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Well, duh! No one who lives in the United States has missed the news that lifestyle choices affect our health, but just in case you have missed one point or two, I have made up an easy-to-take quick quiz. Please choose the healthier of each of the two options listed below:

• Bacon cheeseburger with fries or kale salad with salmon.

• Binge-watching Netflix series or a brisk two-mile walk.

• A double chocolate milk shake or unsweetened green tea.

• A pack of cigarettes a day or an air purifier in your bedroom.

• Sleeping in on Saturday morning or hitting the gym for an hour or so.

• Riding the elevator to the second floor or taking the stairs.

• Driving around the parking lot until you find a parking place near the store or parking at the far end of the lot and hoofing it to the door.

• A six pack of beer before dinner or one glass of red wine.

• A tanning bed or daily sunscreen.

The list goes on and on, but no doubt you made a perfect score on this easy quiz. The correct answer is the second option every time. It turns out, though, that life expectancy depends not just on the choices we make.

It also depends on where we live.

Recently released data compiled by researchers at the Robert Wood Johnson Foundation finds that just as urban areas offer more choices, amenities and overall wealth than rural areas, people who live in urban communities are generally healthier and have longer life expectancies than their neighbors in rural areas. 

Let that sink in for a moment. 

Short of an untimely accident, our own life spans depend not only on our own choices about how we live, but also where we lay our heads at night. For example, the study finds that a person born and raised in Raleigh has a life expectancy of 80 years, while a similar person born in Martin County, a rural area 75 miles away from Raleigh in eastern North Carolina, can expect to live to 73. Equally startling is the finding that life expectancy varies within communities. A person living in an affluent North Raleigh suburb can expect to blow out 88 candles, while a similar person in poorer southeast Raleigh might need only 76 candles.

The entire picture is, as they say, complicated.

Life expectancy in the United States has been rising over much of the last century for all sorts of reasons, including access to healthcare and personal lifestyle choices. More subtle factors are at work as well. 

People without ready access to fresh food — those who live in so called “food deserts,” are more likely to eat larger quantities of processed foods and to suffer from obesity and its dangers. People who live in areas without safe places to walk or with few recreational options are less likely to reap the benefits of regular exercise. 

It gets more complicated and worse. People who live in places with poor schools are less likely to learn healthy living habits, and those with low-paying jobs are less likely to afford fresh foods, even if they are available. People who live in unsafe housing face a number of health issues, including unsafe paints and other pollutants. The list goes on and on.

The folks at the Robert Wood Johnson Foundation stress that their findings are general information, not applicable to specific individuals. Rather, they hope policy makers at the local and state levels will use the data in making public policy decisions. Says Derek Chapman of Virginia Commonwealth University who helped produce maps detailing health and well-being discrepancies by place, “Our goal is really just to help local officials, residents and others understand that there’s more to health than healthcare. We’re really advocating that health be part of the discussion when talking about public policy.”

Chapman probably does not follow decision-making in Fayetteville and Cumberland County, but he is absolutely correct in saying public health concerns should be part of the decision-making process concerning where Fayetteville locates swimming pools and how Cumberland County addresses stunning and embarrassingly high rates of sexually transmitted diseases, especially among young people.

Easy answers and quick fixes do not exist for the complex and intertwined factors that contribute to or detract from good health and longevity. As Chapman puts it, “Improving health requires having a broad range of players at the table. Education and income are directly linked to health. On an individual level, having a higher educational level usually leads to having a better job, better insurance, but your income and education also determine the kind of neighborhood in which you can live.

City council members, county commissioners and legislators, are you listening? 

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