Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 109

The environment in which a person lives can have a significant impact on their overall health status. There are numerous examples of major differences in lifespan in people living in different neighbourhoods that are geographically near one another. One of the most marked examples is in Scotland, where the life expectancy in Calton, a poor suburb of Glasgow, is 54 years, whereas in Lenzie, just 12 km away, life expectancy is 82 years.²⁶ In Raleigh, North Carolina, life expectancy can vary by as much as 12 years, depending on ZIP Code.²⁷ In Canada, people living in poor areas have more arthritis, diabetes, high blood pressure, congestive heart failure, chronic obstructive pulmonary disease, and depression than those living in more affluent areas.²⁸

There are several mechanisms by which the living environment influences health status. Perception of crime limits older people's desire to walk outside their houses, leading to reduced physical exertion and risk of social isolation. Low‐income areas may be ‘food deserts’: areas with limited access to fresh, healthy food options due to a dearth of grocery stores or farmers' markets. Lower life expectancy may also be associated with higher amounts of environmental pollutants, which in turn can lead to respiratory disorders, cardiovascular disease, and adverse epigenetic effects. Globally, an estimated 844 million people lack access to clean, fresh water. Disparities in living environments will require enhanced public policy and environmental regulation. Some older adults who are financially able will ultimately choose to move to another area they perceive as safer, although in doing so, they risk loss of social networks and isolation.