This post is adapted from the author’s presentation at the Colorado Health Foundation’s Colorado Health Symposium on July 30, in Keystone, Colorado.
A common refrain among health care and public health researchers and practitioners is that a person’s zip code has a greater influence on their health outcome than their genetic code. The goal of this statement is to emphasize the importance of social determinants of health in improving health outcomes.
But is this sending the right message, or does it reinforce, in some minds, that health inequities are calcified within communities with little chance of improvement? Has the progress made since the publication of the 2002 Institute of Medicine (IOM) report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, as good as it gets?
My answer to those questions is a resounding “no,” AND, I propose that now is a unique moment to make leapfrog improvements in health equity.
The reason for my optimism is in the alignment of three key factors. The first is the Affordable Care Act, which created a shift in financial incentives from health care to health.
The second is the exponential growth in health technology and innovation sparked by the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the American Recovery and Reinvestment Act of 2009 and the ubiquitous presence of personalized technology, such as smartphones, fitness trackers, and so forth. These devices allow us to move from a mass-marketing approach (that is, mass mailings or signs on public buses) to health disparities to more targeted advertising (that is, pop-up ads) generated from analytics in electronic medical records and other data sources.
The third is the early adoption of technology, particularly smartphones, by communities and populations most at risk for health inequities.
In short, for the first time, we have people incented to create and use solutions that are highly effective in changing behavior and coveted by those people with the greatest needs.
Failure to act in a robust way during these perfect conditions will affect those communities most at riskand our country as a whole. The actions we take must be conscious, planned, and purposeful.
There are three practical ways to begin this work now in a manner that respects and values the resilience and resources of communities experiencing the greatest health inequities.
- Practice. As noted in an April 14, 2015, Journal of the American Medical Association article by Winston F. Wong and coauthors, health care organizations must move outside their four walls in their approach to health equity. They must move beyond equity in health care access to equity in outcomes. We can now use data science to drive the development of community-based interventions that focus on population health in its original meaning—what I like to call “Precision Medicine for Population Health.” Previously, large national data sets such as those that informed the National Healthcare Quality and Disparities Report, published by the Agency for Healthcare Research and Quality, were often outdated by the time we got them. Now with new data analytic capabilities and the multitude of data being generated through personal devices, public data sources, and electronic health records, we have the opportunity to be more precise and timely with identification of disparities and development of interventions and solutions. In addition, special populations that were often not studied because of insufficient data (that is, Native Americans, sub-populations of Asian Americans, and so forth) can now be studied, given the expanded channels of collecting data.
- Policy. Advocating for policies in your local community that support social justice and impact social determinants of health are key to assuring that there is infrastructure necessary to address identified health inequities. In 2010, King County, where Seattle, Washington, is located, adopted a countywide strategic plan to integrate efforts of equity and social justice to “be intentional about providing equitable opportunities for all people and communities.” The significance of this initiative was the collective work to look across various sectors such as transportation, housing, and health to understand how they intersect to affect outcomes for those at risk for disparities. Policy support to examine upstream factors that lead to health inequities is valuable. The next steps required are the development of funding mechanisms for program development (there is a role for philanthropy there), and implementation to address identified needs.
- Support of Innovative Community Partnerships. In today’s digital age, our definition of “community” expands beyond geographic boundaries; however, measuring the impact of change on health outcomes continues to be very local. We need models that use the strengths and expansive capabilities of technology while building on the culture, commitment, and knowledge of local communities to develop and achieve sustainable change.
A great example of a framework that is outside of health care but could easily be translated to health interventions is a program called Black Girls Code (BGC). BGC’s aim is to “increase the number of women of color in the digital space by empowering girls of color ages 7 to 17 to become innovators in STEM [Science, Technology, Engineering, and Math] fields, leaders in their communities, and builders of their own futures through exposure to computer science and technology.” The program’s founder, Kimberly Bryant, describes it as the “Girl Scouts of technology.” Volunteers in local communities sponsor and develop chapters with guidance from program leadership, and the participants develop skills to create technology solutions that address needs within their local communities. Communities then have ownership of the program and increase the likelihood of residents’ buy-in and sustainability.
Another important goal of partnerships should be to build community capacity. Programs are needed that provide service to the community to address health needs and increase access to job opportunities—particularly programs for young people to increase the capacity of communities to create and sustain their own solutions.
With initial funding by the Center for Medicare and Medicaid Innovation and the Centers for Disease Control and Prevention, HealtheRx and MAPSCorps, connected programs on the South Side of Chicago, are doing just that. CommunityRx is an innovative program that connects health care providers and clinics with community health resources to meet their patients’ needs, such as counseling, fitness education, and domestic violence shelters. To assure that the information provided is accurate and up-to-date, CommunityRx founders developed MAPSCorps, which employs local youth to generate the data. Youth then get the added benefit of participating in a program that exposes them to STEM careers and engages them in providing service to their community.
A common thread for each of these approaches is to start with the community–whether it is letting community-generated data inform what types of interventions are developed and where, or guide policies that help us more effectively support programs.
Honestly, this is not groundbreaking information. Many of the examples above are not new, and others are based on examples that people have tried before. It is just the right time.
