May 17, 2018; HealthIT Analytics
The City Health Dashboard, an online resource developed by New York University offering 36 indicators regarding clinical data and social determinants of health, now covers 500 US cities, according to Jennifer Bresnick in HealthIT Analytics.
The 36 measures are subdivided into five categories: social and economic factors, physical environment, health behaviors, health outcomes, and clinical care. For example, “social categories” includes poverty, crime, housing, school, demographic, unemployment, and income inequality figures. The physical environment categories include park access, walkability, lead exposure, air pollution, and access to healthy food. Health behaviors that are tracked include binge drinking, smoking, and teenage pregnancy rates.
“The publicly available tool, developed by the Department of Population Health at NYU School of Medicine with support from the Robert Wood Johnson Foundation and in partnership with NYU’s Robert F. Wagner Graduate School of Public Service, allows users to explore 36 measures of health down to the neighborhood level,” Bresnick explains.
As Bresnick points out, “The majority of the data centers on the social determinants of health, including community factors such as housing affordability, lead exposure risks, racial and ethnic segregation of neighborhoods, and income inequality. Users can also examine educational attainment and school quality statistics, opioid overdose and death rates, and violent crime rates in addition to more traditional clinical information such as rates of obesity, diabetes, or hypertension.”
The dashboard’s focus on social determinants is not surprising, given the obvious impact of socioeconomic and environment factors on health outcomes. As NPQ’s Karen Kahn explains,
Social determinants—the consequences of poverty, racism and other social inequities—have been shown to have a much greater overall impact on health outcomes than clinical care, which accounts for a mere 20 percent of overall health. As health systems move toward bundled or value-based payments, finding ways to address issues such as unstable housing, poor nutrition, inadequate schools, and unemployment, is essential to improving outcomes.
As Bresnick writes in a related article, “States with a higher ratio of social-to-healthcare spending from 2000 to 2009 saw better patient outcomes.” She adds, “A 20 percent increase in the median social-to-health spending ratio was equivalent to 85,000 fewer adults with obesity and [far lower] mental illness…significantly reducing the associated spending on these conditions and their comorbidities.”
One place to invest to improve health outcomes is education. Educational attainment, Bresnick notes, is also “correlated with higher incomes, more social resources and stability, improved healthy behaviors, and an improved ability to tackle social and economic stresses. Individuals who secure stable employment are more likely to live in neighborhoods with access to fresh food choices, higher quality schools for their children, and lower rates of violence and crime. High school graduates are also less likely to be obese, to use tobacco, to be uninsured, to access preventive care and cancer screenings, and to exercise an appropriate amount.”
Economic disparities also are a major driver of poor health outcomes. Bresnick calls these disparities “stark. In the wealthiest cities in the nation, only three percent of children live in poverty. But greater than 60 percent of children live below the poverty line in the most economically challenged regions, leaving them exposed to greater risks of educational gaps, hunger and housing instability, and the inability to access care.”
Marc Gourevitch, MD, MPH, and chair of the Department of Population Health at NYU School of Medicine, has served as the program’s principal architect. Gourevitch notes, “There’s a saying: ‘what gets measured is what gets done.’ Only with local data can community leaders understand where actionable gaps in opportunity exist and target programs and policy changes to address them.”
In an interview with Crain’s New York Business, Gourevitch adds that, “What we hope this resource will do is to bring into a single place not only data about health status but the drivers of health status.”
“The health dashboard,” notes Robin Schatz in Crain’s, “originally launched in January as a pilot in Flint, Mich.; Kansas City, Kan.; Providence, R.I.; and Waco, Texas. The tool has since expanded nationwide with a $3.4 million grant from the Robert Wood Johnson Foundation.”—Steve Dubb