Patricia Mathewsis president and chief executive of the Northern Virginia Health Foundation.
Every March, a national study comes out showing that Northern Virginia is home to the healthiest counties in Virginia, with Arlington, Loudoun and Fairfax counties and the city of Falls Church reliably at the top of the list of counties (and Alexandria and Prince William County typically not far behind).
Northern Virginia should be proud of our overall health and well-being — but also well-informed about what’s missing from the county health rankings story.
The rankings are based on averages that mask tremendous disparities in Northern Virginia. And if you dig deeper, census tract data paint a stark picture of Northern Virginia’s 15 “islands of disadvantage” — clusters of places where residents face multiple health challenges, including poverty, less education, unaffordable housing and a lack of health insurance.
There is always room for improvement. For example, in 2019, Loudoun County and Falls Church ranked 119th and 53rd, respectively, of 133 counties in the commonwealth for “physical environment” (air pollution, drinking water violations, severe housing problems, long commute times) despite being ranked as the No. 1 and No. 4 healthiest counties, respectively, overall. And Fairfax County had lower mammogram screening rates than the Virginia average. Even the top counties can do better.
And because Northern Virginia generally receives high marks — and not just in the county health rankings — local budgets are often challenged and cut because of the assumption that there are few challenges in the region. One such challenge is life expectancy, which, in Northern Virginia, ranges from 71 years to 89 years, depending on where you live.
Neighborhoods with lower life expectancy also tend to have other poor health outcomes, and residents with lower incomes and less education. And the Hispanic and African American populations (about 17 percent and 11 percent, respectively, of Northern Virginia residents) represent much larger proportions of those who live in the region’s more disadvantaged communities, including Woodbridge in Prince William County or Herndon and the Route 1 corridor of Fairfax County.
Part of the problem for Northern Virginia is that many people’s image of poverty is a stereotypical urban view of big dilapidated apartment buildings, no trees and broken sidewalks. Northern Virginia has a lot of trees. And even our most disadvantaged neighborhoods have detached homes that may look nice from the outside but may not be structurally sound or have more people living in them than should be there. There are definitely health consequences associated with inadequate or dilapidated housing.
Take the wealthy Lake Barcroft neighborhood in Fairfax County, for example. Right down the street is the Culmore neighborhood, where household incomes average $100,000 less. And 57 percent of Culmore residents lack health insurance compared with 3 percent in Lake Barcroft — a difference that doesn’t show up in county rankings.
The suburbanization of poverty is something that people have been talking about for some while. And it’s a fact. But it’s not just “those people.” It’s also right here.
The truth is that while Northern Virginia’s average is excellent, its high rankings are misleading because they are disproportionately influenced by the great wealth in Northern Virginia’s counties.
What can we do? We can remind our leaders that census tract data can help us see challenges more clearly and target our efforts and our budgets. We can ask them to pay attention to disparities and inequities — and then take specific steps to reduce those disparities and inequities, beginning with investments in marginalized communities aimed at reversing the consequences of decades of disinvestment.
We also all need to understand and then share this simple fact: Though the opportunities that exist in Northern Virginia — from our quality of life to our economic vitality — are something to be proud of, they are not uniform. Health inequities and disparities affect each jurisdiction’s economy, every business’s health-care costs and each local government’s annual budget. And health inequities and disparities also challenge our basic sense of fairness.