Philadelphia ranks dead last on health. And with budget cuts . . .

The City of Brotherly Love is the poorest big city in America, and also its fattest, and poverty and obesity and overweight are associated with a host of lifelong health problems. (AP Photo/Elaine Thompson)

By Michael Yudell

Here at The Public’s Health we’ve reported on the poor health conditions faced by many Philadelphians. The City of Brotherly Love is, for example, the poorest big city in America, and also its fattest, and poverty and obesity and overweight are associated with a host of lifelong health problems.

And it's factors like these that add up to Philadelphia's ranking dead last for health outcomes in Pennsylvania, according to the recent County Health Rankings Report.  The report is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, and it can be instructive to examine the measures that affected the rankings for individual counties at both the top and bottom of the list. 

Some of the wealthiest counties in Pennsylvania were deemed among the healthiest in the state — Chester (No. 2), Montgomery (5), and Bucks (7) — while more urban Delaware County ranked a worse-than-average 37. The New Jersey suburbs, all of which are less-well-off than their northern counterparts across from New York City, were all in the middle of the Garden State's rankings or worse: Burlington (10), Gloucester (14), and Camden (18).

Philadelphia was 67th out of 67 counties for the third year in a row (and this on the third such report). The overall ranking, to put it mildly, is a failing grade. And among the categories that go into it, premature deaths and general poor health both are also at the very bottom statewide.

Contributing to these awful outcomes is the fact that the city also holds the poorest ranking for low birthweight babies. Tragically, more than 1 in 10 babies born in Philadelphia weigh less than 5 lbs. 8oz., an indication that too many of Philadelphia’s children are getting off to a rough start. From the get-go, these kids face difficult odds — low birthweight babies are more likely to have greater developmental problems (both physical and cognitive), and have increased lifetime risks for cardiovascular disease, respiratory conditions, and type 2 diabetes.

According to the report, 1 out of 5 Philadelphians are in poor or fair health, a state of affairs driven by the high rates of smoking, obesity, physical inactivity, and excessive drinking. Other factors adding to this burden include a high rate of unemployment, an outrageously high rate of children living in poverty (36 percent of kids under 18 in Philadelphia compared to 19 percent statewide, which is also pretty high), and a sky-high violent crime rate. A deteriorated physical environment just makes matters worse. Air pollution in the city is poor (though improving), most city residents have limited access to recreation facilities and healthy foods, and fast food restaurants make up a whopping (and nauseating) 55 percent of all city food establishments.

So what do we do to fix this problem?

Nationwide, the push for austerity measures to balance budgets and decrease stimulus spending is making it harder to implement solutions to these challenges and is having a dangerous impact on public health programs. As most economists agree, austerity in a downturn only makes things worse.

Here in Pennsylvania, we haven’t seemed to learn that lesson, and Gov. Corbett’s budget proposal — with massive spending cuts and no new taxes — includes deep cuts to public welfare and education programs. Back in February, Philadelphia Health Commissioner Donald Schwarz called the cuts “alarming,” and worried about their impact on the city’s most vulnerable, including those with mental illness, the homeless, HIV patients needing hospice care, and the elderly living in the city-run nursing home.

With the poor health outcomes that Philadelphia and other counties in the state are seeing, can we really afford the types of cuts that the austerity disciples are advocating? Are we prepared to bear the human cost of continued cuts to our social safety net?

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