October 27, 2016
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Half of Avertable Deaths Due To Poverty, Poor Community Conditions, Research Shows


Poor education, poor infrastructure and other conditions often found in low-income communities likely contribute to one quarter to one half of all deaths, according to a study in the Feb. 18 online issue of the American Journal of Public Health.
The research, “Avertable Deaths Associated with Household Income in Virginia,” by Steven H. Woolf, M.D., M.P.H., director of the Virginia Commonwealth University Center on Human Needs; Robert Phillips, M.D., M.S.P.H., director of the Robert Graham Center for Policy Studies in Primary Care and Family Medicine, and their coauthors, confirmed what many consider to be common sense: income affects health status and longevity. But, the researchers say, “its magnitude may not be fully appreciated, and our work has sought to put it in perspective.” This study does so by helping pinpoint the toll — in terms of avoidable deaths — that poverty exacts on a community.
“Economic and social policy is health policy,” said Woolf, who is lead author. “People tend to think of jobs, wages, and so on, as separate issues from health reform, but our study shows the powerful interconnections.”
Woolf and his colleagues wanted to know how many deaths would be averted in Virginia if every county and city experienced the mortality rates of the state’s most affluent areas. 
To get an answer, the authors combined census data and vital statistics for the years 1990 through 2006, the most recent year for which data were available. They applied the mortality rates of the five most affluent counties and cities — called the reference population — to the rest of the state.
Their results showed that more than 24 percent of deaths in Virginia would not have occurred if the entire state had the same mortality rates as the affluent regions.
“An annual mean of 12,954 deaths would have been averted, totaling 220,211 deaths between 1990 and 2006,” the researchers write. “In depressed areas of the state, nearly half of deaths would have been averted.”
Approximately 75 percent of the averted deaths involve non-Hispanic whites or adults with no more than a high school education. Adults with college degrees accounted for only 9.7% of the averted deaths.
Moreover, community conditions likely influence the results, they said.
“Northern Virginia may have low mortality rates not only because of its residents’ affluence or education, but also because of the area’s healthcare infrastructure, built environment, supermarket access, social services, school systems, pollution control, and progressive policies (e.g., smoke-free buildings),” they write. 
Woolf and his colleagues plan to continue analyzing the community and demographic factors that, if corrected, would have the most impact on improving health status and avoiding unnecessary deaths.
“For many communities, however, the deepening recession and financial crisis have removed the question of whether economic development is a priority or whether individuals or communities need assistance,” they write. “Families, businesses, and surrounding neighborhoods are all likely to benefit—and sustain each other—when policies promote jobs, education, savings, commerce, and a stronger infrastructure.”
The Robert Graham Center for Policy Studies in Primary Care and Family Medicine conducts research and analysis that brings a family practice perspective to health policy deliberations in Washington. Founded in 1999, the center is an independent research unit working under the personnel and financial policies of the American Academy of Family Physicians.
The information and opinions contained in research from the Graham Center do not necessarily reflect the views or policy of the AAFP. 
Leslie Champlin
American Academy of Family Physicians
(800) 274-2237, Ext. 5224

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