Dr. Vikram Venkateswaran, Marketing Consultant

Dr. Vikram Venkateswaran is a healthcare professional and independent blogger. He started his career as a dental surgeon eventually moving to sales and marketing in technology consulting. His areas of interest include public health policy, e-health and clinical research. He is an avid writer who has authored thought leadership papers in the areas on e-health, healthcare analytics and social media. He is also a blogger and writes two blogs one on management and the other on public Health in India. He can be followed on twitter @drvikram.

The factors that determine community health

sites/himssfuturecare.com/files/Screen shot 2013-09-11 at 10.32.25 AM_0.pngFlickr/Creative Commons photo by kasimir held.
September 11, 2013 AT 2:33 PM

Many believe that healthcare facilities determine the state of a community's health. But interestingly, that's not the case.

Factors external to health services often play a bigger role. For example, the most important factor to determine health is our genetic composition. That's why if you visit a hospital or a physician, you'll be asked questions about your family's health history  -  like has anyone in your family ever had diabetes? Genetic composition determines almost 30 percent of our community healthcare needs.

The second biggest factor is behavior. This includes elements like exercise, diet and habits (primarily tobacco and alcohol), and accounts for 30 to 40 percent of what affects community health.

The last two factors are economic and social conditions (15 to 40 percent) and physical environment (5 to 10 percent).

As I discussed in a previous discussion, to help foster better community health, policy makers look to initiatives like wellness programs, health education and giving economic and social incentives.

Technology can help, but it will be driven by policy. A good example is LoJack. Famous for building tracking devices for cars, LoJack has introduced a wristband that can be put on seniors with Alzheimer's Disease. With this, even if a patient loses his way and ends up miles from home, the local police can track and return him home. As you can see, this is a policy directive because it needs synchronization between police, technology provider and probably a care provider.

In an IBM point of view called Social determinants of health, the authors suggest that we need to adopt a five-point model to look at health holistically. The 5 points are:






I think the first point, Identify, is critical to rolling out a successful program. Elements to be identified are: How complex are the individual's needs? What are the primary requirements and how will they contribute to his health? Also important are the individual's meaningful personal relationships, and key events in the individual's care history.

To learn more about this point of view and share your thoughts, please join POV author Martin Duggan, IBM's director for strategy and market development, in a Twitter chat on Oct. 3 at 11 AM CT.

HIMSS Future Care Editor Ben Harris will host the chat from his twitter handle @bharris_HITN. Please join Martin and the HIMSS Future Care team for this exciting discussion.

I will be on the chat as well, participating under the twitter handle @drvikram

I look forward to talking to you all on October 3, and as always, comments and suggestions are welcome.





I am a bit surprised at the

I am a bit surprised at the title and substance of this article. the title is a bit provocative to me. While family history is relevant, I am not sure its recollection is a determinent. Determinance implys a direct relationship that is veiled in both the completeness of family history and its rendition. I do not beleive this implies genetics so much as anecdotal. I would see as "genetic" the determination of a trait exhibited in my DNA that has been shown to be deterministic at best and related at worst to a particular malidy. I would also see as "genetic" the same for my siblings and extended family. Diabetes, as an example, can emerge as a result of many factors not the least of which is quality of life. Quality of life is also highly correlated (sociologically,demographically, and even geographically) to a large number of amorphous relationships with health that are certainly not deterministic in a known, quantified, causal relationship. Risk factors are important to discuss, and for insurance purposes perhaps important to act on, given the alternative of doing nothing, but it remains unclear to me that the determinates of community health are far more numerous and interact in ways we hardly understand as in any real (quantitative) way deterministic. the fact that the data on most individual health records is poorly represented, the view of "community" or "population" is even more poorly understood. the data on these population aggregates are qualitative at best, and all are stovepiped in various offices, government programs, practices, etc. EHR will correct some of this but given its acceptance in the medical community I suspect that even my records will remain stovepiped among: the hospitals to which I have been admitted, the daisy chain of general practitioners I have had, the slew of specialists who have treated me for a number of special conditions, the testing conducted on me and my tissues by the various medical laboratories who have been sent samples of my DNA, Blood, malignant tissues, benign tissues, etc. People seem so concerned about privacy they fail to remember how difficult it is to create and maintain accurate health records. Maybe in 20 years we will have an EHR system that retains accurate histories and quantitative test results (which do not often agree among repeated trials between laboratories) that are not confusing and remain inconsistent even to the provider ordering the test for each individual but I doubt that will be the case. In fact, U.S. community health policy is more composed of influential peoples' opinions, and not even just the medically astute influential people. The determinants of community health or their supposed factors are not clearly related, orthoginal or accurate. thus they too are the result of people's opinions.

Identification of various

Identification of various needs and determinants will be quite tough. I think we must leverage exisiting infrastructure like schools, clinics, libraries, recreation sites, and places of worship to collect this sort of information systematically.