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Access to reliable, affordable healthcare is just one criterion that establishes life expectancy.

You know that different factors influence your approximate lifespan: smoking or non-smoking, quality of diet, amount of air pollution, regular physical and dental checkups, et cetera. But did you know that where you live can also play a factor in how long you are expected to live? It’s a fact, studied by Virginia Commonwealth University and the Robert Wood Johnson Foundation. Philadelphia is no exception. In some neighborhoods, your likelihood of living to a ripe old age is better than in others.

For example, in tony Society Hill, the average life expectancy is a lengthy 88 years. In North Philly, the number is 20 years lower. Other spots around the city are somewhere in between: 73, 74, 78. What causes the difference in these numbers? From the Inquirer:

Where you are born, grow, work and age are fundamental factors of cardiovascular health over the course of your life. Living in a disadvantaged neighborhood — which can mean having less access to heart-healthy food and fewer socioeconomic resources like education and family income — is associated with a higher risk of cardiovascular disease, leading to a higher percentage of premature deaths.

There are several areas in Philadelphia that lack factors necessary for good cardiovascular health, like access to parks, running tracks, or gyms. You can’t work out if you lack a place to do it, obviously. Then there is the concept of “food deserts.” They are a real thing, and Philly is spotted with them. These are areas of the city that lack convenient access to good grocery stores offering fresh fruits, vegetables, and other necessities for a reasonable price. In these deserts, the only viable options for food shopping may be convenience stores, where much of the food is canned or processed and prices are inflated. You have to have access to good food to stay healthy.

Another unfortunate factor at play is race, and how the racial majority of an area interacts with or trusts healthcare providers. This prejudice can be double-sided. If patients don’t have a good working relationship with the doctors that are charged with keeping them healthy, their lifelong wellness can suffer for it.

The study concluded that changes to these sharply distinct lifespans can only be made over time, with gradual change. There are no easy answers.