Your ZIP Code Knows More than Your Doctor

Published on December 21, 2016

Take a minute to look outside your window. Are you surrounded by parks, healthy food stores, and neatly maintained sidewalks … or fast-food restaurants, liquor stores, and bowling alleys?

Your physical environment plays a significant, but undervalued, role in determining your overall health status, quality of life, and longevity. In fact, your zip code is a stronger predictor of your overall health than other factors, including race and genetics.ZIP vs Doctor.jpg.png

Health disparities are observed across regions of the United States, as well as within local communities. Take New Orleans, for instance. The life expectancy for a child can vary as much as 25 years between neighborhoods just a few miles apart. In Boston, the Roxbury neighborhood has a life expectancy of 58.9 years. This is less than the life expectancy of countries such as Cambodia, Gambia, and Iraq. Residents in an adjacent census tract, just across Massachusetts Avenue, have a life expectancy of 84.2 years – a difference of more than two and a half decades.

These types of glaring health disparities can be driven by a variety of factors, ranging from social and economic determinants to surrounding physical environments. The Robert Wood Johnson Foundation posits that 80% of health outcomes are driven by non-clinical factors and only 20% by care access and quality.

It is one thing to acknowledge that these types of health disparities exist. It is a far greater challenge to identify underlying causes and develop population health interventions to mitigate them. The first step toward eliminating dramatic differences in health outcomes is to study their causes at the individual level. The relationship between unhealthy behaviors – like smoking, poor diet and lack of exercise – and adverse health outcomes is widely understood. However, these behaviors are often related to underlying social and economic factors that are less recognized. Collecting relevant social, behavioral and environmental data is critical for informing meaningful population health management strategies. Innovative organizations are taking action.

Carrot Health, for example, integrates a wealth of social data with health data and builds statistical models on behalf of its customers. Results of the models are thought-provoking and lead health providers to reimagine their patient engagement strategies:

  • People living in areas with a high fast-food restaurant to grocery store ratio are 23% more likely to have hypertension, and 14% more likely to develop congestive heart failure.
  • People living greater than five miles away from the nearest fitness center have 18% higher health care expenditures.
  • Controlling for age, gender, and zip-code level socioeconomic indicators, people with a high ‘social risk’ are 27% more likely to be a high cost claimant, 28% more likely to be diagnosed with diabetes, and 52% more likely to have multiple annual emergency visits.

Once the underlying causes of health outcomes are understood, timely and effective interventions must be employed to engage at-risk populations. Rather than traditional disease-specific treatment plans, new interventions should be innovative and scalable. They must emphasize prevention, and incorporate social needs of the population.

A great example of this new wave of population health intervention took place at CareMore – a California based Independent Physicians Association – during a brutal heat wave in 2008. Physicians worried that the scorching heat would drive their at-risk Medicare Advantage patients to the emergency room. Through telephonic outreach, the physicians identified patients in need of air conditioning, and began purchasing units for them. The theory was that the $500 cost for a unit paled in comparison to the cost of an emergency-department admission. As a result, this social intervention kept CareMore’s patients out of the hospital. And the outcomes have been stellar: CareMore’s hospitalization rate is 24 percent below average, and overall member costs are roughly 18 percent below the Medicare average.

To narrow the health disparity gap in the US, healthcare organizations must identify and treat the underlying causes, similar to CareMore’s intervention with its elderly patients. This process starts with integrating social and health data, and ends with developing programs that enable communities and empower people to take control of their health.

Contact us to learn more about how Carrot Health is developing one of the nation’s largest social determinants of health database.

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