America is facing some daunting health challenges. Spending on healthcare is growing at an alarming rate while health outcomes are barely improving and in some cases actually declining. A recent study even shows that life expectancy for women has declined in 43 percent of U.S. counties.
Thanks to our HealthAround.Me project, I now know that one of the biggest reasons we are seeing diminished returns from our growing healthcare spending is that improving health outcomes is more about improving health than improving healthcare.
If we stop and think about it, healthcare is a very expensive tool that gets mostly used to try to get things back on track after a health disaster. But what are the conditions and inputs that put that disaster in motion in the first place? And what if we could stop that disaster before it happens?
If a section of railroad track kept causing trains to derail we would probably not design special equipment to speed up putting the trains back on the track, we would figure out what was causing the derailment in the first place and work to fix that. Perhaps we would redesign the layout of the track or maybe we would just educate train conductors to slow down on that section of track.
The same idea holds for health outcomes. We need to give people, communities and governments the tools to identify where health derailments are happening, the knowledge to understand why they are happening and the ability to prevent or minimize these derailments in the future. If we stay on our existing course of increased spending to get things back on track after health disasters, we will miss a larger opportunity to significantly improve health outcomes and ultimately lower healthcare costs.
Background: When people ask me what I do, I often tell them the easiest way to describe it is enabling serendipity. Last summer when I was recognized by the White House as a Champion of Change in Civic Hacking it was through pure serendipity that I sat next to Chris Sopher who runs the Knight News Challenge for the John S. and James L. Knight Foundation. In talking to Chris I asked if there was anything that Civic Ninjas could help him with and he suggested I take a look at the Knight News Challenge: Health competition.
The irony I thought at the time was that we are civic hackers, we live on pizza and beer and don’t get nearly enough sleep. So what could we possibly know about health?
But when I thought about it, I realized that all of our civic hacking efforts had a recurring theme. Find, scrape, and aggregate disparate data, then geo-locate it and build a map driven interface for users to interact with that data. We had done this time and time again. So could we do this with health data? And could this add real value?
Fast forward several months and the resounding answer is YES! I now know more than I ever thought I would about public health and public health data. But it is incredibly clear to me that there is huge value in aggregating public health data, geo-locating it and making that data easy for folks to consume. Much of this value comes simply from awareness but it also comes from people taking action, changing behaviors and making better decisions with that data.
We are extremely grateful to the Knight Foundation for giving us the opportunity and encouragement to explore this idea with funding through the Knight Prototype Fund. Additionally, we are thankful to Chris Barr, who runs the Prototype Fund, for introducing us to human centered design (HCD) which completely changed our thinking about how and where to start on this project. I now tell people that HCD allows you to step back from your assumptions and start at the beginning to really understand an opportunity and avoid the pitfalls of thinking you know what is right or what is needed. The original vision for our app was to allow people to explore the health data around them with no particular agenda or mission other than curiosity. It was through our HCD efforts that we learned about the bigger opportunity.
The Bigger Opportunity: In one city in the U.S. there is a 14 year life expectancy difference between two different zip codes. Most people look at this data and readily conclude that the people in the underperforming zip code must have limited access to healthcare and the healthcare they have access to must not be very good. However, if you actually look at the data we see just the opposite. People in the underperforming zip code actually see more doctors and more specialists. But how is that possible? We don’t start to really see what is happening until we look at chronic disease rates and other health indicators for the underperforming zip code. Here we find higher incidences of chronic disease and other negative health indicators.
If people in one area are generally sicker and are dealing with more chronic disease it only makes sense that they will ultimately see more doctors than an area with a comparatively healthier population. So why are all of the extra doctor visits not making them better? What we find out is that access to healthcare and quality of healthcare can only move the health outcomes needle by up to 20%. There is only so much doctors can do to improve health outcomes after a major health derailment.
So why does one area have more disease? And why are people generally sicker in that area? Remember the sayings “an apple a day keeps the doctor away” or “you are what you eat?” As it turns out they are true, in fact not only are you what you eat, you are what you drink, what you breath, where you live, what you learn, where you learn, who you know, what you do, where you work, and where you play among many other health determinants. And all of those Social Determinants of Health (SDOH) combine to control up to 80% of health outcomes in an area. There is very little mainstream recognition of this fact and even less community action to optimize health outcomes based on it.
When we look at health outcomes from this perspective it is easy to see that improving outcomes is more about improving health than improving healthcare. So why aren’t people shouting this from their rooftops?
The answer to that question is complex, but it mostly boils down to two issues: technology and money.
On the technology side geographical Information systems(GIS) have traditionally been cumbersome, expensive, proprietary tools used by highly trained professionals for very specialized applications. It is only recently that open source software has evolved to include powerful mapping and GIS capabilities. These open source tools are now making it possible to build transformative applications like HealthAround.Me. Additionally and perhaps more importantly the availability of GPS on smart phones has completely changed how we think about collecting and displaying geo-located data.
On the money side, there has traditionally been a disconnect between who pays to improve determinants of health and who benefits from reduced future healthcare costs. As America’s health system inches closer to a single payer system, there is better potential for who pays to align with who benefits. Additionally, improving certain determinants have a shorter ROI that accountable care organizations(ACO) and other insurance providers can benefit from. And lastly, cities, neighborhoods and communities are starting to realize that improving certain determinants of health also aligns with improved property values.
Doing our part: We are very excited by what we have learned and the prototype tools we have built that will allow individuals, communities, organizations, public officials and healthcare professionals to start the conversation that leads to better ownership of health outcomes at all levels.
So what is next for HealthAround.Me? We would like to aggregate some more data in Oklahoma and then move on to a few more states but our ultimate goal is to develop a comprehensive platform that we can roll out nationally. We are actively looking for partners that can help us evolve and develop our scoring and ranking models for SDOH, health profiles and health indicator data.
So can we count on you to help us shout from the rooftops about this opportunity? If you represent an organization trying to improve communities locally, nationally or internationally we want to partner with you on this transformative project. Email firstname.lastname@example.org to get the conversation started.