Mapping Neighborhood Health Geomarkers To Clinical Care Decisions To Promote Equity In Child Health

Abstract

Health disparities, which can be understood as disadvantages in health associated with one's social, racial, economic, or physical environment, originate in childhood and persist across an individual's life course. One's neighborhood may drive or influence these disparities. Information on neighborhoods that can characterize their risks-what we call place-based risks-is rarely used in patient care. Community-level data, however, could inform and personalize interventions such as arranging for mold removal from the home of a person with asthma from the moment that person's address is recorded at the site of care. Efficient risk identification could lead to the tailoring of recommendations and targeting of resources, to improve care experiences and clinical outcomes while reducing disparities and costs. In this article we highlight how data on place-based social determinants of health from national and local sources could be incorporated more directly into patient-centered care, adding precision to risk assessment and mitigation. We also discuss how this information could stimulate cross-sector interventions that promote health equity: the attainment of the highest level of health for neighborhoods, patient panels, and individuals. Finally, we draw attention to research questions that focus on the role of geographical place at the bedside.

Keywords: Children’s Health; Determinants Of Health; Disparities; Geography.

EXHIBIT 2. Examples of how census tract–level information can be linked to health outcomes in a staged manner by displaying geomarkers

SOURCE Authors’ analysis of data from the Cincinnati Children’s Hospital Medical Center (asthma emergency visits and hospitalizations); Health Resources and Services Administration, US Department of Health and Human Services (medically underserved areas); Cincinnati Area Geographic Information System (housing code violation density); US Census Bureau (census tracts, poverty rate); and Cincinnati Police Department (crime rate). NOTES This exhibit shows census tract–level information specific to the health service, physical, economic, and psychosocial environments in Cincinnati, Ohio. Geomarkers such as those shown could inform community health assessments and be amenable to population- or patient-level interventions.