Living in well-to-do Washington Park or in the Valverde neighborhood on Denver’s west side can mean a difference in average life expectancy of 11 years.
Depression and childhood obesity rates are four times higher in some Denver neighborhoods, and tobacco use is six times higher in certain areas of the city.
The health disparities are severe, and thanks to data emerging from death certificates and the electronic health records of tens of thousands of Denver residents, public health officials can map the variance down to specific pockets of town. Armed with blunt facts, the public health community has renewed its effort to intervene and help improve outcomes in the unhealthiest neighborhoods.
“These are stark and serious disparities,” said Dr. William Burman, interim chief executive officer of Denver Health. “The idea is to start a conversation.”
Denver Health is creating a new Center for Health Equity focused on closing the health gaps through research, education and recruitment of medical professionals from disadvantaged neighborhoods.
In Denver, 2 miles can mean 10 years in average life span. The average life expectancy in Washington Park is 84 years — an 11-year difference from Valverde, which is just west of Interstate 25 between Sixth and Alameda avenues. Residents of Stapleton, Belcaro and the southwest Denver neighborhood of Marston can expect to live until 83 or 84, but those in Capitol Hill, East Colfax and West Colfax die about a decade sooner, on average.
The life expectancy data, compiled with help from the Robert Wood Johnson Foundation, comes from the vital statistics program at the state health department. To understand why residents of certain neighborhoods are dying sooner, public health officials are tapping into data from the Colorado Health Observation Regional Data Service, or CHORDS, which uses electronic health records to determine the prevalence of depression, tobacco use and childhood obesity, among other health concerns.
In 16 Denver neighborhoods, 20 to 24 percent of children are obese, compared with other neighborhoods where just 4.5 percent of kids are obese. All 16 of those neighborhoods also are among the poorest in the city, with 15 to 77 percent of people living in poverty. “It’s almost perfectly aligned,” Burman said.
The main reasons are lack of healthy, affordable food and few safe places to play outside, public health officials said. Poorer neighborhoods are not just “food deserts” but “food swamps,” meaning they are saturated with convenience stores and fast-food restaurants instead of grocery stores that sell fresh produce. Convenience store windows are plastered with advertisements for cigarettes and sugary drinks.
Denver Health, which has replaced soda with spa-style cucumber and berry water in its cafeteria, is working with the Denver Zoo, History Colorado and others to send the message “it’s not normal to give small kids sugar-sweetened beverages,” Burman said. He called sugary drinks the single biggest factor causing childhood obesity.
Colorado often gets attention as “the fittest state” or the “leanest state” in the country, yet Colorado’s children are just as obese as the national average at 17 percent. Childhood obesity is linked to a host of lifelong health problems, including diabetes, heart disease, asthma and depression.
The new Center for Health Equity intends to take its anti-sugary drink message deeper into communities that most need to hear it, meeting with schools and soccer leagues to point out that kids don’t need bottles of blue or orange sugary sports drinks after playing a soccer game.
The “rethink your drink” campaign also has been incorporated at Denver Health’s Healthy Lifestyles Clinic, which opened in 2014 after data showed 18,000 youths in the hospital system were overweight. Nurse practitioner Shanna Knierim, now director of the clinic, gathered a group of pediatricians, dietitians, mental health professionals and health coaches to fight childhood obesity.
The team travels to community health clinics and schools and has seen 460 patients, many referred by their primary care doctors. They concentrate their efforts in neighborhoods with significant health disparities, offering help with everything from depression due to bullying to teaching families how to cook healthy meals with frozen vegetables, Knierim said.
Conversations with families who live in disadvantaged neighborhoods will help set the agenda for the Center for Health Equity, which will have a community advisory board.
Besides community education, Denver Health also is renewing efforts to increase the number of doctors, nurses, social workers and other medical field professionals from disadvantaged neighborhoods. Doctors from low-income neighborhoods are more likely to practice in low-income areas, and, studies have found, doctors communicate better with patients from similar backgrounds.
Dr. Lilia Cervantes, an associate professor at the University of Colorado School of Medicine and a hospitalist at Denver Health, directs a program to support at-risk youths interested in medical careers. Through the Center for Health Equity, Denver Health’s recruitment program for undergraduates will expand to middle schoolers through graduate students.
Cervantes said “patients’ eyes light up” when they realize she can speak Spanish. Patients aren’t likely to ask for an interpreter, thinking their health issues are not important enough to waste a doctor’s time, she said. Cervantes, who researches health disparities among undocumented immigrants with kidney disease, also dispenses dietary suggestions that are culturally relevant to her Latino patients.
“The idea is that when patients have a doctor who is culturally congruent, they better understand their options and are more likely to make an appointment,” she said.
The way public health authorities approach disease prevention has evolved with the country’s $30 billion move in the last few years toward electronic medical records, part of the Affordable Care Act. But Denver is among the few cities with the “trust and political will” to create a system that allows health providers to share data in the interest of public health, said Dr. Art Davidson, director of informatics and epidemiology at Denver Public Health, part of Denver Health. Other cities have failed to set up such a system because of health providers’ concerns that competitors could use the data to learn proprietary information regarding market share.
Eleven health entities in Colorado participate, contributing data broken down by race, gender, age and location. Denver Health and Kaiser are the two largest providers in CHORDS, the regional data service, with data on about 300,000 people in Denver. Patient names are not included. Contributors can choose whether to answer a request for data.
After the system spits out the data, public health authorities take it to city council representatives and community forums. “Our goal is to change the way a community looks at itself,” Davidson said.
