The Importance of Local Health Data (Plus a v. Brief Comment on Race and Health)

March 7, 2007 at 2:15 am (Michael's Posts)

Today I was reading a paper by Shah, Whitman, and Silva from the Sinai (Chicago) web archive of papers on Urban Health (archive found here) and I just had to share it. Very common sense but also very good to read it in study form. It’s short and not too dense.

The main point of the paper is that to properly understand what’s going on in the health of communities, we need to look not at provincial or city levels, but rather at community levels (zip codes/neighborhoods, not just counties). The blend of all neighborhoods’ data together in a city- or county-wide survey (much more common than neighborhood-based surveys) masks disparities. And if we want to address the needs of communities, we have to understand where those needs lie.

“As urban settings become increasingly diverse and certain populations are disproportionately affected by disease, variations in the health status of these smaller geographic areas may be substantial, and such variations must be considered if true advances in disease prevention and control are to be achieved.” (Shah, et al, 1)

In the study, it was found that very distinct health patterns in some indicators arose depending on the racial and socioeconomic makeup of one neighborhood versus another. For instance, two adjoining neighborhoods with different racial makeups had vastly different rates of tobacco use (39% compared to 20%).

“If data are examined in an aggregated fashion, contextual differences in the demographic and health profiles of specific communities will not be identified, leading to difficulties in identifying and mounting effective community- based public health and public policy programs.” (Shah et al, 5)

In other words, as an example, the two above neighborhoods have different needs when it comes to smoking cessation work and one would benefit more from such work. The argument naturally follows that it would pay to focus the work where it is most needed so as to make the best use of scarce resources.

Their methods are quite good but are also time and money intensive. This is a shortcoming. However, if a philanthropic body can be plied for funds, it may be well worth it to public (state-run and community-supported) health workers to organize such data collection.

When reading this comment on race and health, recall that Chicago, like many American cities but probably more so than its peers, is extremely racially segregated. That is to say, neighborhoods are divided along racial lines. The study also highlights the rift between black and white, underscoring that even the more affluent black neighborhood in the study had much more in common in terms of low health outcomes with the poor black neighborhood in the study than it had in common with the relatively affluent white neighborhood. I found this an interesting, though not surprising, conclusion and one that adds to my understanding of the continuing inequality based on race in this country of ours. This can assure us that if we dedicate ourselves to curing racism in America, while working to heal a social ill we are certainly simultaneously doing important health work.

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