By Pauline Hoffmann and Xiao-Ning Zhang

“We are moving slowly into an era where Big Data is the starting point, not the end.”

Pearl Zhu, digital master

Public health is a science of communities. It provides insights as to how to promote and protect the quality of life within communities. Counties and states across the country have public health offices assigned to protect and improve the lives of those living in the communities. Public health can be quite complex because most problems do not necessarily have one cause. Thus, there is no one answer to solve all of the problems.

When you think of public health, particularly as we work through a pandemic, you may think of vaccination clinics or testing sites or resources and sources of information to protect ourselves from the spread of disease. Public health is so much more than that.

It is the environmental health division that keeps our water, air, homes and public facilities safe and protects against animal-borne pathogens like rabies and Lyme disease. It is the laboratory that processes tests we need, such as COVID tests, water tests and rabies tests. It is nursing that provides home care and other services. It is maternal/child health that ensures the youngest members of a community have access to quality food and health care. It is health education that shares the knowledge needed to improve the quality of life.

Cattaraugus County is in southwestern New York State along the Pennsylvania border. The 2020 United States Census and associated American Community Survey provides a detailed look at the demographics of this county. Compared with New York State and the United States as a whole, Cattaraugus County has an older population, a higher percentage of people with just a high school education, higher poverty rates, more rural environment and fewer households with broadband access.

“Hiding within those mounds of data is the knowledge that could change the life of a patient, or change the world.”

Atul Butte, Priscilla Chan and Mark Zuckerberg Distinguished Professor at the University of California, San Francisco

In the context of public health, we often discuss the social determinants of health (SDOH). SDOH as defined by the World Health Organization are “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels.”

Social determinants of health fall into five categories and may be responsible for many of the health equities faced by communities:

• Economic stability including job opportunities and poverty
• Health care access and quality
• Social and community context including racism, violence, and stigma
• Education access and quality including literacy rates and education levels attained
• Neighborhood and built environment including transportation, safe neighborhoods, clean air and water, access to physical activity, and nutritious food options.

Unfortunately, the SDOH work systematically in a cycle that is difficult to escape. For example, if a person does not have reasonable job options, they may not be able to pay for health care or nutritious foods which will impact their ability, or the ability of their family members, to succeed in school. They may not be able to afford transportation to get to a reasonable job, a primary care physician or specialist, or a store or market with nutritious food. They may also face stigmas associated with their circumstances.

Public health practitioners are well aware of the SDOH and the impact they may have on a community. They help to explain most of the disparities and inequities faced by communities, but explaining alone doesn’t solve problems. Public health officials use a number of publicly available data resources to craft public health plans to tackle the SDOH and improve the health of communities.

“The goal is to turn data into information, and information into insight.”

Carly Fiorina, Former CEO of Hewlett-Packard

One such data set is the University of Wisconsin Population Health Institute’s annual “County Health Rankings & Roadmaps 2022,” a report that details the health factors and health behaviors county by county in each state. Health outcomes measure the length and quality of life generally measured as those who died prior to 75 years-of-age and health status and percent of low birth weight newborns. Health factors include health behaviors (like tobacco use, diet and exercise, alcohol and drug use, and sexual activity), clinical care (like access to care and the quality of care), social and economic factors (like education, employment, income, family and social support, and community safety) and the physical environment (like air and water quality, and housing and transportation).

Cattaraugus County has higher smoking rates than New York State, increased adult obesity, lower access to exercise opportunities, higher teen births, more children living in poverty, higher injury deaths and more drinking water violations. Additionally, comparing clinical care providers indicates a stark disparity from county to state. New York State has about one primary care physician to 1,180 residents while Cattaraugus County has one physician to every 2,170 residents. The number of mental health providers is 1:310 statewide and 1:670  in the county.

Statewide Planning and Research Cooperative System (SPARCS) data are patient de-identified and include information such as age group, gender, race, ethnicity, length of stay, type of admission, diagnosis and procedure information, severity, mortality risk, payment method, method of admission and cost of stay. These data provide insights as to common health conditions and problems reported in the county and allow for comparison across the counties of New York State.

The Community Health Assessment (CHA) is conducted every three years by Cattaraugus County as part of its Community Health Implementation Plan (CHIP) to allocate resources. It is administered electronically and in person to access how people feel in the community on a range of health-related topics. It is self-report data.

In both the SPARCS and CHA data, we see that the leading cause of death in Cattaraugus County is heart disease followed by cancer. The most common conditions are mental health and cardiac and respiratory diseases. The most severe conditions are cardiac, respiratory and infection.

“Data are just summaries of thousands of stories.” — Chip & Dan Heath, Authors

The available data highlight two key areas for Cattaraugus County to work on – preventing chronic disease and promoting well-being and preventing mental health and substance abuse disorders.

Using available data, a community story unfolds. The higher poverty rate, rural setting, less access to primary care physicians, and education all contribute to higher incidences of chronic diseases. If people don’t have access to a primary care physician, they may not get treatment for a disease that is easily preventable or manageable like diabetes.

Providing community mental health training, including suicide prevention is one step toward lessening the mental health burden. Using existing educational resources and reaching out to middle-school and high-school age children will help to prevent bad habits before they start. For example, emphasizing smoking and vaping cessation (or not starting), regular exercise, and the importance of a healthy diet. Promoting healthy lifestyles within the community and by encouraging physicians to “prescribe” diet and exercise will also counter the ill effects of poor SDOH.

Communities and public health entities need to be creative and proactive in combating the underlying conditions, behaviors and factors contributing to poor health outcomes in an area. Knowing is one step; taking actions is next and can have transformative effects on communities in the long run.

Pauline Hoffmann is an associate professor in the Jandoli School of Communication at St. Bonaventure University. Xiao-Ning Zhang is director for the Biochemistry Program and a professor in the Biology Department at St. Bonaventure.

Categories: hybrid journalism, Jandoli Institute