A study performed by the Dallas-Fort Worth Hospital Council found that 75216 in southern Dallas is the unhealthiest ZIP code in the city. In an effort to address social factors that determine a majority of health outcomes in any community, the council looked a number of chronic diseases such as asthma, obesity, heart disease and depression, and found that area has the highest rate of nearly every disease that was measured.
The analysis was done in order to help organizations such as the American Heart Association target certain areas with their health outreach, which was discussed during Dallas Startup Week during a panel called “Removing Barriers: Transforming Social Determinants of Health in Our Communities.”
The panel took place at Blue Cross Blue Shield’s C1 Innovation Lab, and included Stephanie Mace, Vice President of Strong Communities at United Way of Metropolitan Dallas, Dr. Paul Hain, Chief Medical Officer of Blue Cross Blue Shield of Texas, Dee Baker Amos, Vice President of Health Strategies at the American Heart Association, and was moderated by Dr. Joan Welch, Executive Medical Director of the C1 Innovation Lab.
Panelists defined social determinants as factors that detract or add to health outcomes that are not specifically in the medical arena, which can be anything from air and water quality to education and transportation options. There have been several studies and tools created to measure how address or ZIP code impact life expectancy, which reflects how social determinants impact how healthy people are. “If you want to raise the average health in Texas, you can’t do it by making the healthy people healthier,” said Hain.”The ones who are unhealthy have the most to gain.”
Mace discussed how these social determinants have lasting psychological effects that impact physical health as well. When children experience any number of adverse experiences, it negatively impacts their ability to bond with adults around them and have positive relationships with others, which can add to medical problems.
Amos discussed how nonprofit organizations have a responsibility to impact the communities in a way that prevents illness in addition to treating it. “We recognize that it is our responsibility to not only stay in our lane, but to make sure the entire highway is healthy,” she said.
The panel discussed the importance of building a healthy foundation from an early age. The importance of exercise and eating healthy are established at an early age, and it can be difficult to get people to eat healthier when they lack experience with those foods. “You only have one shot at a healthy childhood, and if you miss it, you miss it,” Hain said.
Hain described FoodQ, which launched in Dallas this year and delivers healthy meals to neighborhoods in food deserts, and Mace described how the United Way is pushing to use more telemedicine to expand access to physicians for rural communities and kids in the nurse’s office at school. Amos described cooking demonstrations at the MLK Community Center to expand the palates and possibilities of those who may have not grown up eating many vegetables.
But many of these neighborhoods have problems that a few cooking demonstrations and meal deliveries can’t overcome. Structural problems make transportation difficult, reduce access to fresh fruits and vegetables, and limit educational opportunities. They discussed how much more difficult it is to change when you are surrounded by certain activities, or if your community does not provide access to exercise opportunities or quality food.
While addressing social determinants will benefit people’s lives, there is also a financial incentive for the country to get a handle on these issues. While no country spends more on healthcare than the United States, our health outcomes across all demographics are average at best. The disparity in social determinants contributes to the overall health of Americans, and we sit behind countries in Western Europe and Canada in part because those countries don’t have the health, education, and wealth disparity that exists in the United States. Because poverty is a major driver of many of these determinants, it is often the poor who end up in the hospital because of the impact of social determinants. The hospitals and emergency rooms that deal with these often uninsured populations have to be reimbursed, so as health outcomes go down taxes and premiums creep up, meaning we all pay for these problems one way or another.
Panelists disagreed with an audience member who suggested that unhealthy people should be punished for making poor healthy choices, but said there are programs that provide positive incentive to make healthier choices, such as when federal food assistance counts double when used on healthy foods.
Though it is easier said than done for communities that face a number of negative social determinants, Hain put it succinctly. “If it’s a plant eat it. If it is made and packaged in a plant, don’t.”