Defining the Problem
Geographic health disparities are the differences in health behaviors and health outcomes related to where people live. Geographic location contributes to one’s ability to achieve good health. Geographic disparities exist at the state, county, regional, local and even neighborhood level. Geographic disparities may reflect underlying differences in population characteristics, such as race/ethnicity, poverty or insurance coverage. Disparities tied to geography may exacerbate other disparities, often known as a “double disadvantage”. Whether disparities observed by geographic location reflect other underlying differences and/or exacerbate such differences, it is our hope that exploring geographic disparities will be a useful way to frame health equity programs.
Cancer & Tobacco
Cancer and tobacco continue to be critical public health problems that face our nation. Cancer remains the number one or two leading cause of cancer in all states and approximately 13.4 million U.S. adults are living with cancer. Each year, 1.7 million new cancer cases are diagnosed and over 580,000 lose their battle with cancer. During their lifetime, 40.8% of men and women will be diagnosed with a cancer. Tobacco use is the leading preventable cause of death in the U.S. Smoking is responsible for 480,000 preventable deaths each year. Additionally, tobacco use is responsible for $96 billion in medical costs and $97 billion in lost productivity each year. Importantly, significant disparities in cancer and tobacco use exist based on where a person lives.
States differ greatly in the incidence rates of cancer, screening behaviors, and mortality. For example, incidence of colorectal cancer are highest in the Appalachian region of the country, specifically Kentucky and West Virginia. Similarly, colorectal cancer screening is much lower in those regions than in other parts of the country. Not surprisingly, mortality rates related to colorectal cancer is higher in those areas. Dramatic differences also exist within states, at the county and local level as well.
Tobacco Use Disparities- Similar to cancer, tobacco use rates, exposure to secondhand smoke and tobacco-related mortality also vary by state. Adult smoking prevalence is highest in West Virginia, Arkansas, and Tennessee. Within state differences also exist. For example, smoking rates are also consistently higher among those who live in rural versus urban areas.