Using Small Area Life Expectancy Maps to Start a Conversation about Health Equity

BACKGROUND:  There is growing recognition of the deep influence of place on wellbeing in all its forms — economic growth, social capital, and physical and emotional health. Small area life expectancy (LE) maps can be effective tools to raise awareness of the importance of place-based factors and start conversations about social determinants of health equity. To illustrate this, methods used to create a LE map for Richmond, VA will be briefly described followed by a discussion of the current and historical context and a summary of efforts underway to address these inequities.

METHODS:  The most recently available years of geocoded death data (2002 to 2011) were aggregated into 19 five-year age groups by decedent’s residential census tract. The average number of deaths and a weighted average of 2000/2010 population were entered into abridged life tables using the Chiang methodology. Death and population counts for age groups with zero deaths were replaced with the corresponding death and population counts for Richmond City. Census tracts with ten or more missing age categories, greater than 40% population change and a population count of less than 5,000 in either 2000 or 2010, or greater than 40% population in group living quarters were excluded from the analysis. Tract-level sociodemographic data from the American Community Survey were downloaded from the U.S. Census Bureau’s website.

RESULTS:  Life expectancy at birth ranged from 63 to 83 years across census tracts in Richmond. The highest and lowest LE were found only 5 miles apart. An examination of census-based community characteristics clearly demonstrated the association of concentrated and racially-segregated poverty with LE. Compared to the neighborhood with the highest LE, the tract with the lowest LE had significantly lower median household income ($10,263 vs $77,583) and higher rates of poverty (73% vs 1%), African-American population (89% vs 10%), female-headed households (55% vs 6%) and unemployment (19% vs 2%). When the current LE map was overlaid with “redlining” maps of Richmond circa 1937, it was evident that LE patterns are rooted in macrostructural policies established over 75 years ago. The Richmond Mayor’s Office of Community Wealth Building is making strides to overcome these inequities thorough housing, transportation, economic development, and education.

CONCLUSIONS:  Unpacking the underlying causes of LE gaps through disaggregation of health outcomes and studying their relationship to the social, economic, and environmental conditions that influence health can help clarify actionable solutions to pursue at the national, state, or local level.