This piece, “Zip Code and Health" appeared on page 13 of the Spring 2026 issue of Chicago Life Magazine.
No doctor (except maybe if he’s also your rich uncle) can fix your zip code, which turns out to one of the most important determinants of health. So much of health and quality of life depends on where you live.
It can be viewed using this link: Chicago Life Magazine - Zip Code and Health
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The best way to improve your odds of living a long life is to upgrade your zip code. I live in a beautiful place, half a block from Lake Michigan on Chicago's North Shore. According to the Robert Wood Johnson Foundation, the average life expectancy for me and my neighbors is 88 years, almost ten years more than the mean for Cook County. A betting person with their hands on the data would put their money on a resident of the Fuller Park neighborhood, five miles south of the Loop, making it to 66, comparable to longevity in the Congo and Haiti. That's a 22 year difference in lifespan between them and me!
By comparison, smoking shortens life by about 10 years, half as much as unfavorable place of residence. Yet the risk calculators that health professionals routinely use to guide lifestyle recommendations and therapy choices don't ask for zip code. The reason should be obvious. A doctor can act on a patient's smoking data: recommend they quit tobacco; refer them to a smoking cessation program and even prescribe a drug that curbs the desire for nicotine. What good would it do to suggest they move to a higher-cost, “healthier” neighborhood if they are barely getting by in their low-rent situation?
So the doctor has to take a step back from the blaring truth of the inequity that runs through our society. Urban people of some means generally live in places with more open space and less pollution. Streets are safer. The grocery stores where they shop offer higher quality, fresher foods because their customers can afford them. They are more likely to have health insurance. And healthcare is generally more available because, in the profit-motivated US healthcare system, services follow money. Money can buy access to most everything that's healthful.
Which does not mean, of course, that money itself can just buy health. First of all, there's genetics. For example, best estimates say that heredity accounts for 40%-60% of a person's risk of coronary artery disease, the biggest killer in the US. The other 40%-60% is attributed to more or less modifiable lifestyle factors, like smoking, blood fats, blood pressure, diabetes, stress, diet, exercise and obesity.
If we're talking about longevity, we need also to factor in violence, illegal drug use and alcoholism. In poorer neighborhoods these so-called diseases of despair account not only for a larger number of deaths, but for deaths at an earlier age, especially among young men, thereby having a disproportionate effect on average lifespan. My brain still brims with stories of the human tragedies I encountered during internship at Cook County Hospital, the institution of last resort for many of Chicago's sick poor people. There was little I could do to address issues that are today lumped into a category called “social determinants of health.” That's one reason why I chose rural practice later in my career where, beyond the individual patients I cared for, I could actually influence how our little system cared for everybody.
Back to the city. Take an obese boy living in an inner city neighborhood. I tell him he needs to get more exercise. There are few open spaces in his vicinity. He's at risk of being mugged in the parks that are nearby. I tell him he needs to eat fresh fruits and vegetables. The neighborhood grocery store carries sparse, overripe and wilted items at high prices. A lot of his calories come in the form of candy, packaged pastry, chips, coldcuts and pop purchased at the corner bodega. Nearby restaurants are fast food chains that serve inexpensive meals, loaded with fat, sugar and salt.
If the boy's family has been fortunate enough to find affordable primary care, it may take weeks to get an appointment. When there's an acute illness or injury they go to an emergency room where could wait hours to be seen, briefly and only for the immediate problem. Nobody keeps regular track of the boy's growth, weight gain, blood pressure, blood sugar, diet or immunizations, not to mention his tobacco, alcohol or drug use, adjustment to school, possible depression, knowledge about safe sex, and on and on.
In 2024 the United States spent $5.1 trillion on healthcare. That's $15,474 per person, 17.2% of our GDP. The next closest were Austria and Switzerland at 11.8%. In 2020 the median household income in Fuller Park was $17,217, about $7600 per person. In other words, twice as much money was spent on healthcare for the average Fuller Park resident than they made in a year. (It may cost less to care for poor people because they consume less care. On other, it may cost more because, by the time they do get cared for they are way sicker, requiring much more intensive and expensive services.)
If I ruled the world I don't know how I would choose to spend some of that $17,217 that goes to healthcare. (It's actually more today. Healthcare spending increased by over 7% in 2025 and is expected to reach 10% inflation this year.) What I do know is that we cannot just keep pouring more money into healthcare while getting so little for it, especially for the least well-off who live among us.
Except they don't really live among us. They inhabit different worlds from my affluent one. If we want a healthier, more just society, for starters we all need to get out of our own zip codes.
