Life expectancy and public health in Philadelphia
written by Cheryl Bettigole, MD, MPH, MA Executive Director, Penn Center for Public Health
In its Strategic Plan, Penn Medicine set the ambitious goal of increasing the life expectancy of community residents. To reach that goal, we first need to understand what conditions cause city residents to die early and who is most at risk of early death. In Philadelphia, this data is publicly available on the PhilaStats dashboard as Years of Potential Life Lost before age 75 (YPLL).
Strikingly, four causes of death: heart disease, overdose, cancer, and homicide, made up more than half of all years of potential life lost in the city in 2024.
Early mortality is not equally distributed across the city. 32% of the YPLL lost in Philadelphia in 2024 occurred among Black men, who make up only 18% of the population. If we want to change life expectancy, we need to pay particular attention to strategies that protect the health of Black men. These same four causes of death led to more than half of all years of potential life lost in 2024 among Black men, although homicide contributed disproportionally to early deaths.
Each of the top causes of death is more common among people living in poverty, and we know that racism contributes immensely to poor health outcomes. Public health must align with other groups in working for systems and policy change to address these underlying factors, including the quality and affordability of housing, educational opportunities, mass incarceration, and job opportunities that pay a living wage. We also need to do everything possible to address more downstream risk factors for these specific causes of death and to ensure prompt access to prevention and treatment.
A few examples:
Tobacco use and hypertension are the two biggest drivers of death from heart disease, the top cause of premature death for all groups. Philadelphia has enacted multiple laws and regulations over the past few years to decrease tobacco use and has seen substantial progress, although tobacco remains a major underlying cause of death, causing about 3500 deaths per year. The Affordable Care Act requires insurers to cover FDA-approved tobacco cessation treatments without cost, but this free access is only available with a prescription – over the counter, these products can cost $30 or more per month. CPH is working together with the Nudge Unit and the Department of Family Medicine & Community Health to develop and implement systems-level solutions to improve treatment rates, building on innovative work at CHOP to automate screening and treatment through the electronic medical record.
Only about half of Americans with hypertension have their blood pressure controlled to the older goal of under 140/90, while fewer than a quarter achieve the updated goal of 130/80. The US has made essentially no progress in improving hypertension control since 2009. As a society, we tend to focus on actions by individuals, working to persuade both patients and healthcare providers to change their behavior to improve blood pressure control. Yet the clear lineup of hypertension risk with poverty and race points to the need for systems solutions, including finding ways to improve access to primary care, to make blood pressure medications free to patients, and to improve utilization of single pill combinations pills. These types of solutions can layer onto individual-level interventions to help improve community-level blood pressure control.
As we continue to work to develop strategies to tackle the top causes of early death in the communities around Penn, we look forward to collaborating with the many individuals and groups also working to solve these critical problems, both at Penn and in the community.