How Healthy Are Philadelphians?
What we’re doing right, what we’re not, and which way our region is trending in our physical and mental well-being.
How healthy are you? How healthy is your family? What about your neighbors, the people you work with, your town? We know terroir affects grapes. Does it affect people, too?
Between 2009 and 2015, Pennsylvania fell from 14th to 20th on the Henry J. Kaiser Family Foundation’s healthy-state list. Among the reasons for that drop: Our population’s older, and much of it is rural. We smoke more than the national average. Our cancer and heart disease rates are high. We’ve seen an explosion in substance-abuse deaths.
Yet at the same time, we’re making progress. The number of Pennsylvanians without health insurance fell under the state’s Medicaid expansion. The teen pregnancy rate is down. We’re below the national average for alcohol- and Alzheimer’s-related deaths.
Locally, the outlook is most bleak for Philly, which ranked dead last of Pennsylvania’s 67 counties in the Robert Wood Johnson Foundation’s most recent health rankings. There are reasons for that, as public health researcher Norma Padrón explains in her essay on page 97. Health is tied up in a tangle of socioeconomic factors — education, income, access to healthy food, crime, air pollution — that health-care analytics are only beginning to tease apart.
Those analytics helped us put together this snapshot-in-time of our region’s health, county by county (including nearby New Jersey counties), so we could answer questions like: Where’s the worst air pollution around here? What county’s worst for diabetes? Who gets the most exercise? Once we had our numbers, we turned to experts for context, asking more than a dozen medical and scientific specialists from more than a dozen hospitals to weigh in on the host of factors that go into the health calculus.
What we found was surprising, encouraging — and sometimes infuriating. For some health conditions, we’re doing so much better. For others, there’s still so far to go. But until you know where you stand, you can’t figure out where to go next. Here’s where we stand.
Death rate from all cancers per 100,000 people
National median: 185
The good news? Cancer rates have been gradually falling over the past 10 years, says Susan G. Fisher, an epidemiologist with Fox Chase Cancer Center. The better news? The cancer death rate has shown a steeper decline. Fisher cites increased screening, earlier detection and better treatment options as factors in the dual drops. Still, a man has an estimated one in two chance of being diagnosed with cancer in his lifetime—and women are closing a long-standing gap. Worried about your genes? Fisher says environmental factors—including social determinants like access to health care and behaviors like smoking and drinking—impact more than half the diseases we develop. “There are a very small number that genetics affect,” she says.
Adult smoking rate
National median: 21.7%
Forty years ago, a third of the U.S. adult population smoked. America’s anti-smoking campaign, says Abington Hospital family physician Neil Skolnik, is “one of the great public health successes of the past 50 years.” If you haven’t quit yet, good news: The best predictor of quitting successfully, Skolnik says, is having tried and failed. More good news: Drugs like Chantix and Zyban nearly double the quit rate. Skolnik is confident current smoking rates will drop by half. But he’s worried about e-cigs, now more common in teens than regular cigarettes. Though they offer “the illusion of safety,” he predicts they’ll turn out to be dangerous in the long run.
Years a child born today can be expected to live
National medians: 75.0 Male, 79.8 Female
Chester: 78.8 Male, 82.8 Female
Montgomery: 78.2 Male, 82.3 Female
Bucks: 77.6 Male, 81.9 Female
Burlington: 77.5 Male, 81.3 Female
Gloucester: 75.9 Male, 80.6 Female
Camden: 75.3 Male, 80.0 Female
Philadelphia: 71.5 Male, 78.4 Female
Last year, for the first time in decades, U.S. life expectancy fell. The downturn was slight, but it concerns social epidemiologists like Carolyn Cannuscio, of Penn’s Center for Public Health Initiatives. Behind the slippage: “alarming patterns of worsening health for middle-aged U.S. whites,” Cannuscio says. Still, every local county but Philadelphia remains above the national median, and the city, which is almost half African-American, is up 3.9 years for women and five years for men since 1985. But there’s a 10-year — 10-year — difference in life expectancy for a kid born in Center City and one born in West Philly. Just don’t blame city living, warns Cannuscio: “Philly is the poorest of the 10 largest cities in America. It’s not the city that’s bad for health. It’s poverty.”
Poor Physical Health Days
Average number of physically unhealthy days adults reported in the past 30 days
National median: 3.8
How many days in the past month were you in poor physical health? Go on — count them up. “There are many more things that affect your health than just, ‘Are you taking your medication?'” says Madelaine Saldivar, an internist and public health expert at Lankenau Medical Center. Quantifying our day-to-day physical health allows us to track not only how well our doctors are doing at keeping us healthy, but also how well — or not — our communities are able to reinforce our good health, with things like parks to play in, access to gyms and community centers, and healthy food options. This link between place and health is what’s leading to efforts that strengthen physicians’ ties to patients’ communities, such as Lankenau’s work with the Food Trust’s farmers’ markets in West Philly, and its half-acre organic farm, which provides produce that’s given away to patients and also used in the hospital’s cafeteria. Explains Saldivar, “As doctors, we have to build community relationships so that we can address people — and empower them — within their comfort zones.”
Adults with a BMI of 30.0 or higher
National median: 30.4%
In 1985, no U.S. state had an obesity rate over 15 percent. Today, the rate’s above 30 percent in 25 states — and above 20 percent in all states. Pennsylvania ranks 24th of the 50 states in obesity. Locally, male rates have outstripped female rates. Richard Ing, a specialist in bariatric surgery for Main Line Health, says surgical treatments aid those who are already obese, but preventive care is what’s needed. Income and genetics play roles, but another big battle is societal—and insidious: “Food scientists design products that taste better. The culture says more is better. Our bodies haven’t changed, but the calories we take in have doubled. We have to separate out what we want from what we need.”
Adults diagnosed with diabetes
National median: 8.1%
So America’s having a diabetes crisis, right? Maybe, says Laura Fitzpatrick, an endocrinologist at Doylestown Hospital. “The definition of diabetes has changed over time,” she notes, and that can affect the incidence. The A1C blood test catches once-missed diagnoses. Meanwhile, doctors are treating more pre-diabetes cases, hoping to keep them “pre.” Locally, rates are finally inching down. Are we past the crest? “Time will tell,” Fitzpatrick says. It’s possible we’ve just maxed out: “If only 15 percent of people are susceptible genetically, we could be approaching that ceiling.” Down the road: treatments based on your genes. “Everybody who has diabetes has a slightly different form of it. There are so many genetic variations,” Fitzpatrick says.
Drug Overdose Deaths
Drug-poisoning deaths per 100,000 people
National rate: 17.2
Opioid overdose deaths in America have quadrupled since 1999, according to the CDC. In Pennsylvania, the death rate went up 20 percent just from 2014 to 2015; it rose 16 percent in New Jersey in the same year. Making for the perfect storm, says Penn psychiatry professor and addiction expert George Woody: overprescribing of opioids like Vicodin and Percocet, and the proliferation of fentanyl, a painkiller more powerful than morphine and heroin that suppresses breathing and is frighteningly easy to overdose on. Many drug users get prescribed painkillers from a doctor and then turn to street drugs. “The fix would be to mandate fewer opioids prescribed per prescription and for doctors not to prescribe opioids for moderate or less than moderate pain,” says Woody. Change is coming: Last summer, Pennsylvania launched the Prescription Drug Monitoring Program, which lets doctors track when a patient was last prescribed a painkiller. And in February, New Jersey passed a law that mandates a strict five-day limit on first-time painkiller prescriptions. The law is being hailed as one of the most stringent in the nation.
Births per 1,000 females ages 15 to 19
National median: 42
Across the country, teen birth rates have been falling for the past 20 years. “We think of teens as a high-risk group because teen birth is a proxy for other factors,” explains Laura Goetzl, an OB and section chief of maternal fetal medicine at Temple University Hospital. Among them: STDs, pre-term births, low birth weight and preeclampsia. And the risks — medical, social, economic — are compounded when a teen mom has a second baby, which the CDC says nearly one-fifth do before age 20. One big leap forward, says Goetzl, was Pennsylvania’s decision in November to provide Medicaid coverage of long-acting reversible contraceptives — i.e., IUDs — for women right after they give birth, a practice that has cut repeat pregnancies for teens in other states. (Postpartum IUD insertion isn’t covered in New Jersey, though it’s under consideration.) “IUDs give people a very effective birth control method even if they don’t change their behavior,” Goetzl says.
Poor Mental Health Days
Average number of mentally unhealthy days reported by adults in the past 30 days
National median: 3.8
The Mental Health Parity Act and Affordable Care Act helped those with serious mental illness by improving access to care, says David Mandell, director of Penn’s Center for Mental Health Policy and Services Research — “but both are in danger of being dismantled.” Also problematic: Many primary-care physicians aren’t equipped to screen for conditions like depression, and strict health privacy laws make it difficult for care teams to share information about mental health. Mandell’s goal: a truly integrated and holistic health-care system in which we’re screened for mental health problems as well as cancer and heart disease. Smart employers fold mental health initiatives into corporate wellness programs; employees with less stress or depression are much more productive.
Adults who have asthma
National figure: 7.4%
In 2015, the Asthma and Allergy Foundation of America ranked the Philly area the third worst place to live with asthma, up two spots from 2014. We even beat out Detroit. “Asthma is reversible if you treat it effectively,” says Mark Posner, an asthma specialist at Abington Hospital. Trouble is, many folks diagnosed with asthma are only treated symptomatically, rather than with therapies that actually get the condition under control. Worse still, many never receive treatment at all. “A lot of primary-care physicians still don’t like to label patients with asthma, so as specialists, we only see the tip of the iceberg,” Posner says. And that’s a problem: In 2013, medical costs associated with asthma totaled nearly $2 billion in PA, of which Medicare and Medicaid paid around 71 percent. Luckily, most parts of our region are headed in the right direction. Posner says it’ll take everything from smart environmental policies to lower air pollution to physicians treating the condition aggressively to keep us inching forward.
Malignant Skin Melanoma
Cases per 100,000 people, with the percent of change between 1980 and 2014
National median: Male 4.5, Female 1.9
Gloucester: Male 6.0 (+21%), Female 2.2 (-6%)
Chester: Male 5.5 (+14%), Female 2.4 (+3%)
Delaware: Male 5.5 (+7%), Female 2.2 (-15%)
Bucks: Male 5.2 (+2%), Female 2.1 (-13%)
Burlington: Male 4.9 (+9%), Female 2.0 (-7%)
Camden: Male 4.7 (-17%), Female 1.9 (-17.2%)
Montgomery: Male 4.4 (-7%), Female 2.4 (-1%)
Philadelphia: Male 3.4 (-20%), Female 1.6 (-27%)
Virtua cancer surgeon Arnold M. Baskies, who’s also chair of the board of directors of the American Cancer Society, says America is suffering from a “tsunami” of skin cancer, of which melanoma is the deadliest type. The lower rates in Camden and Philly are linked to demographic changes; African-Americans develop melanoma less often than whites, though they still get the disease, especially on their hands and feet. Melanoma rates are high locally — the worst state in the country is neighboring Delaware — thanks to nearby beaches, an older population, and plenty of military veterans, many of whom got a ton of sun exposure before anyone realized the damage it could cause. But there’s a spike in young people, too, says Baskies, linked to the desire to look tan and to tanning beds, which are even more dangerous than the sun. Rates are lower in women, according to Baskies, because “they tend to take care of themselves and go to the doctor and get checked. Men don’t get screening and preventive care.” But there’s also a hormonal component; melanoma rates are high for men with prostate cancer. “Testosterone plays some role in melanoma development,” Baskies says. He begged us to emphasize sun protection for everyone, especially those with blue eyes and fair skin.
Adults who report either binge or heavy drinking
National median: 17%
Why are we all drinking so much? David Greenspan, chair of psychiatry at Einstein Medical Center, says that alcohol consumption (except for drunk driving) doesn’t have the stigma of other bad habits like smoking and drugs: “We wind down with a drink, celebrate with a drink, drink at weddings.” Increases in rates for women may be the lamentable result of more “equality”: “If you have two full-time jobs — working and child-rearing — that’s stressful.” Well-off working women are also a magnet for alcohol marketers. Meantime, college kids may be binge-drinking to cope with social media and the stress of always being “on.” “We have a huge social experiment going on,” Greenspan says of our infatuation with the Internet. Historically, cultures with big increases in substance use are “on the downslide as civilizations,” he adds — “though it’s hard to tell if that’s a cause of the decline or a response to it.”
Average daily density of fine particulate matter in our air, measured in micrograms per cubic meter
National median: 10.7
Breathe easy, Philly: Our air quality’s improving, thanks mostly to reductions in power-plant and vehicle emissions over the past decade, according to Peter DeCarlo, head of the Drexel Air Resources Research Laboratory. Reducing the junk in our air is important because inhaling fine particles doesn’t just damage our lungs; it’s also been linked to blood clots and heart attacks. Still, there’s only so much we can control: Philly is an industrial city, and industry creates pollution. And unfortunately, fleeing to the suburbs may not help; wind patterns push the city’s emissions well beyond its borders, particularly toward the northern suburbs and New Jersey. “Philly is part of a larger air-shed region from D.C. to New York, so there are many factors we can’t control,” says DeCarlo. “But within the city, we can make a difference by driving less, electrifying transport, and investing in clean electricity generation.”
Coronary Heart Disease Deaths
Premature cardiovascular disease mortality rate per 100,000 people
National median: 126.7
Nationally, deaths from cardiovascular disease fell by 50 percent between 1980 and 2014, but it’s still our most common cause of death. “It’s not about hospital care,” says Temple University Hospital chief of cardiology Daniel Edmundowicz. “This is not about the number of catheter lines or hospital beds. Philadelphia has a lot of those — maybe too many.” Death rates are down thanks to education on contributing factors like smoking and how to recognize the signs of stroke. While that’s great, “We’ve focused on what to do when people are already to the far right of the coronary disease timeline,” Edmundowicz says. “We need to shift to prevention.” That means lifestyle changes like exercise, healthier food, and cholesterol and blood pressure meds: “Nothing fancy. Nothing that costs a lot of money. Just doing what we can before patients get to that far right.”
Adults reporting no leisure-time physical activity
National median: 26%
“Human beings are animals, and all animals need to move,” says Perry Weinstock, head of cardiology at Cooper University Hospital. Active people usually weigh less, are better able to control blood sugar and cholesterol, tend to eat better, and have less stress; physical inactivity has been related to all sorts of woeful (and costly) conditions, including diabetes, cancer and stroke. We’re trending in the right direction, but we can do more, says Weinstock: Meeting the American Heart Association’s guideline of 150 minutes of moderate exercise each week is easier than you might think. Just five days of moderately brisk walking for 30 minutes does the trick. And those minutes don’t have to be continuous. So park farther away at work, and take an extra lap at KOP. “Most of this can be achieved by being a little bit clever about how you organize your day,” Weinstock says.
Our statistics come from the Robert Wood Johnson Foundation, the City of Philadelphia and the Gates Foundation and are the most recent available.
First published as “How Healthy Are We?” in the May 2017 issue of Philadelphia magazine.