Mapping a Solution for Social Determinants of Health

Eight miles can be the difference between living to the age of 87 or dying at the age of 66. That twenty-year gap is a stark illustration of how socioeconomic status and neighborhood impacts life expectancy.

Baltimore’s Clifton-Berea neighborhood is just eight miles southeast of the Cross-Country/Cheswolde area, yet they are worlds apart. Below is a comparison of the two, published by the Baltimore City Health Department in 2017 as part of their Neighborhood Health Profile Reports. The data is available in an interactive map, powered by Esri’s geographic information system (GIS) platform named ARCGIS.

“When it comes down to it, the biggest driver is poverty,” said Baltimore Health Department Commissioner Dr. Leana Wen in a 2017 CBS News segment. “If we look at things like infant mortality, if we look at things like drug addiction, homelessness, crime, violence, those are the same areas that you’ll see these big differences [in income] too.”

It is interesting to note that health insurance coverage in the two areas is comparable vs the other socioeconomic indicators (90% coverage in Clifton-Berea, 93% in Cross-County/Cheswolde). This seems to indicate that coverage may not be a determining factor in life expectancy.

Nothing more personal than where you live, shop and work

Dr. Este Geraghty is the Chief Medical Officer and Health Solutions Director at Esri. She offers this explanation of how interactive maps can help local governments mitigate the socioeconomic factors that impact health (commonly referred to as Social Determinants of Health or SDOH).

“There is nothing more personal than where you live, where you shop or where you work. Is it any surprise then, that geography plays a significant role in determining your health? Do you have ready access to fresh fruits and vegetables? Can you access care easily? Are you able to get to a pharmacy? Is there health-promoting community programs near you? When you see these things placed on an actual map of your city, it changes your perspective. Suddenly gaps in food, housing, education, jobs, and healthcare become highly visible. Once you see those gaps, you can begin working to eliminate them.”

Mapping social gaps is not a new concept

Using the power of geography to tackle socio-economic and healthcare inequities is not a new concept. In 1889, an English social researcher by the name of Charles James Booth conducted the most extensive study of poverty in London’s history. Booth took it upon himself to determine the exact level of pauperism in the city. He went street by street and made note of the class of people he observed living there. Booth also made note of where he saw smoking, drinking and opium use.

Booth found that the actual level of poverty was closer to 35% which was a lot higher than the 20-25% politicians had been quoting at the time. Alone this finding would have been interesting, but it was how Booth chose to present his results that were notable. He published them superimposed on a map of London. The London School of Economics and Political Science offers an online interactive version of Booth’s original work on this website.

“Booth was ahead of his time,” admires Geraghty. “His map grounded his findings in something tangible and real. It motivated him and the local government to push for social reforms. Booth’s work ultimately resulted in the creation of Old Age Pensions which helped to reduce the socioeconomic gap between classes in London. I like to think that politicians were moved by Booth’s map. There is something powerful that happens when you can put an ‘X’ on the exact location of a challenge.”

Reducing pediatric scalding with the help of geospatial analysis

A modern example of geospatial analysis (maps) being used to improve community health, is the work of Children’s National Hospital in Washington DC. The hospital noticed that many children were presenting in their ER with scald burns. A team at the hospital decided to use their ARCGIS system to map the cases. The resulting geospatial map showed clinicians a pattern that would otherwise have gone unnoticed.

It turned out that most of the children were from a Spanish-speaking neighborhood. When social workers went to investigate, they found that the parents did not know how to adjust the temperature of their water heaters due to the language barrier. In collaboration with community leaders, the hospital created an educational program to address this gap in knowledge. This program reduced the number of scald cases to near zero.

Helping patients achieve wellness through personalized maps

Loma Linda University Health (LLUH) is another organization that is using the power of maps to address SDOH in their community. The team at LLUH felt they could be doing more to help their patients achieve wellness goals and stay on track with the treatments prescribed to them.

“We were doing a good job helping patients understand WHAT they needed to do, but we wanted to also help them with HOW they could achieve it,” said Dr. Stephen Corbett MD, Chief Medical Information Officer at LLUH during his presentation at HIMSS17.

With this goal in mind, the team at LLUH combined the information inside their EPIC EHR with the geospatial tools of ARCGIS. The result is an application they call the Wellness Map.

Through the app, patients can quickly find community resources like parks, non-fast-food restaurants, nearby grocery stores that sell fresh food and community support centers. Because the app is integrated with EPIC, patients are also able to see the location of their upcoming appointments, the office of their Primary Care Provider, nearby labs, pharmacies and urgent care centers. For each, the hours of operation, lists of services, website link, and most importantly, public transportation options are available through the app itself. There is no need to hunt for that information in a different app.

The power of GIS for SDOH

“When you say SDOH, I say unmet basic needs,” explains Stacy Lindau, Founder and Chief Innovation Officer at NowPow, a company that offers a GIS-powered app that connects people to high quality community resources to address chronic health and social conditions. “Real-time spatial data shows us, for the first time, the distribution of these human needs in relation to the supply of programs, services, resources, businesses, organizations, and expertise that can address those needs. To date, we have been flying blind when it comes to placing resources where they are needed most.”

Lindau believes, that the time has come for community and healthcare leaders to make use of all available information when making resource allocation decisions – especially geospatial data. Using a system like NowPow, decision makers would be able to clearly see the swaths of their communities that are considered “deserts” for fresh food, community programs, etc. Conversely, city planners can see where there is an over-abundance of certain retailers – stores that offer tobacco products or fast-food restaurants, for example.

There is ample evidence that geospatial analysis can lead to key insights that aid in addressing SDOH. It doesn’t matter if that analysis is through pen-and-paper or through powerful GIS applications, the result is the same – a powerful visual tool that can better focus political attention and resources.

Not only can GIS help with macro-issues like the location of parks, community programs, and healthcare facilities, but more promising is how it can help individuals. Clinicians can now adjust treatment and wellness plans to match the resources that are within the geographic and economic reach of patients with the aid of applications like LLUH’s Wellness Map. Just imagine how effective healthcare would be if we were able to tailor based on the patient’s home/work environment in addition to their specific genomic makeup.

Numbers in a report are ethereal. Lines on a map are visceral. As healthcare begins to grapple with the complex issue of SDOH, the more tangible we can make things, the faster we can navigate to a solution.