quality schools, nutritious food, reliable and accessible transit, safe streets and parks, culturally competent health care and health insurance, and clean water and air. The directing and coordinating authority for health within the United Nations, the World Health Organization, describes it this way:

The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries.6


In short, health is political. PLACE MATTERS is a national initiative of the Joint Center for Political and Economic Studies (Joint Center) to eliminate health disparities, working in 24 locations across 10 states and the District of Columbia to identify and address social, economic, and environmental attributes of neighborhoods, schools, workplaces, and other places that shape health.7  Such a complex and multi-factorial problem requires a comprehensive strategy that includes organizing and mobilizing, media, and policy changes.

PLACE MATTERS teams work with members of the community who are affected by their conditions to identify the most pressing concerns and devise an action plan for agreed upon priorities. For example, some sites might work to keep students in school and out of prison, provide opportunities for those who have been incarcerated, and address mental health needs.8  Other sites might work to improve access to fresh and healthy foods by enabling farmers’ markets, community gardens, and the construction of grocery stores. Yet others might focus on transit issues—ensuring public transportation connects to economic opportunities, making neighborhoods walk-able through the installation of sidewalks and pedestrian bridges, and developing safe, well-lit parks and green spaces.

The Joint Center is certainly not alone in its efforts. Other non-profits, state governments, and, indeed, entire nations are working together to eliminate health disparities by addressing social determinants. For legislators looking to join this movement, here’s the message—Legislators can only be effective by engaging with those who are most affected

An enormous contributor to poor health is disenfranchisement—the constant reinforcement that one is powerless to control his or her life outcomes. Any solution must include the exercise of power for those individuals. Power requires them to play an integral role in identifying their problems, prioritizing them, and helping to solve them as part of a team. It builds community bonds and social capital, and ultimately the political power necessary to solve a political problem: health.


  1. Goode, E. (2002, Dec. 17). “The Heavy Cost of Chronic Stress.” The New York Times. Retrieved from http://www.nytimes.com/2002/12/17/science/the-heavy-cost-of-chronic-stress.html?pagewanted=all&src=pm 
  2. Iton, T., et al. Life and Death from Unnatural Causes: Health and Social Inequity in Alameda County. (August 2008). Government Report. Retrieved from Alameda County Public Health Department website: http://www.acphd.org/media/53628/unnatcs2008.pdf 
  3. Iton, T. (2012, June 27). “Health in America: The Crucial Reform No One’s Talking About,” presentation. University of Southern California Annenberg’s California Endowment Health Journalism Fellowships Program. Retrieved from YouTube:  http://www.youtube.com/watch?v=T8v6e4SjT8Q 
  4. Place Matters web page. (2013, Nov. 24). Retrieved from Virginia Commonwealth University Center on Soceity and Health website: http://www.societyhealth.vcu.edu/Page.aspx?nav=200 
  5. McGinnis, J.M. & Foege, W.H. (1993, Nov. 10). Vol. 270(18): 2207-2212. “Actual Causes of Death in the United States. Journal of the American Medical Association. Retrieved from:  https://galileo.seas.harvard.edu/images/material/2800/1140/McGinnis_ActualCausesofDeathintheUnitedStates.pdf
  6. Social Determinants of Health web page. (2013, Nov. 23). Retrieved from World Health Organization website: http://www.who.int/topics/social_determinants/en/  
  7. PLACE MATTERS web page. (2013, Nov. 23). Retrieved from Joint Center for Political and Economic Studies website: http://www.jointcenter.org/hpi/pages/place-matters 
  8. Saxton-Ross., A. (2013, October 18). “Zip Code-Drive Death: Why PLACE MATTERS to State Legislators,” presentation. Jackson, Mississippi Quad Caucus Meeting of the National Black Caucus of State Legislators, National Caucus of Asian Pacific American State Legislators, National Caucus of Native American State Legislators, and National Hispanic Caucus of State Legislators.
Ajenai Clemmons, MPP

NBCSL Policy Director serves as NBSCL’s policy director. She was formerly the ombudsman for Denver’s Office of the Independent Monitor, where she helped establish a civilian agency that monitors police and sheriff internal affairs investigations. She has worked in the Iowa State Legislature as well as non-profit and private sectors. Ms. Clemmons holds a Master of Public Policy and B.A. in International Relations, Spanish, and Latin American History.

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