Your zip code has some impact on your health, but the details are not as simple as one might imagine. We know, for instance, that lifestyle health benefits are more difficult to achieve in people in the inner city, who work long hours, who have lower income with financial stress, and who live in rural areas. People traditionally who live in areas with more health care also tend to engage in more beneficial lifestyle practices.

But in fact, as indices such as the Dartmouth Atlas have shown, it's not the healthcare making them healthier, it's them. Higher proportions of hospitals, academic centers, and specialty care is inversely connected to health outcomes; the more specialists, the worse the health, the more the overtreatment, and the higher the cost. This has been a consistent finding. What matters more in medical health is access to primary care and to an emergency room; both are in short supply in rural areas, and the inner city lacks robust primary care, as does most of the country.

We will dissect the relationship between where you live to your health, and it comes down to two factors we often discuss: primary care and lifestyle.

A lot of people have started buying devices promising to find problems and lead to cure. These may include sugar monitors, blood pressure cuffs, and even monitors to find heart irregularities including the dreaded afib. But are these devices helpful, or could they have a dark side? We discuss all of this today, but we also focus on what is most important to home safety and health promotion, and it has nothing to do with gadgets. Well, one gadget is beneficial, one that you can press if you fall! But a major goal of the home is to set it up to prevent falls, to let in light, to enable you to get out (and others to get in) to keep you social, to help you to eat well. We talk about the best ways to assure you are safe and thriving at home, and talk down the recent focus on gadgets to find problems that are not really important.

Alan and Andy discuss the HALE scale, a subset of longevity that measures the average length of years people live without being disabled. The longevity in our country averages 79 years, about 4 years lower than most industrialized nations. But we do far worse in the HALE score, where our healthgevity (the average length of life we live not disabled) is 63 years, meaning that on average we spend the last 16 years of our lives suffering poor health or frank disability. Compare this to other industrialized nations, where the average HALE age is 74 years, a full 8 years longer than us, with less end of life disability. Why?

We spend far less on primary care and lifestyle care than virtually any other country. We are a specialized, high tech system that becomes interested in you only when you get sick. Thus, little attention is spent on prevention. How can we fix this? We lay it out in our book, and we talk about it on this podcast. The solution is easier than you may know, but it will take some pushback from those most harmed to create change.