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Social Determinants of Health: Exploring Healthography

Janelle Schrag
November 25, 2014

Healthography: the notion that our neighborhoods and residential environments greatly impact our health and well-being. This may be a new term, but it is a well-established idea, and I had the privilege to learn more at the American Public Health Association’s (APHA) 142nd annual meeting in New Orleans.

Aptly themed “Healthography” by the APHA, the annual meeting highlighted the fact that that our zip code or street block can be as significant a health indicator as our genetic code. I thought about this idea as I walked the streets of New Orleans, where just a few miles can mean a 25-year difference in life expectancy.

Built and Service Environments

One of the foundational elements of neighborhood health is the physical characteristics, or built environment. The age and condition of structural buildings, particularly housing units, may contribute to airborne irritants such as dust and mold, as well as harmful chemicals such as lead or asbestos. Similarly, proximity to industrialized areas that house harmful air or water pollutants may also negatively impact health. One of the meeting sessions I attended explored this idea by investigating the asthma hot spots for children living in downtown St. Louis, Missouri. Unsurprisingly, the hot spots were linked directly to areas of substandard housing and a nearby industrial plant.

The service environment, or availability and accessibility of services, is another major neighborhood health factor. Access to both primary care and hospital services is a critical element for promoting and maintaining positive health outcomes. Additionally, access to employment opportunities, quality schools, and other city services can promote better economic conditions for a community and its residents. Likewise, the accessibility of nutritious foods is an important step in combating food insecurity.

Another important factor is whether the built and service environments are connected through a traversable neighborhood that is safe for pedestrians. Well-lit sidewalks a nd crosswalks, both built features, can greatly facilitate access to essential services. In addition, walking paths, bike lanes, and recreational spaces promote physical activity in safe spaces.

Neighborhood Social Relationships

The social relationships and interactions within a neighborhood can also influence health behaviors and outcomes. Individual social capital is one factor, as having supportive relationships close to home can greatly benefit health. However, larger community relationships also come into play, such as feelings of mutual trust and connectedness. Neighborhoods that experience positive social relationships are more likely to see widespread healthy behaviors and positive health outcomes. Conversely, neighborhoods that experience greater degrees of mistrust, social disorder, or crime have been linked with worse health outcomes, including high levels of anxiety and depression, among residents.

These social relationships are especially influential for children and adolescents. I found a certain APHA session incredibly enlightening, as three public health leaders described the issue of chronic stress on disadvantaged adolescents. Not only can these stresses lead to poor health outcomes, but they can greatly impact school performance and long-term academic success, another social determinant of health.

The West Baltimore Neighborhood

After four days of intense healthography sessions, I couldn’t help but think back to the work happening at Bon Secours Baltimore Health System. Located in the heart of West Baltimore, Bon Secours serves patients who face a number of neighborhood-related challenges. In response, the hospital system created Bon Secours Community Works.

In addition to addressing a number of social determinants, Community Works strives to improve the local neighborhood. The Clean & Green initiative has focused on beautifying local areas by transforming vacant lots into green spaces. Not only have these efforts helped reduce an invasive rodent population, but they have also reduced areas of crime. Additionally, this project trains local participants in landscaping services, opening the door for future employment opportunities.

Another Community Works initiative is Neighborhood Revitalization. This project works to address abandoned houses, illegal dumping, and minor crimes. Most importantly, the program has also facilitated community members coming together to form stronger, trusting relationships. Overall, these efforts have allowed residents to feel safer, happier, and empowered in their neighborhood.

Our Hospitals Are Essential Community Members

Reflecting back on the APHA annual meeting and the model work of Bon Secours, it is easy to see that essential hospitals are vital members of their neighborhoods. As prominent institutions, they can act as champions for transformation and community revitalization. Many patients cared for by essential hospitals experience negative health impacts due to their neighborhood environments. However, by leveraging their influential role, our hospitals can combat negative neighborhood factors and improve patient health outcomes.

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