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Insights vol.7web.pdf

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Insights vol.7web.pdf

  1. 1. 758 Insights Vol. 7 Visual Insights on Social Determinants
  2. 2. Examining health through a different lens helps to uncover bigger, underlyingsocial issues that can’t be solved by the latest app or device alone. This visualexploration helps us to “see the forest for the trees” as it relates to health in theMetro Washington D.C. area.Sto ry & Ph otos By Ted Eyta n, M D W e are relying too much on modifying a person’s individual choices to improve health. The social determinants of health can loosely be defined as how the circumstances in which people develop and live affect their mental and physical well-being and life expectancy, and have been characterized as the causes of the causes of health (or ill health)1 Insights Vol. 7 59
  3. 3. Seven Visual Insights on Social Determinants Many citizens, 1 few health professionals If you look visually at a health system, like this example based on Kaiser Permanente, you can see that we are out-personned. There aren’t enough people working in health care to reach every person we serve to guide their daily choices. People and organizations outside of health care are needed. 0.18 Million Staff 0.05 Million Nurses 9.0 Million Patient Members 0.017 Million MDs The Actions of a relativley small staff/Nurse/Physician group and population approaches.60 Insights Vol. 7
  4. 4. Seven Visual Insights on Social DeterminantsPeople aren’t hoping that we’ll improve their health care experience; they are hoping that we improvetheir ability to live a long healthy life. The groundbreaking Marmot Review in 2010 depicted big differences in life expectancy anddisability-free life expectancy among the best-off and worst-off neighborhoods in England. The graph above (licensed under the Open Government License v1.0)2 is full of information thatshows that people who are socially deprived will not (a) get to a certain age and (b) if they get to thatage, are unlikely to get there without a disability. We don’t usually measure this in United States health care today. What we are working to 2 improve, should matter to people. Insights Vol. 7 61
  5. 5. Seven Visual Insights on Social Determinants 3 Use images, not words MOST HEALTHY The difference between the most healthy and the least healthy people describes the health inequality in a patients staff population. Society is better off when there is a smaller difference in this range. We can show the spread via the disability-free life expectancy metric, using smooth bars. Their height is equal to the disparity between the healthiest and the least healthy. The gray bar shows the spread for or own staff – their health inequality matters, too. And images are the most powerful way to demonstrate this. LEAST HEALTHY # OF PEOPLE62 Insights Vol. 7
  6. 6. Seven Visual Insights on Social Determinants The Future We Want MOST MOST HEALTHY HEALTHY staff patients patients staff The Future That Scares us MOST MOST HEALTHY HEALTHY patients staff INTERVENTIONS patients staff LEAST LEAST INTERVENTIONS HEALTHY HEALTHY # OF PEOPLE # OF PEOPLE LEAST LEAST HEALTHY HEALTHY # OF PEOPLE # OF PEOPLEThere are two alternate futures. The future we want is the one where everyone is healthier.There is less of a disparity between the most healthy and the least healthy. Our staff showseven greater health gains, leading our members. The future that scares us is the one where the most advantaged are much healthier, theleast advantaged are only a little healthier, and our staff is no healthier than the people theyare serving. 4 Two alternate futures Insights Vol. 7 63
  7. 7. Seven Visual Insights on Social Determinants 5 A total health approach “These serious health inequalities do not arise emphasis by chance, and they cannot be attributed simply on to genetic makeup, ‘bad’ unhealthy behaviour, , or difficulties in access to medical care, individual important as those factors may be.”2 This image describes the interventions that are focused on individual choices – this could be a calorie counting app or a game that promotes competition among friends. If 100% of our effort is applied to these interventions, we won’t reduce health disparities. Individual & FamilyOn the other hand, a Total Health approach,based on the social ecological model firstadvanced nearly 30 years ago, addresses thefamily, community, and societal environment Home, School & Workthat shapes individual behavior choices.There’s some investment at every level, as the Neighborhood & Communityimage below depicts. Society64 Insights Vol. 7
  8. 8. Seven Visual Insights on Social Determinants MOST MOST HEALTHY HEALTHY staff patients patients staff Total Health Approach Individual & Family Home, School & Work Neighborhood & Community Society LEAST LEAST HEALTHY HEALTHY # OF PEOPLE # OF PEOPLE TODAY: 2013 TOMORROW: 2020Using the visual thinking approach, this is the one image that includes the Who/What and Howof behavior change and social determinants to improve health. If we spend the right amount of time at the individual level as well as the societal level,people at all levels of the health gradient will improve their health, and the gap between themwill decrease. We will model the improvement in our own workforce. 6 The tomorrow we want Insights Vol. 7 65
  9. 9. Seven Visual Insights on Social Determinants 7 The tomorrow we don’t wantIf we invest poorly, and do what seems easiest, we’ll get the outcome we don’t want. Themost advantaged, who didn’t need as much help in the first place, will get healthier. The leastadvantaged may or may not get healthier. Our workforce will not achieve greater health gains.Our costs, and more importantly their costs (money, time, lives) will not be manageable. Thatwill make all of us unhappy. MOST MOST HEALTHY HEALTHY patients staff patients staff emphasis on individual LEAST LEAST HEALTHY HEALTHY # OF PEOPLE # OF PEOPLE TODAY: 2013 TOMORROW: 202066 Insights Vol. 7
  10. 10. Seven Visual Insights on Social DeterminantsHowever, we are not trying to fixan image. We’re trying to fix realsocial problems like obesity andcrime represented in the imagesto the right (data and images frompresent day, Washington, DC,USA) We need to understand the role of health care in improving health; we cannot do it alone We need to have a measurable goal in mind – not just pounds lost or blood pressure lowered, but longer, healthier life, and less inequality between the most healthy and the least healthy When we talk about innovatingin health, we need to think beyondindividual interventions – this isin the scope of health care and ahealth care Innovation LearningNetwork. The ambition is to create theconditions for people to takecontrol over their own lives. Ifthe conditions of daily life arefavourable, and more equitablydistributed, then they will havemore control over their lives in Visualization of crime in Washington, DC, with the biggest cutouts being homicide, theways that will influence their and smallest assault.their families’ health and health Referencesbehaviours.2 1. Royal College of Physicians, How doctors can close the gap: Tackling the social determinants of health through culture change, advocacy and education. 2010. 2. Marmot M. The Marmot Review: Strategic Review of Health Inequalities in England post-2010. 3. Garner T, Trombatore D, Raza U. Obesity in the District of Columbia. Washington, DC; 2010. 4. Eytan, T. Quantified Community: Visualizing the Health and Illness of Washington DC Through Open Data and Art. 2012 Ted Eytan, MD Physician Dir., Center for Total Health Kaiser Permanente Washington D.C., USA Insights Vol. 7 67