Posted: Jun 25, 2019 6 min. read

How can smart health communities improve our health and wellbeing?

By David Friedman, Federal Health Consulting leader, Deloitte LLP

It has been 100 years since Charles-Edward Amory Winslow launched a public health program at Yale University. He defined public health as "the science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts.”1 While the health sector has undergone tremendous change over the past century, the connection between community and health has never been more important.

The communities in which we live, and the people with whom we interact (both virtually and in-person), can have a powerful effect on our health. Communities can influence everything from what we eat, where we live, and how often we exercise. And communities continue to evolve. The internet, mobile technology, apps, and the widespread adoption of social media have all played a role in the emergence of virtual communities—influential groups that aren’t restricted by geography or socioeconomics. Unlike physical communities, where individuals might have little in common outside of their shared geography, virtual communities are scalable and can be focused on a particular issue. Virtual communities on their own, or in combination with geographic communities, can be highly influential in reducing disease, empowering consumers, and improving the overall well-being of their populations. These are smart health communities (SHCs).

Between 80 percent and 90 percent of health outcomes are caused by a host of factors not related to the medical system, according to the National Academy of Medicine.2 Creating SHCs could help to address some of those factors and improve health outcomes. The Deloitte Center for Health Solutions and the Deloitte Center for Government Insights recently interviewed innovators who are using new approaches to engage people through virtual and geographic communities. These SHCs are often led by technology companies, start-ups, and other non-traditional health stakeholders that are highly effective at engaging with and influencing consumers.

Government agencies could play key role in smart health communities

Some government agencies are beginning to play a collaborative role in SHCs by funding innovative pilots, or by establishing data-sharing agreements that allow them to collect, analyze, and share data about local population needs. Such collaboration between government agencies and other stakeholders could lead to innovative communities that work to improve the health of a particular group of people. Additionally, governments can help SHCs by developing and/or supporting their technological infrastructure and governance, including the standardization and security of data. My hope is that the health sector will grow to view government agencies as collaborators, rather than entities that might hinder innovation.

In my role as leader in Deloitte’s Federal Health sector, I am proud of the work our clients are doing (and that Deloitte is supporting) to address type 2 diabetes prevention. Between 15 percent and 30 percent of people who have prediabetes will develop diabetes within five years unless they change their lifestyle habits, according to the American Diabetes Association (ADA). Early intervention can prevent or delay the onset of diabetes among those who have prediabetes.

The National Diabetes Prevention Program (DPP) was established in 2010 and is an excellent example of federal agencies, hospitals, health centers, technology companies, and community organizations coming together to build an ecosystem aimed at improving health and wellness. The Centers for Disease Control and Prevention (CDC) developed the program framework around an evidence-based lifestyle-change intervention and engages with more than 1,500 in-person and digital providers who offer the program across the US.

The DPP is delivered in community group-based settings where coaches encourage participants to proactively manage their weight and exercise. The US Centers for Medicare and Medicaid Services (CMS) pays these programs for their services if they meet CDC’s standards. Many private health plans also cover the program for their non-Medicare enrollees. Examples of organizations that provide the DPP intervention include YMCAs, Weight Watchers, Omada Health, and many others.

The five core features of a Smart Health Community

With billions of people around the world now interacting and sharing experiences via social media, digital communities have the potential to help combat disease. The most effective SHCs typically use some or all of the following capabilities to encourage their community members to adopt or maintain healthy behaviors:

  • Empower proactive health and wellbeing: SHCs should encourage healthy lifestyle choices and help individuals make decisions that allow them to play a more significant role in their own health—and reduce adverse health outcomes in the future.
  • Foster a sense of community and belonging: Group activities could have a bigger influence on health than what someone can do alone. Sharing goals and outcome data with peers, for example, can help motivate some individuals to continue with diet and exercise regimens despite feeling like giving up. In addition, online discussion boards and social media groups can give individuals a place to share information, discuss challenges and successes, and seek support from each other. Case in point: Virtual National DPP groups and online discussion boards such as Cancer Survivors Network allow individuals to share success stories and challenges and seek support from each another.
  • Incorporate digital technology: The use of technologies such as mobile apps, fitness trackers, and GPS-enabled devices is a key function of advanced SHCs. But such digital technologies aren’t limited to virtual communities—some geographic communities are leveraging technology, too. Case in point: Louisville, Ky. was recently ranked as the seventh most challenging US metropolitan area for people living with asthma.3 AIR Louisville, a private-public collaboration launched in 2015, made GPS-enabled “smart” inhalers available to residents who have asthma.4 Each time an individual takes a puff, the inhaler logs the location, time, weather, and pollutants in the air. The individual then receives notifications about bad air quality days and information that helps predict the time and location of asthma attacks. Participating organizations include the Institute for Healthy Air Water and Soil and the Department of Civic Innovation. The initiative is funded by the Robert Wood Johnson Foundation.
  • Use data to improve health outcomes: As technology makes data collection and data sharing easier and cheaper, many SHCs are using the information to build models that predict risk, create a continuous learning loop through experimentation and innovation, and conduct research and evaluation. Case in point: The Chicago Department of Public Health and the Department of Innovation and Technology created a predictive-analytic model to help prioritize health inspections of retail food establishments. The tool combines information from various sources on Chicago’s open data portal with sophisticated analytic techniques to identify risk factors most likely to result in health code violations. The project includes a range of 311 data such as nearby sanitation complaints, previous inspection results, food license history, and outdoor temperatures.5 The city was able to use predictive analytics to identify violations most likely to lead to food-borne illness.6
  • Enable new and innovative ecosystems: Enabling new and innovative ecosystems of public and private entities is another essential element of SHCs. Case in point: In 2016, Mayor Rahm Emanuel and the Chicago Department of Public Health launched Healthy Chicago 2.0, a four-year program that includes 200 strategies to improve the health of all Chicagoans by focusing on social, economic, and other issues that negatively impact health.

Technology is helping to break down geographic barriers while building up new types of communities. With billions of people around the planet now sharing their experiences with each other, smart health communities offer the potential to improve our health as they become larger and more influential. In the future, we expect many more of the communities in which we live, work, and interact (both virtually and physically) will include a web of interconnected SHCs.

Endnotes
 1. C-E.A. Winslow, who launched public health at Yale a century ago, still influential today, YaleNews, June 2, 2015
2. Social Determinants of Health 101 for health care, National Academy of Medicine, October 9, 2017
3. Asthma Capitals 2019, Asthma and Allergy Foundation of America
4. AIR Louisville home page
5. 311 is a non-emergency phone number that people can call in many cities to find information about services, make complaints, or report problems
6. Food inspection forecasting, City of Chicago

 

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