Wealth and Health or Health and Wealth

On Wednesday at 10:15AM October 13th, my body was intact with no parts missing. At two AM, Thursday October 14th, I awakened in someone else's bed. Lahey Hospital's. At 3AM, I sat in a large leather reclining chair (I tried wheeling it to my car, but the nurses stopped me) giving thanks for thoughtful and caring friends. 

Exactly 24 hours after the anesthesiologist put me under, I stood in my kitchen with a catheter and one rather important body part missing. Boy, that all happened rather fast!

The sequence of doctor's visits, surgery, and follow-up force me to ask, "what matters?" Our wealth or our health? You might think, "Health, of course!" Someone else might reply, "Wealth; my health will take care of itself if I have plenty of money."

Health never takes care of itself. All kinds of stuff goes on under the skin that needs attention. Overlooking, procrastinating, disliking doctors will not slow-down the creeping effects of cancer or other ailments. Prostate cancer kills. Men need to take careful steps to protect themselves. Actions may not ward off cancer (they did not for me); they will allow time to manage it quickly and wisely. Most men just do not get it.

Life expectancy also differed much more for low-income people living in different cities than for wealthier Americans. For instance, poor Americans in New York City had a life expectancy that was six years longer than it would be had they lived in Detroit. For the richest Americans, the project found, the difference tied to living in one of the two cities was less than a year.

But annual income may fill in only part of the picture. Lorraine Dean, an assistant professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health, and her colleague Emily Knapp have begun using credit scores to assess the relationship between financial insecurity and physical health conditions, from breast cancer and HIV to obesity.

"There are more people living on the brink than income alone will tell you," Dean says. "An economic shock like a major health event can really devastate you financially."

Credit scores are perhaps the most sensitive and immediate measure of financial well-being, because all consumers must submit to credit analyses if they want to obtain a credit card or purchase a big-ticket item, such as a house or car. Miss a payment, and the credit agency takes note. Credit scores also capture individuals who don't have a stable income because they are self-employed or working temporary jobs in the gig economy.

In one study, Dean and Knapp used credit scores to examine the relationship between poor credit and obesity in the Philadelphiaarea. They obtained social, demographic and health information from more than 2,000 participants through a random telephone survey, and mapped a credit union's projection of average scores to where participants lived. Using census data, the researchers also were able to create statistical profiles of each neighborhood.

They found that a 50-point improvement in a neighborhood's credit score was correlated with a marked drop in body mass index. People living in neighborhoods with excellent credit, reflected by scores of 800 or above, were projected to fall into the healthy range. People in neighborhoods with lower scores around 700 were still likely to qualify for loans, but were also more likely to be overweight.

Those in neighborhoods with credit scores of 550 – poor enough to disqualify them from obtaining loans – had an estimated measurement of body mass index that, Dean says, "put you in the obese range, for sure."

Such data can determine a community's future, Dean says. Businesses use credit information to decide where to invest their money, establish new locations or expand their services – moves that drive growth, create jobs, boost tax revenue and increase demand for vital infrastructure, including schools and hospitals.

An absence of those factors can transform a community with potential for growth and prosperity to one confronting "disinvestment" and decline – a downward spiral that can turn a community on the brink into a 1990s-era East Lake, one battling poverty and public health concerns.

And it's never just one thing that plagues a neighborhood, says Dr. Bruce Lee, executive director of the Johns Hopkins Global Obesity Prevention Center. "Obesity, opioid abuse and chronic diseases tend to cluster," he says. "They're symptoms of a community problem, rather than separate problems of their own."

The push to tackle these multifaceted problems has brought together some unlikely players and partners, and some of the most established – like The Colorado Trust – are foundations created out of the sale or restructuring of nonprofit hospitals.