The Social Impact of Zip Codes on Human Health

Human health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Modern approaches, along with geographic factors, suggest considering genetics, environmental conditions, social circumstances, and individual behavior to conduct a more targeted and effective policy for providing health care (Graham 2016). According to Holmes et al. (2018), the geographical particularities of an area depending on a zip code have multiple influences on human health status due to a combination of such factors as air pollution, access to healthy food, access to healthcare, and others. Attempts to divide determinants into macro and micro levels have revealed more specific social problems: educational level, incidents of racism and discrimination, and food security (Ritchie 2013; Zope et al. 2019). The following are social determinants in which geographic areas may affect human health – education, healthcare infrastructure, physical health, mental health, race, and age.

The literature review presented below emphasizes the influence of each of the listed variables separately. This paper tests two hypotheses aimed at foreseeing the effect of particular determinants related to zip codes on health outcomes. Firstly, it is hypothesized that individuals living in zip codes with more highly educated populations will have better health outcomes than individuals living in zip codes with less educated populations. Secondly, individuals living in rural areas will have higher rates of mental unwellness due to having less access to mental health facilities than people living in urban areas. The conceptual descriptions of the chosen variables are presented below.

Different zip code areas will be evaluated for the educational level obtained by the population living in those areas. The individuals representing the compared areas will be surveyed to evaluate their health outcomes as informed by educational level. The indicators of educational opportunities are influenced by the ratio of the number of higher educational institutions and annually graduating specialists to the territory and population density. The relationship between education and health has been vividly addressed in research, where scholars claimed that “adults with higher educational attainment live healthier and longer lives compared with their less educated peers” (Zajacova and Lawrence 2018 273). Thus, the educational level will be approached from the perspective of the population’s degrees and qualifications as the factors for opportunities and inequalities in healthcare.

Access to mental healthcare facilities is an important factor of human well-being since it provides the basis for long-term health quality and timely administration of treatment and preventative measures. This parameter might be measured through the number of mental health facilities in the given areas and the quantity and content of programs they have (El-Amin et al. 2018). Finally, health indicators, ideally, can be taken with the consent of the test takers from their medical records and medical histories, otherwise – using questionnaires containing both general questions and more detailed clarifications of their state.

The organization of society is fundamental in this study since, most often, these are traditions and values ​​that drive people and are almost indestructible. While urbanization and a large number of postal codes contribute to a higher self-interest among residents, at the same time, the opposite effect of alcohol consumption and smoking is increasing (Airaksinen et al. 2016). The connection between proneness to substance use and rural area residency might be found in the interaction with such stressors as crowded spaces, commuting, or long working hours. It is most likely due to the great opportunities in big cities, which provide all the necessary variety of services to maintain health and at the same time a wide range of products for bad habits. Usually, the big city possibilities open up more education methods, but people are not always inclined to choose such ways.

In the field of health at the moment, there are many problems multiplied during the pandemic. However, more developed infrastructure in specific regions correlates with the population’s health: for example, people are more likely to develop sepsis in regions where medical services are limited (Goodwin et al. 2016). As a result, life expectancy is declining in regions with poor access to health services, down to the level of third-world countries (Graham, Ostrowski, and Sabina 2015). Indeed, areas with insufficient access to healthcare, under-developed medical spheres, and poor environmental conditions, such as air pollution or poor water quality) are harmful to people’s health and reduce their longevity. Socio-economic factors such as income inequality, unemployment, and poverty are the most recurring social determinants of health. Financial instability is a significant barrier in accessing better healthcare, having an education, living in a society that allows being well (Seavey, 2008). Scientists are proposing a health education solution that is more affordable than it seems, thanks to smartphone technology. This idea opens up equal opportunities for health education for all, contributing to eliminating discrimination and structural racism.

The ZIP code in this study appears as a set of social and economic factors, united by a territorial basis: for example, including the accessibility of the mental health facilities, educational institutions, and the stability of housing (Obuobi, Belardo, and Gulati 2021). Mental health is an important indicator of human well-being, which is why the development of the infrastructure for mental health services is vital. Indeed, it has been found that “adults residing in rural geographic locations receive mental health treatment less frequently and often with providers with less specialized training when compared to those residing in metropolitan locations” (Morales et al. 2020 464). The level of development, number of facilities, qualification of the specialists working in them, and the quality of programs available differ from zip code to zip code, with significant disparities noticed between rural and urban areas.

After conducting assessments in specific zip-codes for mental healthcare facilities accessibility and educational opportunities, the target audience is selected for the survey for taking final measurements. With the consent of the tested, it is possible to get acquainted with the history of their diseases to have reliable data on health indicators. As a result, the dependent variables are physical health indicators and access to mental healthcare facilities, while the independent variables are the rural and urban zip codes and education in the region. Social variables of age and race were introduced to search for additional correlations, although they are generally statistical and reference in nature.

In conclusion, the zip codes may influence the health systems and wellness of individuals within that locality. Naturally, these studies alone will not prevent sources of problems. Only in the unification of the state, the relevant systems, and above all, the population itself can the necessary results be achieved (Slade-Sawyer 2014). Social determinants can be used as indicators of possible problems, as a starting point and a roadmap for the zip-codes of the country. However, the necessary actions will require a more comprehensive and detailed approach, born from a discussion process among all stakeholders.

References

Airaksinen, Jaakko, Christian Hakulinen, Laura Pulkki-Råback, Terho Lehtimäki, Olli T. Raitakari, Liisa Keltikangas-Järvinen, and Markus Jokela. 2016. “Neighborhood Effects in Health Behaviors: A Test of Social Causation with Repeat-Measurement Longitudinal Data.” The European Journal of Public Health 26 (3): 417-421.

El-Amin, Tramaine, Britta L. Anderson, Jonathon P. Leider, Jennifer Satorius, and Alana Knudson. 2018. “Enhancing mental Health Literacy in Rural America: Growth of Mental Health First Aid Program in Rural Communities in the United States from 2008–2016.” Journal of Rural Mental Health 42 (1): 20-31.

Goodwin, Andrew J., Nandita R. Nadig, James T. McElligott, Kit N. Simpson, and Dee W. Ford. 2016. “Where You Live Matters: The Impact of Place of Residence on Severe Sepsis Incidence and Mortality.” Chest 150 (4): 829-836.

Graham, Garth N. 2016. “Why Your ZIP Code Matters More Than Your Genetic Code: Promoting Healthy Outcomes from Mother to Child.” Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine 11: 396–397.

Graham, Garth N., MaryLynn Ostrowski, and Alyse Sabina. 2015. “Defeating the ZIP Code Health Paradigm: Data, Technology, and Collaboration Are Key.” Health Affairs. Web.

Holmes, Joshua R., Joshua L. Tootoo, Julia Chosy, Amber Y. Bowie, and Ranjani R. Starr. 2018. “Examining Variation in Life Expectancy Estimates by ZIP Code Tabulation Area (ZCTA) in Hawaii’s Four Main Counties, 2008–2012.” Preventing Chronic Disease 15: 1-3. doi:10.5888/pcd15.180035.

Morales, Dawn A., Crystal L. Barksdale, and Andrea C. Beckel-Mitchener. 2020. “A call to Action to Address Rural Mental Health Disparities.” Journal of Clinical and Translational Science 4 (5): 463-467. doi: 10.1017/cts.2020.42

Obuobi, Shirlene, Danielle Belardo, and Martha Gulati. 2021. “The Precision of Cardiovascular Disease Prevention Begins with a ZIP Code.” Journal of the American College of Cardiology 3 (6): 982–984.

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Ritchie, Dannie. 2013. “Our ZIP Code May Be More Important Than Our Genetic Code: Social Determinants of Health, Law and Policy.” Rhode Island Medical Journal 96 (7): 14.

Ross, Allison, and Mark Searle. 2019. A conceptual model of leisure time physical activity, neighborhood environment, and sense of community. Environment and Behavior, 51, no. 6: 749-781.

Seavey, John W. 2008. “How’s Your Health? What’s Your ZIP Code? Poverty and Health.” The University Dialogue 42. Web.

Slade-Sawyer, Penelope. 2014. “Is Health Determined by Genetic Code or ZIP Code? Measuring the Health of Groups and Improving Population Health.” North Carolina Medical Journal, 75 (6): 394-397.

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