By Sarah Moyer, MD

Many of our patients often face real-life situations that can make controlling such chronic conditions as diabetes and hypertension difficult. As physicians, we are often unaware of the daily struggles preventing patients from adhering to our best-laid treatment plans. A recent experience with a patient suffering with diabetes made me acutely aware of this.

My patient’s blood glucose levels would be under control at one visit and horribly out of control at the next. For months we adjusted medications and discussed the importance of adhering to a regimen of healthy eating and physical activity. After several months of yo-yoing glucose levels, we finally got to the root of the problem.

Her early and mid-month glucose levels were in range because that’s when she got paid and could afford to buy healthy food. When her money ran tight toward the end of the month, she was forced to rely on neighbors and food pantries for food, often eating processed foods high in sugar, causing her levels to rise precipitously.

Building Infrastructure

The solutions to so many individual health issues that our patients face lie in building an infrastructure for good health throughout the community. This requires collaboration from many sectors—physicians, businesses, government, schools, civic and nonprofit organizations.

The solutions to so many individual health issues that our patients face lie in building an infrastructure for good health throughout the community.

We know that social determinants—your income, the neighborhood in which you live, your race, your education level—are powerful predictors of how healthy you will be. Only when we understand these outside factors, can we address the obstacles that stand in the way of better health.

In the case of my patient, connecting her with a community health worker who helped her connect to reliable resources to free up her finances for food made the difference in her ability to gain control of her glucose levels.

The solutions to many health issues lie not just in better access to clinical care, but in better social policy. In fact, research indicates that the greatest impacts on health are such socio-economic factors as food security, housing and education. The next greatest health impact will come from changing the social context so that the healthy choice becomes an individual’s default choice.

Smart Tech

Technology can also help to capture and analyze data about the patient’s real-world activities to inform patient care and public policy.

AIR Louisville—a collaborative initiative of Propeller Health; the Institute for Healthy Air, Water, and Soil; and the city of Louisville uses smart-technology to equip asthma patients and their physicians with data to identify asthma triggers to better control the condition. It also provides data that city officials can use to implement solutions.

In a 12-month period, there has been an 82 percent reduction in asthma rescue inhaler use among participants; 29 percent of uncontrolled patients gained control of their asthma; and on average, participants more than doubled their symptom-free days.

By identifying local asthma hotspots, we’ve also developed such interventions as a daily asthma forecast email, changing truck routes to reduce exposure to fuel emissions and planting trees in high-risk areas.

Physicians Needed

Physicians are vital to the work of building a healthier community. The Louisville Health Advisory Board, a collaboration of more than 60 private and public organizations committed to making our city healthier, hosted by Humana, needs your involvement.

The board’s mission is to improve the physical, mental and social well-being of Louisville, with the goal of increasing the number of Healthy Days–your quality of life–20 percent by 2020 and beyond. Healthy Days is a tool created by the CDC that tracks quality of life by measuring individual physical and mental health in a 30-day period.

We believe that creating a healthier community depends on collaboration to build an infrastructure for good health. We believe that public health is the work of all of us. It’s what we do together that gives every single person in our community the best possible chance at a healthy and productive life. Together we can break down the barriers to better health.

For more information, visit louisvillecultureofhealth.com.

-Dr. Sarah Moyer is director of Louisville Metro Department of Public Health and Wellness, the city’s chief health strategist and an assistant professor at the UofL School of Public Health and Information Sciences.