How Doctors Are Finding Neighborhoods That Make Their Patients Sick

Our health isn't just about us, as individuals—our well-being is connected to the state of our communities and the resources available to us within them. Understanding the social, economic, and material factors that make people in one area healthier than those in another is key for improving policy and patient care.

Doctors at the Cincinnati Children's Hospital have been investigating how housing data at the neighbourhood level can be used to predict the morbidity rate, or risk of re-hospitalization, of people suffering from asthma for several years. In 2013, a team led by Andrew Beck, a physician, found that admission rates for asthma were closely linked to a neighbourhood's median income and access to care. Poorer neighbourhoods were sending more kids to the hospital with wheezing coughs.

To refine their approach to identifying which neighborhoods are making their residents sick, Beck and his colleagues looked at the rates of reported incidents of housing code violations —like cockroach infestations or mold—in low-income, racially-divided neighbourhoods in Cincinnati. Their study, published today in Health Affairs, found that children who had been hospitalized for asthma in the past were 1.84 times more likely to return to the hospital if they lived in the highest quartile of housing code violation areas, compared to those living in the lowest.

One neighbourhood, Avondale, was singled out by the researchers as being severely impacted. Avondale is a largely black neighbourhood and is fraught with poverty. According to the researchers, linking health and housing data is an important step to identifying at-risk neighbourhoods like Avondale and improving them through policy and patient care.

"If you can begin to predict or more accurately identify the parts of people's lives, parts of their day-to-day context, and the neighbourhoods that are either keeping them healthy or making them sick, perhaps we could more effectively target need and allocate resources," Beck told me.

The findings have implications for health care at both the individual and systemic levels. Beck said that knowing which areas are experiencing widespread health problems due to poor living conditions and lack of health infrastructure like pharmacies and clinics could be useful to policy makers at the local level. It's certainly a nice idea, but it's not like this knowledge has helped in the past, at least at the level of policy. That concerns over the state of low-income public housing led to the wholesale abandonment of their upkeep and subsequent liquidation instead of their improvement is a well-documented, though often hidden or outrightly denied, fact about America's relationship with the poor.

Indeed, the perception of the uncleanliness of the poor and non-white has historically proven to be a self-fulfilling prophecy of sorts. For example, as Robert D. Bullard reported in his article The Mountains of Houston, nearly all of Houston's garbage incinerators and all of its dumps were built in neighbourhoods dominated by black and otherwise non-white people, who didn't have the political clout to move such works elsewhere.

At the level of individual patient care, however, the advantages afforded to physicians caring for sick children by housing data could be enormous. If data about what resources a child's neighbourhood has and what health risks are known to be present there were included in their electronic health record, Beck explained, a doctor could prescribe treatments that take their environment and predicted morbidity into account.

"I can prescribe all the medicine that I want, but if the family I'm trying to keep out of the hospital is worried about keeping food on the table or a roof over their head, then I want to make sure that I'm aware of that," Beck said.

Using data and other uncommon technological means—like text messaging—to address the needs of distressed and disadvantaged communities is becoming a popular idea among healthcare professionals. After all, Facebook and the government are using our data for ends arguably less noble than improving the health of underserved neighbourhoods. Why not hospitals?

"The business world and politicians know everything about everything because they use data so well, but in healthcare we're just learning about that," Beck told me. "How can we use data in ways that are non-invasive—that don't cross the boundary that we want to maintain with our communities and patients—to make sure that we're actually providing the treatment to families that they'll most benefit from and that they want?"

Using nonmedical data relating to socio-economic status and the number of housing code violations in an area to address health concerns is likely too fresh a practice to have concrete applications, Beck noted. Even so, it's an important step to conceiving of healthcare as less about us, and more about Us: the society we've built, and who is left out in the cold with a bad cough.