The condition in which people are born, grow up, live, work, and age may invariably affect their state of health and well-being as well as impact their health decisions.
These are referred to as social determinants of health and include income level, social status, education, employment and working conditions, housing, healthcare access, personal health practices, transportation and nutrition.
A study by Bradley et al published in 2016 and titled Variation In Health Outcomes: The Role of Spending on Social Services, Public Health, And Health Care, 2000-09, found that places with a higher ratio of social to health spending had significantly better subsequent health outcomes for adult obesity, asthma, mentally unhealthy days, days with activity limitations, and mortality rates for lung cancer, acute myocardial infarction (heart attack), and Type 2 diabetes.
It concluded that investments in health should not only be focused on healthcare but also in social services and public health. It is true that lower socio-economic countries and communities tend to have a greater disease burden than their counterparts.
Infusing the details of persons' health, social and economic conditions into electronic health records (EHR) can provide insight into the direct effects on persons' health. It can also provide much needed data for governments to be able to make useful interventions.
The Government recently announced a ban on sugary drinks in schools - quite a commendable move. If the Government had access to social determinant information in an EHR database, then it could take this a few steps further to identify all the other non-health-related issues that lead to this choice, the communities most affected and the various illnesses they face as a result. This would allow for broader interventions.
The fact is that clinical care only plays a small part in overall health. In fact, most would say prevention is always best and the type of data that can be captured here can go a far way in putting in place mechanisms for disease prevention by identifying specific problem areas and individuals.
The fact that we have begun a process of healthcare digitisation in Jamaica means that we can successfully meet these objectives. Once the public sector incorporates more health technology into its operation, including a national EHR system, there will be so much more that we can achieve by way of progress in eliminating inequities in health and improving overall population health and well-being.
To achieve this, population data capturing the social determinants need to be incorporated within the EHR. We already have a basic framework that we can use - Jamaica's Economic and Social Survey, a population-based data source that is frequently updated and has cross sector application.
Personalised Individual Patient Data
But one important thing that we must remember is that personalised individual patient data is second to none when it comes to creating treatment and care pathways.
This is usually achieved at the level of interaction with the healthcare institution and/or practitioner. Imagine if all the disparate databases could be linked so that if someone moved from private to public care, for example, their information and care pathway remains consistent - this is the basic idea behind a national EHR.
Analysis of this data can allow the Government to determine what section of the population is most at risk for certain illnesses, where they live, work or go to school, their income and education level. The data can also allow governments to use a community's health status to determine the kind of social interventions that may be required.
The data analytic tools within the health technology can assist with the knowledge gap between extracting and applying data.
We must begin to think about the need to first use technology in healthcare as a priority and then using that data to improve people's lives. Since we know that in any system there is shared responsibility for population health, the technology through the EHR will also enable cross-sector collaboration to identify problems and implement solutions.
I can guarantee that if we improve the health of our population significantly, then social and economic gains will follow and overall health spend will be much less. Health technology has given us a chance to move at a greater pace towards these goals.
- Doug Halsall is the chairman and CEO of Advanced Integrated Systems. Feedback: Doug.firstname.lastname@example.org
Published:Sunday | September 23, 2018 | 12:00 AM Doug Halsall