Every morning during my commute to work, in the span of 25 minutes on the Paoli-Thorndale train from Suburban Station to Overbrook, I witness what I know to be true through data and statistics: Pronounced socioeconomic disparities have resulted in health inequities in our region. According to the Robert Wood Johnson Foundation’s County Health Rankings, Montgomery County stands first among Pennsylvania counties in the socioeconomic factors that determine health, whereas Philadelphia ranks 67th out of 67 counties in those same factors. These counties are separated, not by hundreds of miles or natural barriers, but by one street: City Avenue.
This is the age of analytics, in everything from baseball to journalism to manufacturing: how many pitches thrown, clicks on that post, widgets sold. Now, Moneyball has met health care, and the evidence is clear: Economic inequality and lack of mobility result in negative and lasting adverse health consequences. We already have data that shows the strong association between health and economic inequality. The question now is how to change those social and economic factors to improve and maintain the health of those on both sides of the avenue. Without a doubt, that requires a more complex math.
What I see on my morning commute are hospitals, schools and public transportation, all of which can be thought of as anchor institutions. While government administrations and policies continually change, these institutions remain in place through the years and can — should — be vital allies in ensuring health and well-being in our communities. As our nation continues to negotiate the future of health care, it becomes ever more important that such local partners and stakeholders collaborate with one another. Since we know that health is mostly determined outside the hospital, we find ourselves — academics, policy makers, health systems and community partners — in the uncharted territory of coming together to design, implement and evaluate strategies to ultimately improve the health of our population.
In 1884, John D. Lankenau, then president of Lankenau Hospital, amended its mission to provide care for those who were unable to afford it. This was more than a hundred years prior to the enactment of the federal law that requires anyone coming to an emergency room to be treated regardless of insurance status or ability to pay. To update his vision, we need to really understand our communities — to understand us.
A big step toward such understanding was the establishment last year, in collaboration with the Thomas Jefferson University College of Population Health, of the Main Line Health Center for Population Health Research. As its associate director, I focus on identifying and closing care gaps and disparities in our community and designing health strategies that are tailored to real needs. One of our first projects has been the creation of a health “dashboard” that provides information on the sociodemographics, health risk factors and economic circumstances of individuals living in Montgomery, Bucks, Philadelphia, Chester and Delaware counties, using open data. This dashboard was inspired by the amazing work done by the City of Philadelphia with its Community Health Explorer tool. Philadelphia has a history of commitment to open data efforts, making information on the social determinants of health increasingly easier to find and use.
Each day, 253,000 workers commute into Philadelphia County, and 146,825 residents leave the county for work. County lines show up on maps; they shouldn’t show up in lives. Health partnerships like the one between Jefferson and Main Line Health may be new, but changing the outlines of local health maps will require such collaborations. I am energized by the evidence that there is already a strong foundation for the work ahead.
NORMA A. PADRÓN is associate director of the Main Line Health Center for Population Health Research at the Lankenau Institute for Medical Research, located on the campus of Lankenau Medical Center.
First published as “The Hard Truth Behind Our Numbers” in Philadelphia magazine’s May 2017 issue.