​“Zip Code Matter”

​“Zip Code Matter”
Debra Johnston, MD


Those of us who make our homes in the rural midwest understand that we face medical challenges our countrymen in more populated areas don’t. For example, there are two pediatric rheumatologists in the whole state of South Dakota. . . and they are both based in Fargo. In contrast, there are 10 in the Twin Cities with the University of Minnesota alone. In Winner South Dakota, you are nearly 150 miles away from emergency access to a neurosurgeon, assuming you can go by air. No matter where you are in Connecticut, that help is no more than 50 miles away. 


These ideas are probably obvious to anyone reading this. If we haven’t had to travel for medical care ourselves, we know someone who did. But other factors, things that have an even bigger impact on our well being, may be less familiar. 


Economics plays a role, of course. Can you afford your medicine, or to go to the doctor? Do you have time off for that appointment? Are you choosing between keeping food on the table and a roof over your family’s head? Are you filling up on cheap empty calories, or are you able to buy fruits, vegetables and eggs? 


Where you live matters in other ways. Can you buy those healthy groceries nearby? Are there safe places to walk, and for your children to play? How clean is the air in your community? Does your home have lead paint or asbestos insulation? Is the water that comes out of your tap safe to drink, or is it contaminated with chemicals or lead? Does the noise in your neighborhood keep you awake at night? 


Zip codes can impact the infrastructure around you in ways that affect residents unequally. How accessible is the environment? Are people with mobility challenges able to easily enter retail spaces? Do they have housing options? Are the schools able to support children who face learning challenges? Can you find childcare while you work? Can you practice your faith in your community? Social engagement protects your well-being. 


Even our genes are affected by our environment. This is a fascinating new concept that many of us never study in school. Scientists have learned that external factors influence how our genes are expressed, without changing our DNA. These factors start working before birth: nutrition and stress experienced by a pregnant woman influences the development of her child, and has an impact not only throughout that child’s life but into subsequent generations. 


As we think about health, let’s not forget that we aren’t all starting in the same place. It’s worth thinking about how we can address some of those disadvantages.


Debra Johnston, MD. is part of The Prairie Doc® team of physicians and currently practices as a Family Medicine Doctor at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB and  streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust.