Keeping Score on Public Health

There is ample evidence that healthy people tend to live in healthy communities -- places with clean air, safe sidewalks and parks, quality housing, and easy access to healthy food and medical care.

For confirmation, we need look no further than our large American cities where complex, interrelated problems put the community's health at risk -- struggling local economies, areas of concentrated poverty, violence, food "deserts", lack of open/green space for recreation, exposure to large numbers of pollutants (e.g., lead paint, rodent or insect infestation, smog) to name just a few.

Investigators have estimated that only 20% of health can be attributed to access to medical care, and another 30% can be attributed to health behaviors (e.g., diet, exercise, substance use); the remaining 50% is attributable to socioeconomic factors (e.g., quality housing, adequate income) and the built and natural environment (e.g., good air quality, walking/biking paths, safe streets).

The health stakes for U.S. cities are high, but the game is changing thanks to new concepts, new players, and new technologies.

For instance, the Health in All Policies (HiAP) concept holds that a healthy community cannot be created without health being an integral part of policy decisions in every sector; urban planning, transportation, housing, education, law enforcement, parks and recreation, and public health departments all must play a role.

In a recent survey, savvy health officials in large U.S. cities identified HiAP as a top priority: Seattle/King County, Wash.; Los Angeles; San Francisco; Washington; Boston; and Nashville, Tenn. have already implemented formal HiAP initiatives that leverage analytic methods, engagement and leadership strategies, and legal and policy tools to get at the root causes of illness and involve nontraditional sectors in health-related activities.

A recent technology and politics report in The Economist honed in on Boston's CityScore, an innovative approach to using data from multiple city sources to "make cities more efficient -- and more democratic" -- to which I would add, "more healthy."

Boston mayor Martin Walsh keeps tabs on what is happening in every neighborhood of his city with a large screen dashboard, the centerpiece of which is CityScore -- the city's overall health reduced to a single number based on 24 metrics including public safety, education, basic city services, innovation and technology, health and human services, and constituent satisfaction.

The scores are determined by comparing the city's current performance to either a target set by the city or a historical performance average.

Consider how much more the city might learn from such data!

One new project at MIT envisions small robots deployed in city sewers to collect and analyze samples to reveal everything from the citizens' diets to how many of them have the flu.

In New York City, the Center for Urban Science and Progress plans to place sensors in neighborhoods to generate more health-related data; e.g., measuring air quality in an area and comparing it with hospitalization rates for asthma.

As a physician practicing in an urban academic setting, I look forward to the day when all cities connect public health to politics and city planning and use aggregate data to improve urban planning, services, citizen engagement, and population health.

Isn't it time that we all begin to keep score?

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Keeping Score on Public Health