Health and wellness: Is zip code more important than genetic code?

The evidence exceeds the tipping point — that point where compelling ideas by necessity transform into action. The evidence? Unmet social needs significantly affect our health, especially our emotional wellbeing. In fact, it is often said that zip code is more important than genetic code in determining overall health and wellness.

More specifically, zip code-based health disparities include such factors as unhealthy housing, unsafe neighborhoods, proximity to pollutants, sub-quality food options, etc. As Beacon Health Options continues to recognize July as Minority Mental Health Awareness Month, it is important to examine how such social determinants of health (SDoH) affect the mental health and health in general of people of color. Approximately 39 percent of Black and 33 percent of Latino youth in the United States live in poverty — more than double the 14 percent poverty rate for non-Latino, White and Asian youth. Further, research shows that poor mental health is prevalent among individuals with lower incomes.

When we use the term ‘social needs’, many of us don’t think of healthcare. Yet, approximately, 40 state Medicaid programs are addressing SDoH through their managed care contracts and other avenues. The shift in focus is a positive sign as the personal costs are too great, and the downstream avoidable healthcare and societal costs are becoming unsustainable.

Supportive housing: An example of an SDoH solution

In a recent study, 17 Medicaid managed care organizations (MMCOs) representing care delivery in 10 states reported that housing, behavioral health, substance use and nutrition/food security were the most common areas of focus. Other MMCOs focused on specific populations, such as people formerly in prison.

It’s not surprising that housing is a common focus. Chronic homelessness is associated with high utilization of healthcare services and increased mortality. Further, people of color disproportionately represent homeless populations: Black Americans, for example, constitute more than 40 percent of the homeless population but represent only 13 percent of the general population. Specifically, housing instability is strongly associated with:

  • High stress
  • Poor mental health
  • Low medication adherence
  • Postponement of needed medical care
  • Increased emergency room use/hospitalizations

Therefore, permanent supportive housing programs  for chronically homeless individuals represent one of the most compelling arguments supporting SDoH investments.

For example, Beacon’s Massachusetts Behavioral Health Partnership, in collaboration with the Massachusetts Housing and Shelter Alliance, administers the Community Support Program for People Experiencing Chronic Homelessness (CSPECH). Once participants are housed, they meet with community support workers to coordinate access to physical, behavioral health, and social services. Individual lives improve and states can save money. One 2017 study found that per-person monthly costs were $765 lower in the 24th month following CSPECH entry than in the month prior.

More to be done

Housing is just one SDoH example of how we can move the needle on the mental health for people of color. In addition to cultural competency training as discussed in our last blog, there are other steps we can take to address inequitable mental health care. Below are some recommendations from researchers at the Health Disparities Unit at Massachusetts General Hospital on how to address barriers to care as they relate to SDoH:

  • Integrate behavioral health services into other naturally occurring community-based settings, i.e., housing, employment support programs and faith-based organizations
  • Promote use of peer specialist outreach — Address stigma and trust issues through certified peers with similar background and life experiences who can help with navigating housing, employment, educational and other services
  • Increase use of telehealth and telephonic clinical solutions to help those people with transportation or other care-access issues

Regardless of one’s ethnicity or background, the most significant impacts to our health are socially determined. Not surprisingly, the path to a solution requires collaboration among diverse groups of people. Beacon Health Options calls upon all stakeholders to rethink how we think about healthcare — physical and behavioral — to address health disparities among people of color.


18 Comments. Leave new

excellent. thank you

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Yasamin Larizadeh
July 22, 2020 7:43 pm

I appreciate that Beacon is focused on observing and learning about People of Color (BIPOC). It would be more appropriate to use POC mental health services INSTEAD of Minority.

Not best choice of language during an awakening time

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Dale Seamans
July 23, 2020 12:37 pm

Thank you for sharing your opinion regarding the blog. Beacon Health Options believes that open and transparent dialogue supports the movement to ensure health equity for all.

At this time, use of the term “minority” refers to the official name of July as Minority Mental Health Awareness Month as designated in 2008 by the US House of Representatives and the primary patient advocacy organizations of NAMI and MHA.

Beacon is currently reviewing the terminology we use to describe people of different racial and ethnic backgrounds. We are seeking the input of our Diversity and Inclusion Committee and reviewing what is becoming the accepted terminology among the general public.

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Lynda Hiatt
July 22, 2020 7:47 pm

Excellent information and plea for awareness of a Desperate Need!

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We all need access to good healthcare, and unfortunately when access is interrupted or not given in the first place, we find the negative consequences the above article mentions.

Hopefully there will be financial support provided to back these suggestions as well, to facilitate the work ahead.

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Any solid, evidence-based action steps would be helpful. An overall plan as to how to move forward towards a more equitable future would be completely amazing.

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Good material

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good article

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Judy Figura
July 22, 2020 9:34 pm

I want to commend Beacon for giving overdue attention to this critical problem in our nation. Racial inequity in all its dimensions must be addressed with all the force and resources that we can put forward. Thank you for lending your voice in this arena. Until all people in our rich country have basic needs met for physical, emotional and social safety, we must all work towards repairing these societal problems.

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Nancy Lim-Yee
July 22, 2020 9:53 pm

I would like to comment on these statements in your article: “More specifically, zip code-based health disparities include such factors as unhealthy housing, unsafe neighborhoods, proximity to pollutants, sub-quality food options, etc. As Beacon Health Options continues to recognize July as Minority Mental Health Awareness Month, it is important to examine how such social determinants of health (SDoH) affect the mental health and health in general of people of color. Approximately 39 percent of Black and 33 percent of Latino youth in the United States live in poverty — more than double the 14 percent poverty rate for non-Latino, White and Asian youth.” Do you not include Asians or recognize Asians as “individuals of color”? There are over 39 subgroups of Asians, and yet, they are often lumped together as one group. When the numbers/data for Asians are disaggregated, the results can show that some Asian groups are not doing very well at all. Hence the need and importance to disaggregate data.

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I participated in a 2015 study that compared zip codes with adverse childhood experiences (ACEs) in our Midwest city of about 135,000 people. We found higher ACEs scores in one particular zip code. Research has shown that higher childhood ACEs scores have been positively correlated with greater risk of developing physical and mental health concerns as an adult.

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HeleneZimmermanLCSW
July 22, 2020 10:31 pm

There is no substitute for appropriate housing. Too often clients end up in shelters, they are not safe and conducive towards productive living. Institutions are not the answer, however individual rooms in a large building with supervision should be the first step, especially when families are unavailable.

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Important to recognize the societal issues that contribute
that cause stressors and poor health for many minority people.

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Bernadette Behary
July 23, 2020 2:30 pm

Without Supportive Housing, individuals would be homeless in many situations. So glad Beacon recognizes this need.

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Education is more important than zip code. Family systems is more important than zip code. Our citizens living in poverty need a way to rise up and motivation to rise up. Opportunity zones were helping… Get our citizens out of poverty, into education, and continue valuing family – however ‘family’ is defined. Providing mental health – or social health – will also support our poverty-stricken citizens understand that there is help for them and people willing to offer that help. We are in this together ! Keep up the good work Beacon !

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Any organization that works with , or has any impact on social values or wellness can join this fight. Health insurance providers are important in this effort, and hopefully will face how politics, usually of one party, foster the inequalities mentioned in this piece. In a normal society poverty should be practically non-existent. Systemic social and economic inequalities precipitated by faulty leadership cost all of us, including insurers, a lot more.

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Marie L Fahringer
July 24, 2020 10:40 am

Thank you for information. Excellent insight for those in need of our continued care.

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Cherie Baetz-Davis
July 25, 2020 8:45 pm

I appreciate this article being shared!

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