Welcome to the July 2023 episode of the Healthy Intersections podcast!
Local Social Inequity in Life Expectancy scores from the RTI Rarity project. Bright yellow indicates higher risk of shorter life expectancy.
This month, we talk about the state of Florida with Lauren Pierce, who formerly worked at the Florida Department of Public Health and is a long-term resident of Tallahassee. We debut the brand new RTI Rarity™ interactive national dashboard and focus on northern Florida, along the I-10 corridor. We discuss food insecurity, housing, smoking, and life expectancy — and how these all intersect.
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Transcript below.
Lisa Lines
Hello listeners and viewers. I’m Lisa Lines, the host of the Healthy Intersections Podcast sponsored by the American Public Health Association, Medical Care section, and the Medical Care journal. And we’re hosted at The Medical Care Blog. I’m one of the co-editors of the blog, and I’m also a senior health services researcher at RTI International. And I’m also the project director for the RTI Rarity project. And I’m part of the series that we’ve been doing, we’re talking about different states and our scores that we’ve developed for the RTI Rarity project. They’re called Local Social Inequity in Life Expectancy scores. And they’re, you know, basically scores that explain the risk of shorter life expectancy based on the social and behavioral determinants of health. So as part of that series, today, we are focused on Florida. And with me today on the podcast is Lauren Pierce. Lauren, please introduce yourself to the audience.
Lauren Pierce
Hi, there. My name is Lauren Pierce, and I live in Tallahassee, Florida, I’ve lived here for about 30 years, I worked for the Florida Department of Health for around 15 years in various programs. And currently, I work as a public health consultant across several, several different contracts.
Lisa Lines
Great, wonderful to have you here. And I’m so grateful that you’re willing to come on and share your expertise and your knowledge about Florida with our audience. So I’m gonna start by sharing the map that shows all of the Florida and basically shows all of the different counties. Generally in the past, we’ve been kind of moving around the state and talking about various parts of the state. But today, we’re going to do it a little bit differently. We’re really going to only focus on Leon County, which is up here in the northern part of the state. It’s where Tallahassee is located. And this is where you live right, Lauren?
Lauren Pierce
Correct. So the state capitol, Tallahassee, the State Capitol, yep. And home to a couple of universities, Florida A&M and Florida State University.
Lisa Lines
We are going to look at the top 10 highest food insecurity block groups. So this is Leon County, Tallahassee. And what are we looking at here?
Lauren Pierce
You look at Apalachee Parkway where it intersects with Monroe Street. And if you can point there, that’s the state capitol. It deadends into the state capitol right there. And so what what we’re looking at, if you see the the area that has the hatch marks, that’s considered the poorest ZIP code in the state of Florida, that ZIP code is 32304. The City of Tallahassee, I think, along with one of the, I believe it’s second harvest of the Big Bend has been working on a project to identify block groups that have the highest rates of food insecurity. And four of those actually overlap with the zip code that’s considered the poorest in the state. And if you look over here, you can see that the food insecurity, in some of those, it’s two out of three people, for instance, and the number one blog group, but it’s over half.
Lisa Lines
Tell us about food insecurity. What are we talking about there?
Lauren Pierce
Let me speak to what I think of, just you know, access to healthy food, how far you have to travel to access food, or what kind of transportation you have.
Lisa Lines
USDA has a measure of limited supermarket access, which is their different different measures. And, you know, it has to do with how far you have to go to get to a supermarket. You know, whether you have a car or not, and you know, whether whether there’s a supermarket within half a mile without a car, or in more rural areas, different different cut points for where how far to be from a supermarket, food insecurity. I think it’s also modeled with poverty and limited supermarket access. So it’s kind of that combination of the food deserts and the poverty.
Lauren Pierce
So we were talking about earlier, you know, you know where you live. And so when you just think about driving down Apalachee Parkway to the Capitol, that would be a left hand turn down Monroe Street. I can picture the neighborhoods and areas I’m driving through and I’m not surprised. You don’t see a lot of grocery stores. You don’t see a lot of ways to access food.
Lisa Lines
Yeah, right.
Lauren Pierce
That’s not scientific. It’s just observation.
Lisa Lines
Yeah, yeah, we know, we know. I mean, we know this stuff. It’s ground truth. Really. It’s ground truth. It’s what we know, from just being in places, how different places can be from one block to the next, you know, and, and how that can really drive outcomes.
So as I mentioned, this is the RTI Rarity project that I’ve been directing for the past few years, we now have a dashboard with the ability to look at across the whole US, including Alaska and Hawaii, and DC. And look at these scores. So we’ve got it on high detail terrain now. So we can actually see on the map, what we’re talking about with the map is actually, you know, it’s got symbols on it. So you can see all of the different kinds of businesses that are there, and that kind of thing. And thenup here, we have the layers. So I’m gonna show the LSI life expectancy scores. So there’s a quite a bit of overlap, I think, between what we were just looking at in terms of food insecurity, and poverty, but life expectancy is driven by lots of other things. So in terms of smoking and other cancer related risk factors, what’s it looking like there?
Lauren Pierce
I mean, overall, I would say, in Leon County, I haven’t looked at the most recent tobacco use data, but Leon County tends to have a lower smoking rate than some of the other counties in this area that we call the I-10 corridor, because the interstate 10 stretches straight across this area of Florida, to the state line. Some of the other health behaviors, and we’ve noticed in the past that the I-10 corridor, including Leon County, in some areas seem to have health outcomes and health behaviors that are poor than other areas of the state.
Lisa Lines
And when we look at, sort of zoomed out, the state, as a whole, you know, all of this coloring is actually relative to the entire US. So you know, when you think about the bright yellow here, that is relative to the rest of the country, these are tracts with the top 20% of risk of having a shorter life expectancy.
So, you know, smoking is the number one predictor of life expectancy in our models in Florida. I thought that was pretty interesting to see that pop up, as you know, really a very, very strong driver. And I mean, the the rate really varies wildly from from place to place,
Lauren Pierce
it would be interesting to know and I’m thinking just Leon County, but — probably other areas as well — in these census tracts, where you have, and block groups, where you have food insecurity, what is the retail environment look like in terms of tobacco retailers? And you know, in terms of food, really healthy food retailers? Yeah, if people are accessing their food in places where there’s access to tobacco, higher rates in some of these areas.Lisa Lines
So one of the things that we’ve done with this map is we’ve overlaid some locations of some various clinics, like, for example, the mental health services, you know, we can see just from looking that they’re not evenly distributed across the state, it’s clustered in the cities. And a lot of the areas that have high risk of poor outcomes, have no clinics, no services, we’re gonna talk about that a little bit more.
Lauren Pierce
You know, I’m seeing some of these areas, that I’m guessing are some of the smaller cities in the I-10 corridor, you’ve got one provider for, you know, I don’t know how many 1000s of people, when you’re looking at Leon County, I’m looking at the majority of the providers are clustered in areas that are of lower risk. And in this county, when I look at this, it doesn’t, in terms of the risk, it doesn’t surprise me at all. I’m very familiar, I live in one of these lower risk areas, live work and play in the northern part of the county. And you know, it’s not surprising, based on what I know about the county, the people who are living in these areas that are at higher risk, and may have less access to transportation, are not really anywhere near these providers.
Lisa Lines
So telehealth could certainly come in handy in some places like that. And, you know, in terms of where the resources are located relative to the people, I mean, we do have more people living in you know, Tallahassee area, then sort of some of these more rural areas, we actually overlay the rural, the urban rural classification, so you can see that a little bit, so you can see the rural areas of the state. They definitely have fewer people and so it’s less shocking that they would have, you know, fewer providers. Also very hard to get providers to live in some of these very rural areas.
Lauren Pierce
Have you looked at internet access?
Lisa Lines
Yes. It’s not on this map. It’s not one of the things that we can show on this map. But we do have internet access. And broadband is definitely a social determinant of health, we know that more than ever, it is a social determinant of education and employment and of health. So it’s all of those things. And that’s why, you know, some states — Massachusetts has 98% broadband access across the state. And they’ve really made a push for that. I don’t know if there’s the same kind of efforts in the state level in Florida. But I know that the federal government has just made some plans to put out a lot of funding for getting broadband and more rural communities.
Lauren Pierce
I know that the city did send out a survey asking for kind of our experience, you know, what kind of access we have, and what, how do we feel about our access, and I was assuming that was leading to something down the road that they’re trying to do. I do know, during COVID, when all the kids were at home and trying to access. It’s very difficult for, you know, certain areas of the county, I mean, even the area I live in is not great doing we had some difficulties. But there’s also more resources to work around those difficulties, like getting on a hotspot, your phone, or you know, whatever you may have access to, but there were anecdotal stories, parents sitting in the parking lot in the school where the school had provided some sort of access so their kids could get online. It’s, I think, a struggle. And when you think about looking at these census tracts that are the yellow color in Leon County, and hypothetically someone needs mental health services, they don’t have good internet access, they don’t have transportation, what do they do.
Lisa Lines
And we also have the ability to overlay substance use services, although this area doesn’t have the highest risk of substance use in terms of drug overdose, but still very high risk, you know, in some parts of the county, in terms of life expectancy, and also cancer mortality, they look pretty similar, the life expectancy and cancer mortality maps.
Lauren Pierce
It’s amazing to me, that overlap between all of the different scores that are showing. I believe I was telling you earlier, I was looking at some data on life expectancy in the county. And there’s a 20-year gap between the census tract with the lowest life expectancy and the tract with the highest life expectancy. And they’re five miles from each other. I know that we, you know, in public health know this, but if you just go into your county and do that exercise, it’s really mind boggling, because it’s real. Because you know the neighborhoods, you can visualize the neighborhoods that you’re looking at. And to realize that someone who lives in one neighborhood will die 20 years before on average, somebody who lives… you know, I live in one of the census tracts that has the highest life expectancy. And to just to realize that, okay, well, people in my census tract are going to live 20 years longer. It’s, it’s just hard to wrap your head around that. It really is.
Lisa Lines
It really is. I mean, that level of inequity in such a basic public health outcome, you know.
Lauren Pierce
In the state capitol, in a place in a place where almost 50% of people in this county have a bachelor’s degree or higher. So I mean, think about just that difference in what you have going on.
Lisa Lines
Yeah. So the path forward — we think about, you know, how can public health try to help address this? You know, one of the reasons that we do this project, with RTI Rarity, is to try to show where there’s potential for resources to be potentially enhanced in some places. For example, there’s an effort to have nonprofit grocery stores, in places with, you know, high food insecurity and no good access. So some great, you know, philanthropist could potentially, you know, seeing this map and seeing these areas, could potentially help put something together with the community to have a community-based food co-op. Other things like transportation, beefing up public transportation, housing. I don’t know about the quality of housing, the details in Leon County, but I would suspect that a fair number of these poor areas have substance substandard housing.
Lauren Pierce
There is a housing shortage here. Just across the board, there’s an affordable housing shortage across the board. And I think that’s probably the case in a lot of areas. It’s not just confined to Leon County, there are efforts to increase affordable housing here. If anyone’s interested who’s listening to this out there, the city is working on — they’re calling it the 32304 Project. That’s the ZIP code we were talking about earlier, we can dig a little bit deeper and find out some of the actions that the city is trying to take with partners to increase you know, food security and access to health care, in these these areas. Access to affordable housing. I recently heard the city speaking about transportation, they’re trying to work to provide more transportation in this area. So I think they’re trying, but you know, someone, to me if I come in and I see a map like this, I think policy, like how do we how do we change policy to help? Which, yeah, that can also be difficult depending on the state you live in. And the environment at the time. So sometimes it really is dependent on local leaders and local partners.
Lisa Lines
Well, looks like we’re just about out of time. I really want to thank you for coming on the podcast today and talking with me about Florida. It’s been really great to hear your insights and your thoughts about how public health can really make a difference in reducing some of these inequities that we see across the US and in your own county.
Lisa M. Lines