Community health index: a tool for healthy lives

Residents in Hartford's Northeast and Upper Albany areas lead shorter and sicker lives than people in the West End.

African-American and Hispanic males in New Haven's poor neighborhoods are at greater risk of being murdered than residents a few blocks away.

The stigma of teenage pregnancy keeps girls in Groton's Fieldcrest neighborhood from seeking first-trimester prenatal care, even when services are readily available.

Local public health officials and health care providers are zeroing in on health disparities by using the "health equity index," an online tool to measure the correlation between health and the socioeconomic factors that define a community.

The tool is changing the way experts approach public health concerns from obesity, heart disease and diabetes to sexually transmitted diseases, homicide and depression by examining the root causes of poor health. They hope to use data from the index to promote initiatives such as outreach efforts to take medical services to a community, programs to help residents shop for healthy food or the re-thinking of housing policies that promote disease.

"We as a nation and state have done little to change the course of health disparities. If we really want to address health inequities, we must begin by critically looking at the impact of social conditions on a population's overall health," said Jennifer Kertanis, who until recently was executive director of the Connecticut Association of Directors of Health (CADH), a nonprofit agency that developed the index.

In Connecticut, health disparities are well documented among African Americans and Hispanics, compared with their white counterparts.

"Everybody should have the same opportunity to be healthy, no matter where they live or what their socioeconomic status," said Russell Melmed, an epidemiologist with the Ledge Light Health District, which serves New London and four surrounding communities.

The index gathers information from multiple sources to measure seven "social determinants" - economic security, employment, housing, education, community safety, civic involvement and environmental quality - and their correlation to 13 specific conditions, including cancer, respiratory illness, childhood illness, kidney and liver disease and health care access.

While some connections seem apparent, such as the link between income and educational attainment to poor health, other findings are subtler, such as that between industrial pollution and sexually transmitted diseases.

The index generates community-specific scores ranging from one for "poor" to 10 for "excellent." The scores can be displayed on geographic information system maps that depict neighborhood disparities block by block.

Reaching vulnerable communities

At Saint Francis Hospital and Medical Center in Hartford, health care professionals are using the index to better deliver services to people such as Karin Astorga of Glastonbury, a former Hartford resident, whose two children have relied on the hospital's Pediatric and Adolescent Medicine Clinic.

"I'm not sure what we would do without this place," said Astorga, whose children are insured through the state-subsidized HUSKY program. Located on the hospital campus, the clinic handles about 17,000 visits a year, mostly patients from Hartford, where nearly a third of all families live in poverty.

"You can't talk about the health care needs of a vulnerable population without identifying the social, economic and other barriers that prevent people from seeking care," said Dr. Adam Silverman, a primary care physician and consultant at Saint Francis.

In Hartford, high poverty, unemployment and crime rates coupled with low educational attainment, sub-par housing and a blighted environment contribute to poor life expectancy and health outcomes, particularly among African Americans and Hispanics, according to "Healthy Hartford," a community health needs assessment published by the Hartford Department of Health and Human Services this spring. The report used the health equity index, among other tools, to examine the city's 17 neighborhoods.

While the index can't prove "direct cause and effect relationships," said Silverman, it can show how "socioeconomic factors can promote wellness or illness."

For Pitts, the reasons for poor health outcomes often go beyond access to medical services and health insurance. "Relatively manageable conditions such as chlamydia and gonorrhea, for example, can serve as markers for people who are living in the shadows of society, taking risks due to the loss of hope," he said. "They don't believe they have opportunities to advance and pursue the American Dream. As a result, they are more likely to put themselves at risk for things like sexually transmitted diseases."

In New Haven, health officials used the index and other resources to examine the public health implications of violent crime, including homicides, assaults and the onset of depression and cardiovascular disease from the stress of living in unsafe communities.

"The health equity index helped us to understand as a community why violence is a significant public health concern," said Amanda Durante, chair of the city's Health Equity Alliance and an epidemiologist at the New Haven Health Department, which last year published "Creating a Healthy and Safe City: The Impact of Violence in New Haven."

Among the report's findings: Assaults were the leading cause of death for men ages 15 to 39, accounting for 38 percent of the deaths among African-American and Hispanic males in this age group.

At least 75 percent of all violent crimes occurred in just 20 percent of the city's area.

Expect to hear more about the index in the future as health care reform focuses on keeping people healthy with preventive and primary care services as a way to contain costs, experts said.

In rural areas, health officials are using the index to assess health care needs in Litchfield, New London, Tolland, Windham and Middlesex counties thanks to federal "community transformation" grants ($494,000 a year for the next five years) to tackle chronic disease and health inequities. CADH has obtained a grant that will make the health equity index available to all local health districts and local departments through March 2013.

This story was reported under a partnership with the Connecticut Health I-Team (www.c-hit.org).