Imagine that major-league baseball changed its rules, and divided its teams into two categories.  For half of the teams, players would come to bat with two strikes already logged against them.  For the other half, batters would come to the plate with no balls or strikes, just like now.

The only difference being which city/franchise the team came from: the Nationals might play under the traditional clean slate, no balls and strikes against them when their batters come to the plate, while the Phillies' would step into the batter's box with two strikes already charged against them.

No matter how smart their manager, or how well they do in acquiring good players, or how hard their players tried, the Phillies wouldn't win many games.

Rigging baseball's rules so blatantly and arbitrarily in favor of some cities and their teams over others would be totally unfair, of course, and would never happen.

But what if health care were rigged like this?  Imagine that people in some towns start out with two strikes against their health, starting from the time they are in their mother's womb. They would suffer poorer health, and, likely, die earlier, no matter what they did to try to stay healthy.

As hard as it is to accept, your health may in fact be rigged against you, based solely on where you were born, live and work.  A new paper from the American College of Physicians (ACP), the nation's largest physician specialty society, found that "social determinants of health – non-medical factors that can affect an individual's health, including conditions in which people are born, work, and live – often have a significant impact on health."  Here are some of the research findings cited in their report:

  • In the United States, place of birth is more strongly associated with life expectancy than race or genetics.
  • The primary nonmedical factor affecting health is socioeconomic status. Neighborhoods with concentrated poverty often lack grocery stores with fresh food, adequate public transportation, access to public spaces, adequate employment prospects, and access to health-care services; often have underfunded schools; and often are situated near environmental hazards.
  • Living in dilapidated housing with ongoing exposure to harmful pollutants is likely to result in poorer health.
  • Lack of transportation options creates barriers to health-care access, leading to missed appointments, missed or delayed medication use, delayed care, or poorer management of chronic conditions.
  • Access to a healthy and adequate supply of food is necessary to living a healthy and productive life, yet approximately 11 percent of households in the United States (25.8 million adults and 12.4 million children) are considered food-insecure. Food insecurity is a broad concept that includes the physical feeling of hunger and anxiety about access to food.

Consider Philadelphia: In the lower North Philly neighborhoods, life expectancy for a man is 65.4 years, 75.3 years for a woman.  This translates into more than 14,000 years of potential life lost before age 75, that is, the average number of years that residents would have lived if they hadn't died before age 75 multiplied by the neighborhood's population.  In neighborhoods within Center City, life expectancy for a man is 78.9 years, 83.6 for a woman, which translates to 5,484 potential years of life lost.

ACP argues for concerted effort to limit the adverse impact of social determinants of health, by pushing for research and advocating for policy to improve housing, transportation, the environment, and access to healthy food and nutrition.  There is only so much your doctor can do to keep you healthy if you have two-strikes against you before you even arrive in the  office.

Addressing social determinants of health is no game, but a matter of life and death.

Robert Doherty is senior vice president of governmental affairs and public policy for the American College of Physicians, the largest physician specialty society and second-largest medical organization in the United States, and also a member of the Inquirer's Health Advisory Panel.