Access Denied: When Geography Becomes a Health Risk

Authored by: Rma Polce

Art by: Priscilla Liu

When we think of a healthy person, we often envision someone who exercises regularly, eats nutritious meals, and has access to preventive care. But imagine you’re in a place where an outside run means exposure to harmful pollutants, the healthiest food nearby is a fast-food sandwich, and the closest clinic is an hour away. This is the reality for millions of Americans who live in medically underserved communities. In these areas, your family history and habits are not the only factors determining your health – your ZIP code plays just as significant a role.

In majority-minority communities and rural areas, chronic disease risk and prevalence are significantly higher than in affluent, majority-White communities. For example, the prevalence of cardiovascular disease-related death is highest among minorities, with Black individuals having the highest age-adjusted mortality rate [1]. Alarmingly, roughly 33% of the disparity in rates of uncontrolled blood pressure (a common comorbidity of cardiovascular disease) between Black and White populations can be explained by social determinants of health [1]. Additionally, rural residents have higher rates of diabetes and hypertension than their urban counterparts [2]. These disparities translate into worse outcomes: rural counties report higher premature death rates, particularly from ischemic heart disease and diabetes [3]. Mechanisms driving these inequalities in health outcomes include fewer grocery stores and healthy food options, higher poverty and unemployment rates, and reduced access to preventative care [2]. In short, where one lives has a significant impact on both the likelihood of developing a chronic illness and the chances of surviving it.

These disparities are relatively well-documented, and the rural-urban gap is especially striking. The life expectancy for rural men at age 60 is 20.9 years, compared to 22.9 years for their urban counterparts, indicating that, on average, rural men live 2 years less [4]. The gap is smaller for women, but still notable: rural women, on average, live six months less than their urban counterparts [4]. Rural populations also have fewer projected healthy life years than urban residents [4]. Access plays a major role in this divide: rural communities face not only geographic isolation from hospitals but also a dwindling healthcare workforce. In 2019, 64% of rural health staff reported difficulty finding specialists for patient referrals [5]. Infrastructure exacerbates these challenges, as an estimated 40% of rural roads are “inadequate for current travel,” and nearly half of rural bridges are considered “structurally deficient” [6]. These realities underscore how geography and infrastructure intersect to shape life expectancy. 

Other communities have similar, seemingly embedded, disparities. For example, the uninsurance rate is 18% in formerly redlined districts, compared to only 6% in A-rated census tracts [7]. This directly limits access to care, since healthcare becomes more costly without coverage [7]. Beyond this, neighborhoods historically recognized as underserved have dramatically higher rates of chronic disease than their counterparts [8]. In 2024, the Primary Care Development Corporation reported that previously redlined communities had a poverty rate nearly four times higher than “more desirable” census tracts [7]. These areas also have lower median household incomes and home values, leaving residents economically disadvantaged [9]. The effects are also social: approximately 60% of Black, 50% of Native American and Latino, and 40% of Asian adults reported feeling they had to be careful about their appearance or brace for possible insults during healthcare visits [7]. These statistics underscore how historically marginalized communities continue to face disparities in health outcomes and community well-being simply because of their location.

These patterns are the result of structural and historical forces that have shaped where people live and what resources they can access. White flight in the mid-20th century left many urban minority neighborhoods with declining tax bases, underfunded schools, and reduced investment in healthcare infrastructure [11]. Similarly, redlining and housing discrimination systematically restricted where Black and immigrant families could buy homes, locking them into neighborhoods with fewer economic opportunities and weaker public services [12]. Over time, these socio-economic conditions have compounded, embedding health risks into the very geography of a community. In other words, ZIP codes bear the weight of social determinants – including economic opportunity, housing quality, and environmental conditions – that profoundly shape who can live a healthy life. 

Emerging solutions to these entrenched inequities increasingly focus on addressing their root causes. Habitat for Humanity’s Cost of Home campaign is designed to reverse the legacy of disinvestment and segregation through down payment assistance, equitable lending, reinvesting in historically redlined neighborhoods without displacing current residents, and reforming exclusionary zoning laws to allow for more affordable, mixed-income housing [13]. Equally important are efforts to strengthen affordable rental programs, such as expanding housing vouchers and providing mobility support so families can access high-opportunity neighborhoods [13]. Together, these strategies aim to close the racial homeownership gap and stabilize communities by ensuring residents have access to safe, affordable housing. While these interventions are primarily framed as housing policy, they are inextricably linked to health. Stable, affordable housing reduces stress, improves access to quality schools and healthcare, and fosters healthier environments overall.

Ultimately, addressing health disparities demands systemic interventions that reshape the environments where people live, learn, and work. By investing in equitable housing, infrastructure, and community resources, we can begin to ensure that a person’s ZIP code no longer dictates their life expectancy or quality of life, but instead supports the health and well-being of all residents.

References: 

1. Chaturvedi, A., Zhu, A., Gadela, N. V., Prabhakaran, D., & Jafar, T. H. (2024). Social determinants of health and disparities in hypertension and cardiovascular diseases. Hypertension, 81(3), 387–399. https://doi.org/10.1161/HYPERTENSIONAHA.123.21354

2. Ricketts, T. (2002). Geography and disparities in health care. In Guidance for the National Healthcare Disparities Report. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK221045/

3. Eberhardt, M. S., Ingram, D. D., Makuc, D. M., et al. (2001). Urban and Rural Health Chartbook: Health, United States, 2001. National Center for Health Statistics .https://www.cdc.gov/nchs/data/hus/hus01.pdf 

4.  Chapel, J. M., Currid‐Halkett, E., & Tysinger, B. (2025). The urban-rural gap in older Americans’ healthy life expectancy. The Journal of Rural Health, 41(1), e12875. https://doi.org/10.1111/jrh.12875

5. Lahr, M., Neprash, H., Henning-Smith, C., Tuttle, M., & Hernandez, A. (2019). Access to Specialty Care for Medicare Beneficiaries in Rural Communities. University of Minnesota Rural Health Research Center. https://drive.google.com/file/d/19F780DnYgdqW_d9RAwa94jERIQGt7BkX/view

6. Rural Health Information Hub. (2024). Barriers to transportation programs in rural areas - RHIhub Toolkit. RHIhub. https://www.ruralhealthinfo.org/toolkits/transportation/1/barriers

7. Chen, A. M. (2025). Barriers to health equity in the United States of America: Can they be overcome? International Journal for Equity in Health, 24(1), 39. https://doi.org/10.1186/s12939-025-02401-w

8. Mohottige, D., Davenport, C. A., Bhavsar, N., Schappe, T., Lyn, M. J., Maxson, P., Johnson, F., Planey, A. M., McElroy, L. M., Wang, V., Cabacungan, A. N., Ephraim, P., Lantos, P., Peskoe, S., Lunyera, J., Bentley-Edwards, K., Diamantidis, C. J., Reich, B., & Boulware, L. E. (2023). Residential structural racism and prevalence of chronic health conditions. JAMA Network Open, 6(12), e2348914. https://doi.org/10.1001/jamanetworkopen.2023.48914

9. Perry, A., & Harshbarger, D. (2019). America’s formerly redlined neighborhoods have changed, and so must solutions to rectify them. Brookings. https://www.brookings.edu/articles/americas-formerly-redlines-areas-changed-so-must-solutions/

10.  Zou, L. (2021). White flight may still enforce segregation. American Psychological Association. https://www.apa.org/news/press/releases/2021/10/white-flight-segregation

11. Blakeslee, J. (1978). White flight to the suburbs: A demographic approach. Focus: Institute for Research on Poverty Newsletter, 3(2), 1-4. https://www.irp.wisc.edu/publications/focus/pdfs/foc32a.pdf 

12.  Peiffer, E. (2023). The Ghosts of Housing Discrimination Reach Beyond Redlining. Urban Institute. https://www.urban.org/stories/ghosts-housing-discrimination-reach-beyond-redlining

13. 5 policy solutions to advance racial equity in housing. (n.d.). Habitat for Humanity. https://www.habitat.org/stories/5-policy-solutions-advance-racial-equity-housing