Commentary: Phila. must close its rich-poor life expectancy gap

By Thomas Farley

The Robert Wood Johnson Foundation recently released a map showing shocking differences in health between the rich and the poor in Philadelphia.

The map shows that life expectancy at birth in Strawberry Mansion is only 68 years, 20 years shorter than just a few miles away in Society Hill. This 20-year gap isn't right, and it isn't something that we should accept.

What's behind these numbers? The biggest killers in Philadelphia are chronic illnesses like heart disease, cancer, and diabetes. Underlying these diseases are a few unhealthy habits, particularly smoking, poor nutrition, and physical inactivity. Alcohol and drugs are responsible for many early deaths, and shootings cut short the lives of far too many black men. And behind these risks are what have been called "the causes of the causes" - poverty, unemployment, and lack of education. If we want a child born in our poorest neighborhood to have a fair shot at a long, healthy life, we have to act on all these problems.

Philadelphia's smoking rate of 22 percent is the highest of any major city. The Philadelphia Department of Public Health has worked hard to help smokers quit, which has lowered the smoking rate from 27 percent in the past seven years. But we still need to contain the flood of marketing that the tobacco industry aims toward low-income neighborhoods and communities of color. When children live and walk to school surrounded by cigarette ads, they see smoking as a normal part of growing up rather than a lethal habit.

Our obesity rate is among the highest of U.S. cities, driven by a food environment filled with sugary drinks and snack foods. Just as Big Tobacco has targeted youths, particularly in communities of color, Big Soda marketing targets African American and Latino youths. In fact, African American children see twice as many sugary-drink ads as white children, which may help explain the fact that black teens in Philadelphia are much more likely than their white peers to consume sugary drinks daily - and are more likely to be obese. And it helps to explain why nearly one in five African American adults in our city is suffering from diabetes - and at risk of consequences such as vision loss, kidney failure, and amputations.

At the same time, it's not easy for children and families to be physically active in every neighborhood. The city has a network of parks and recreation centers, but many are in poor repair and lack funds for programming.

We can do something about all these problems. Mayor Kenney's budget plan addresses our epidemics of obesity and diabetes at the same time that it combats the "causes of the causes." The sugary-beverage tax would nudge people to choose water or unsweetened drinks instead of sugary drinks; it's probably the single best thing we can do to stop the rising tide of diabetes.

Expanding prekindergarten would help ensure that every child enters school ready to learn. Beyond that, studies show that children in high-quality programs in the first few years of life have healthier habits in their teenage years and become healthier adults. The mayor's plan for community schools would bring services right to where children and families can use them, helping the most disadvantaged kids stay in school. And his plans to rebuild and renovate recreation centers and provide programming at these centers would help children establish healthy habits that can last a lifetime.

Closing the gap in life expectancy between the rich and the poor will take tough choices and it will take years, but we can do it. Don't the children of Strawberry Mansion deserve it?

Thomas Farley, M.D., is commissioner of the Philadelphia Department of Public Health. Thomas.Farley@Phila.gov