Published on April 17, 2018
In the last several issues of Carrot Health Insights, we discussed each of the “Big Four” social and behavioral determinants that affect population health and cost outcomes. To recap: a person cuts his or her risk of cancer by 60%, and risk of most chronic illnesses by 80%, if he or she consistently does these things:
- Doesn’t smoke (Healthy Behavior #1)
- Gets around 150 minutes of moderate exercise per week (Healthy Behavior #2)
- Has a normal body fat percentage (Healthy Behavior #3)
- Has a healthy diet (Healthy Behavior #4)
Unfortunately, 82% of the US population demonstrates zero, one, or two of these behaviors. As a result, our country is suffering from an epidemic of chronic illness. We spend an enormous amount on sick care (treating chronic conditions after they emerge), and not nearly enough on health care (keeping people healthy, thereby preventing many chronic conditions from happening in the first place).
If we’re going to bend this unsustainable cost curve, we need to flip the sick care/health care equation upside down. Data – especially consumer data on Social Determinants of Health (SDoH) – will help guide the way forward.
What does the data show when we combine all of the Big Four SDoH factors together? Can we distill the vast universe of SDoH into a single measurement that allows us to evaluate and track the health of different communities? To answer this question, the Carrot Health data science team created the Carrot Health Score. We started with the Big Four, and then added in several other SDoH factors that are known to influence population health outcomes, as shown in the table below:
Social Determinants of Health – Factors Used in the Carrot Health Score
When applied to a population, our model generates a number that summarizes the projected long-term overall health of a given community. The map below shows a county-level view of the Carrot Health Score for the US. The green areas represent the best-scoring (healthiest, lowest risk) counties; the red areas represent the lowest-scoring (unhealthiest, highest risk) counties:
Carrot Health Score – United States (County Level)
This map vividly illustrates the geographical health disparities in our country. Our results are generally consistent with other widely-used studies such as County Health Rankings, but there are some interesting variances. For example, Marshall County ranks #1 out of 165 counties in Kansas based on its Carrot Health Score, but #31 according to County Health Rankings. Our analysis also demonstrates the limitations of analyzing populations at the state level – Colorado is a relatively healthy state, for example, but a few Colorado counties have very low Carrot Health Scores. The table below shows the 10 highest- and lowest-scoring counties in the US:
Highest- and Lowest-Scoring Counties in the US
The Carrot Health Score allows us to track community health at a much more granular level – all the way down to neighborhoods and individual households. Drilling down further geographically, the map below shows the Carrot Health Score for the Los Angeles metropolitan area, at the ZIP Code level:
Carrot Health Score – Los Angeles Metropolitan Area (ZIP Code Level)
As underlying SDoH data factors change over time, Carrot Health Scores change too. This means that Carrot Health Scores have value as benchmarks – they can serve as independent measurement frameworks that healthcare providers, payers, community health and social workers, public health officials, and other stakeholders can use to target resources and track progress.