What Lessons Can Philadelphia Learn from Inequality Observed in Latin American Cities?

A new study found wide-ranging differences in lifespan in six major Latin American cities. The findings – which may be the first to give comprehensive, standardized data about life expectancy at birth within small areas of the cities – help researchers pinpoint what forces are linked to these disparities and what lessons can be learned by Philadelphia and other cities experiencing similar issues.

The findings, recently published in The Lancet Planetary Healthfrom researchers at the Salud Urbana en América Latina (SALURBAL), or Urban Health in Latin America project at Drexel University’s Dornsife School of Public Health, are the latest among growing efforts by the group to evaluate how environment and public policies influence the health of the 80 percent of Latin Americans who reside in cities.

The team looked at six Latin American cities that are collectively home to more than 60 million people – Buenos Aires, Argentina; Belo Horizonte, Brazil; Santiago, Chile; San Jose, Costa Rica; Mexico City, Mexico; and Panama City in Panama – and found broad contrasts in life expectancy when comparing specific areas located within these six metropolitan locations.

The researchers mined each country’s census and vital registration data for stats on socioeconomic status measures, death rates, gender and other population metrics, and did the heavy lift of standardizing the data for all areas that make up these cities. The researchers then calculated life expectancy at birth by gender for each of the areas in the six locations.

The group found higher differences in life expectancy at birth within cities than among cities. For example, the largest difference was found in Panama City, where residents of the areas with the highest life expectancy live 18 years longer, on average, than residents of areas with the lowest life expectancy. Meanwhile the difference between the city with the highest overall life expectancy (Panama City) and the lowest life expectancy (Mexico City) was much lower – seven years for men and 11 for women.

“Inequality harms everyone,” said lead author Usama Bilal, MD, PhD, an assistant professor in the Dornsife School of Public Health. “It destroys social cohesion, tears at the fabric of communities and harms the way of life for all. There is great opportunity here to use standardized data and collaborate with policymakers and community leaders to solve these challenges and chart a better path forward. One important first step is to make the public aware of these inequalities.”

By comprehensively studying life expectancy in these areas, the researchers uncovered some of the earliest data used in pinpointing the determinants, or factors, that influence health for residents.

“These stark differences in health across neighborhoods arise from differences in social circumstances and physical environments that can be addressed through policy,” said SALURBAL principal investigator Ana V. Diez Roux, MD, PhD, dean of the Dornsife School of Public Health. “They highlight how health is affected by much more than health care.

The data comes at a time of renewed attention to income distribution in the region. Among the 20 countries in the world with the highest income disparities, eight of them are within Latin America. Additionally, income injustice is an often cited reason by demonstrators behind recent protests in Chile and Ecuador.

But action to fix disproportionate wealth and improve population health cannot begin without data. In a strategic plan published in October, the Pan American Health Organization acknowledged that equity is “at the heart of health,” but progress is limited by a “lack of consistent disaggregated data to track and reveal disparities.”

This behind-the-scenes data gathering and analysis is the critical foundational work by the SALURBAL project that will help influence public policy and opinion to address health equity challenges.

Similar data from the U.S. Centers for Disease Control and Prevention and the Associated Press reveal even broader disparities in life expectancy here in Greater Philadelphia. Residents in nearby Lower Merion Township in Montgomery County have an average life expectancy of 92 years, while life expectancy a few miles away in Philadelphia’s Strawberry Mansion section is at 64 years.

Where you live can have a major impact on your lifespan, both in Philadelphia and its suburbs. This can also be said for much of Latin America.

“Now it’s on policymakers and institutions to build on this data and use it to close these gaps,” Bilal said.

If interested in talking to Dr. Bilal or Dr. Diez Roux, contact Greg Richter at 215-895-2614 or gdr33@drexel.edu. For more information on SALURBAL, check out the LAC-Urban health site.

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