3 Miles from the Highway in Neighboring Counties: Real Social Determinants of Health

When was the last time you saw a large group of children, the oldest no more than 10, crossing a highway on-ramp to walk to school, without any accompanying adult?—?in your own neighborhood? When was the last time you saw a woman dressed in tattered lingerie and a leather mini-skirt smoking a cigarette on the corner?—?in your own neighborhood? When was the last time you passed a playground next to a domestic violence shelter?—?in your own neighborhood?

Although this is a wild supposition, if you’re reading this, I’m assuming the incidents above are relatively foreign to you. You may have read about neighborhoods like what I described, but you probably don’t live there. And neither do I. But I drive through one every day.

My neighborhood (natch, my entire surrounding area) is so homogenous, it could have been the model for the opening sequence of the TV show, “Weeds”. All the houses look the same. All the cars look the same. The school district is the best in the state. Lacrosse is the most successful sport. College is a given.

However, my daughter attends a magnet school program 30 miles from my home, in a depressed area of a neighboring county, and the drive to her school is an eye-opening opportunity to research the social determinants of health. Each day, we see examples of the scenarios I described?—?and more. We pass Jake’s Place and the Pony Showbar strip clubs, where the marquees are typically announcing a dancer’s birthday or, “Hiring Dancers”. We pass 3 homeless or domestic violence shelters, often with very young children playing on decrepit swingsets while an adult looks on from a nearby picnic table. On Fridays, there’s a line around the block at each of 2 food pantries. But there are no doctors. Not a single one, of any kind.

In an industry where “population health management” is all the rage, how is this neighborhood’s population’s health being managed, without healthcare?

My daughter and I started quantifying differences between what we see in our neighborhood, between the house and the entrance to the highway, and what we see in her school’s neighborhood, between the highway and the school. Both distances are approximately 3 miles. In our neighborhood, we pass 14 different kinds of doctors in the 3 miles to the highway (along with a sign that says another orthopedic practice is “coming soon”?—?when we already have one, plus a sports medicine clinic). We have an urgent care clinic (as well as another “coming soon” to the corner Walgreens). There are 4 pharmacies.

Although there is not a hospital between our house and the highway, there are 3 hospitals (and a free-standing ER) within a 10-minute drive of my neighborhood. The nearest hospital to my daughter’s school is a 15-minute drive, and there are no urgent care clinics or free-standing ERs. There is 1 pharmacy (and I’m generous in counting it, as it’s contained in a grocery store that is only visible down the street?—?it is not technically ON our 3 mile drive to school from the highway). As the hospital is the only healthcare service provider accessible to the school’s neighborhood, it’s important to also address its performance.

Would you want to have a baby, or a heart attack, or a pulmonary embolism in this hospital?

With so much talk about “value-based care” and “healthcare reform” (also dubbed, “Obamacare”) revolutionizing patient care and driving improved health outcomes and patient experience, and all the new federal programs designed to increase “accountable care” and provide reimbursement for “comprehensive primary care”, how are we bringing value, being accountable, and providing ANY kind of care?—?let alone “comprehensive care”?—?to neighborhoods like the one surrounding my daughter’s school, where no healthcare services are available, the nearest hospital’s quality ratings are abyssmal, the low high school graduation rate hints at a low level of literacy (let alone health?—?or government and insurance-form?—?literacy), adult poverty and uninsured population hovers in the 20% range, and the homicide rate (predominantly gun-related) is 3 times that of the national average?

Has anyone driving these healthcare innovation programs ever spoken to the homeless mother at the shelter, watching her child play on the swing? Or the people standing in line to receive food? Or the pastors of any of the 9 churches I pass in that mere 3-mile stretch of road?

Have all policy decisions about what’s best for underserved populations been made from the ivory tower of pure research: sanitary analysis of isolated data points, lacking the real-world context of applied study?

The full text of this post is available on Medium.