A Tale of Two Zip Codes

Pritpal S Tamber

April 18, 2016

How Building Healthy Communities' recent animation goes beyond the usual rhetoric on 'social circumstances' to focus on 'opportunity' as key to health, and not just for the poor, but for all

Over the weekend one of California’s largest foundations, The California Endowment, convened over 600 partners from across the state to celebrate the first five years of Building Healthy Communities (BHC). BHC is a 10-year, $1bn comprehensive community initiative to change the narrative around health, advance statewide policy, and transform 14 communities devastated by health inequities into places where all people have an opportunity to thrive.

In addition to dozens of workshops highlighting successful strategies on everything from reforming school discipline to stopping displacement, the convening put the BHC theory of change into action with a march, entitled ‘Taking It To The Street’, to deliver a message of “solidarity in support of equity and inclusion”. With the hashtags #WeAreBHC and #GetLoud it created quite a flurry over social media.

It’s important to note that they did not say ‘health equity’. They said ‘equity’. Their work centres on the idea that our health is the result of our social circumstances. These are not equitable (‘fair and impartial’, according to my dictionary), which is why the health outcomes seen between and across communities are not. BHC’s leaders believe ‘inclusion’ is key to health.

Anthony Iton, the Senior Vice President in charge of the programme, was a member of the 2015 Creating Health Collaborative (and will return for 2016). In our recent report, Eleven Principles For Creating Health, he talks about how one of their key challenges is communicating their work (see page 24):

One of the challenges we face is telling our story. We must make order out of a complex effort in a way that inspires others, allows them to see themselves in the work, and motivates them to replicate it.

To preface this weekend’s event Building Healthy Communities embraced this challenge by producing an animation, A Tale of Two Zip Codes. As well as share the animation, I am also sharing the script (see below) with two parts made bold, which I comment on.

Here’s the script:

What determines how long we’ll live? Is it what we do? Is it who we are? Actually, when it comes to predicting how long you’ll live, your zip code is more important than your genetic code! Here’s how this works…

Meet Deb and Maria.

They both have jobs, they’re around the same age, they’re both married, and they both have two kids. Deb lives in A-Town, while Maria lives in B-Ville, less than one mile away. They’re similar in so many ways… but here’s the thing: on average, residents of B-Ville will die more than 15 years sooner than the residents of A-Town.


Because where you live is about more than just your address; it’s about your opportunities. For example, Deb and Maria’s access to healthy options is really different. In A-Town, Deb’s family is surrounded by healthy food options, including farmer’s markets, specialty shops, and grocery stores. The air in A-Town is cleaner and fresher. And there are lots of safe clean parks where Deb can exercise, and her children can play. A-Town has good  public schools for Deb’s kids, and easy access to emergency and preventive health care.

On the other hand, B-Ville has broken, badly lit sidewalks. And the parks are unsafe. The air is filled with truck exhaust from the nearby highway. And for food options, Maria’s only choices are B-Ville’s many liquor stores, fast food places, or convenience stores. The schools in B-Ville are overcrowded, and under-supported. And even if Maria can get her kids into better schools far away, she needs to figure out how to get them there without access to a car.

So for Maria, having to juggle so much to find healthy options can be an overwhelming source of chronic stress, which is a serious health risk factor. In fact, for all the residents of B-Ville, chronic stress drives health problems like obesity, diabetes, asthma, and heart disease.

How did A-Town and B-Ville get so different?

Well, in many cases in cities and towns across California the root cause was racial and economic discrimination. Over the generations, poor white people and people of colour were pushed to less desirable parts of town, where banks refused to lend money, businesses left, jobs too, schools declined, and the neighbourhood crumbled. Everyone who could move away did. 

And what’s more, when communities like A-Town and B-Ville are so unequal, B-Ville isn’t the only one that suffers. Because, it turns out that not only is your zip code a predictor of how long you’ll live, so is what country you live in! Countries with the greatest income inequality have the lowest life expectancy. So even Americans like Deb, who are white, insured, college-educated, and upper income, die younger than their peers in other countries. In fact, our life expectancy is 43rd in the world, and that number is slipping.

In the end, our biggest health risk may actually be inequality, and extreme inequality hurts us all! So what do we do? Well, if we’re all going to be healthier, we don’t just need to help the folks in B-Ville beat the odds, we need to change the odds for everyone.

I think what I like most about this ‘tale’ is how it doesn’t just rest at social circumstances (a euphemism for being poor). It goes further by not only saying that ‘opportunity’ matters but also that it matters for all, not just the poor. It is, in fact, more than just a tale of two zip codes. It may well be the tale of our times.

This is a slightly edited version of the original post (which was also sent by email). The first two paragraphs have replaced the original paragraph, which read: “Over the weekend the California-based programme, Building Healthy Communities (BHC), held an event entitled Taking It To The Street to hone, amplify and deliver a message of “solidarity in support of equity and inclusion”. With the hashtags #WeAreBHC and #GetLoud it created quite a flurry over social media.” This paragraph wasn’t as clear as it could have been, hence the edit. 

Pritpal S Tamber

I’m a doctor who trained as a medical editor and publisher and now researches and consults on the link between community power and health equity. My interest in community power started when I was the Physician Editor of TEDMED and is explained in My Perspective. I also work as a freelance medical editor and publisher for organisations that want to write high-quality articles and a strategy for their publishing and promotion. Find out more on my About page.

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