New Maps of DC health data – Not yet one culture of health

Catching up on social innovation I haven’t yet posted about…

I have complained previously about the fact that data purporting to show Washington, DC’s health status as a county is usually wrong (see: Do national numbers inaccurately represent Washington, DC’s obesity condition? | Ted Eytan, MD – Answer: YES) because DC has 8 wards within it that are not accounted for in the County Health Rankings’ of the world (@CHRankings). This makes these tools less useful in a place like our nation’s capital. What if you live here and love this city and want to make a difference?

Community Commons (@CommunityCommon) to the rescue. Earlier this year they so very nicely agreed to add Washington, DC ward boundaries to their most awesome mapping system , and some key health data points based on DC-level data. They even created a special hub “Center for Total Health” that’s invite only so I can bring community health activists to map their city, collaboratively.

Here’s the obesity map for Washington, DC:

Obesity by Ward, Washington, DC USA 51195

Here’s the smoking status map for Washington, DC by Ward:

Smoking Status by Ward, Washington, DC USA 51194

These are new; previously there was no way to understand DC’s health using an interactive system because all of the data is clumped at the county level. As you can tell from the above, if you see an obesity rate of 21 % for “Washington, DC” you’ll miss important distinctions.

Now, here’s the race / ethnicity map for Washington, DC, available by census tract:

Race/Ethnicity by Tract, US Census 2010, with Ward Boundaries  51203

Do you see a picture of different health status on the left side of the map vs the right side of the map?

Wanna play? Click on either map

The new capabilities provided by Community Commons allow us to map any sub-county level data over ward boundaries so we can understand our city better. I even created a few interactive ones that you can play with here. Just click through, you’ll need to create an account on to make any changes. Up to you.

While I was at it, I also created a map using DC-data-whiz Michael Schade’s (@mvs202) interactive Google Places map, plotting presence of what Google labels “gyms” in a 4-metro station radius of Shaw/Howard University Station:

Heat Map - Gyms in Washington DC 51193

You can see that gym businesses in the Google places database encircle Dupont Circle (14.4 % obesity rate), with a lot less presence east of Shaw/Howard University Metro (17.4 % obesity rate heading into 35 % obesity rate). These distinctions are important – people who spend their time in the western half of the city may believe they own a culture of health, but it’s only they that do.

I mention Shaw/Howard, because I recently read the excellent book S Street Rising: Crack, Murder, and Redemption in D.C. by Ruben Castaneda (@RCastanedaWP) which has stimulated tons of thinking about how a city creates and loses health. More on that later…

Yesterday, I happened upon a ribbon cutting ceremony by our Mayor (@MayorVinceGray) (who has done incredible things for human rights) in that neighborhood. I asked a bystander if she was here during the riots that destroyed this part of the city in 1968. She said, she was, and it was a scary and sad time. I believe her.

Photos: S Street, 1968 and 2014 – next to Shaw/Howard Street Metro

She told me that her friends told her she should have taken photos of the before and after, because so much had changed. I responded that there were still plenty of photos to take – even though the buildings look new, there’s plenty of “before” to be found, the maps show it.

Thanks a ton, again, to Community Commons for being responsive/interested/supportive and no negative vibes meant to County Health Rankings – we are all friends and the two resources go together in the most useful way. Sometimes you have to go to the places that no one else goes to find and create innovation in health. That’s what social innovators do 🙂 .

If you’d like to do some DC mapping, drop me a line/comment/tweet and I’ll invite you to the hub on Community Commons.


Now Reading: Addressing Climate Change among Insurers, some are doing more than others

When I asked about the phenomenon of climate change and if the impact on our health was real, a wise person once said to me, “look at insurance companies.” Meaning, look at the industry whose role in society is to understand risk.

This report put out by Ceres (@ceresnews), a nonprofit organization advocating for sustainability leadership, capitalized, or should I say, leveraged, a movement by the National Association of Insurance Commissioners, to mandate disclosure of climate change related risks by insurers. This culminated in 3 states (California, Washington, and New York) mandating disclosure of any insurer writing more than $300 million in premiums, which effectively captured the entire insurance market.

This is a report of the analysis of the disclosures of 184 companies, spanning the insurance spectrum, including health insurance. So that’s why a doctor is reading this report.

That and the fact that it validates that I do work in a health system that is paying more attention to this issue than most. 

The news is overall not very good. On the one hand, there is confirmation that insurance companies are paying attention to climate change and it is affecting their behavior, in terms of what they invest in, where they write (or don’t write policies), and how they are planning for catastrophes in areas where they operate. Of note, there appears to be the most effort underway with regard to hurricane prediction and loss modeling there. In other words, this is seen as a real threat.

On the other hand, there are well-known, highly visible insurance brands quoted who appear to either not be preparing for climate change, don’t feel it is a concern, or are adopting a wait and see type attitude with regard to future claims and viability of their organizations.  

There’s a whole section on health insurers, and as with the other sectors, there’s variability. Kaiser Permanente is called out specifically:

Especially within Health and L&A, but even among some P&C insurers, many companies view climate change as an environmental issue immaterial to their business. Only one health insurer, Kaiser Permanente, has a strong climate position. With the exception of Prudential Financial, virtually all L&A firms have little or no focus on climate change.


“If greenhouse gas emissions continue to increase, climate change will cause health effects that will directly impact Kaiser Permanente’s ability to fulfill its promise of quality, affordable care,” 


Only one example of innovation was found: “The Kaiser Permanente Research Program on Genes, Environment, and Health (RPEGH) was launched in 2005, with the goal of building the largest and most comprehensive resource in the United States for research on the influence of both inherited and environmental factors on people’s health.

To Heal, You Have to Not Harm – Validated Green House Gas inventory, Kaiser Permanente (click to enlarge)

Read more about the report here: Kaiser Permanente Leads Insurers in Addressing Climate Change: Report | Kaiser Permanente News Center

I think this is a fascinating window on industry in general, in terms of which specific organizations are aligning themselves with health and in the reduction of health inequalities through addressing this social determinant of health.

Now Writing: Seven Visual Insights of Social Determinants and Behavior Change – ILN INSIGHTS 2013

Innovation Learning Network (@HealthcareILN) Insights 2013 is here! And thanks to to the graphical stylings of Tim Rawson (@noswar) and the editing ambrosia of Chris McCarthy (@McCarthyChris), I get to be a part of it. The article as published (on page 58), entitled “7 Visual Insights of Social Determinants” was actually posted on this blog in draft form to get community feedback. That feedback was super helpful, as it exposed the first iteration as a bit of a jumbled mess (see: Requesting crowd Peer Review: Visual Primer on Social Determinants of Health | Ted Eytan, MD).

Maybe it’s still a jumbled mess, you tell me. Either way, this is the publication to be a part of. It only comes out once a year, it’s tied to the best Innovation Learning Network and it’s a great vehicle for the non-compliant physician article writer.

As we all worry about the choices people make that result in good or poor health, I wanted to distill what I’ve been learning over the past 2 years about (a) what our goal should be – reduce health inequalities, and (b) how we should get there – focus on the causes of the causes of poor health.

I believe that since I envisioned this piece that the concept of social determinants of health has gotten broader exposure. You tell me if you’ve heard this all before.

The link above is to the entire publication (which you should read), but if you want to sneak a view at just my article, here it is. Enjoy, comments always welcome, thanks for crowdsourcing me out of the fog.

Community Health Needs Assessment includes the Environment, and Green Health Care Resources

After I had the opportunity to write this post on the Robert Wood Johnson Pioneering Ideas blog (see: Pioneering Idea: Your Patient’s Community Health Needs Assessment on the Desktop – Robert Wood Johnson Foundation), I learned courtesy of the Environmental Stewardship workgroup that I serve on at Kasier Permanente that one of the indicators in the main indicator library is Poor Air Quality, reported at the level of the census tract. I ran that map in a few clicks for the east coast.

It’s a great addition to the main indicator library, especially since it’s known that an unhealthy environment disproportionately affects those with greater health inequalities. It’s a reason why this whitepaper, How doctors can close the gap | Royal College of Physicians, has such a strong emphasis on environmental stewardship.

And speaking of environmental stewardship in health care, here’s a list of resources to access to learn and participate more, also courtesy of the Environmental Stewardship workgroup. Prevention is the new HIT. Enjoy.

Green Health Care Resources

Photo Friday: Climate Change is about People, not Polar Bears

Top image (March 2012): Ineffective

Bottom Image (November 2012): Effective

If you fly through DCA airport to get to Washington, DC, you’ve probably seen one of the images above on your way to the baggage carousel. I’m there enough that I was able to snap the image on the top, in March, 2012, and the image on the bottom, in the same space, in November, 2012. Note how the focus has changed – from “Polar Bears” to “People.”

I noticed the first image back in March because of the research I was exposed to about this phenomenon in learning about Green Healthcare. (see: Not using stock photography: Better images to talk about green in health care #greenHCTed Eytan, MD | Ted Eytan, MD)

The two together are great examples of ineffective (top image) and effective (bottom image) means of creating awareness about climate change, which is impacted by environmental stewardship, which is impacted by Green Health Care, which is impacts health.

Not harming people at the same time you are working to heal them is part of total health. A few more images related to climate change and green health care (or lack thereof) are below. Click to enlarge. Prevention is the new HIT.

Now Reading: Walking and walkable urban places will drive an economic as well as a health renaissance

Continuing on in this series in preparation for this week’s walking summit (now with hashtag! It’s #EBWPartners , which stands for “Every Body Walk Partners”), I am going from the medical, to the social, to the economic.

I have to say it’s kind of wonderful in the era of thinking of Total Health, that physicians and community partners look beyond the medical causes of good health, to explore the causes of the causes. That’s where the action is.

What this is

WalkUPs stands for “walkable urban places,” and this report presents an impressive body of work in the making by Christopher Leinberger at the Brookings Institution and now published by the George Washington University School of Business. 

Leinberger coincidentally began publishing his work right when I came to DC, and I latched on to it right away (see: “Footloose and Fancy Free: A Field Survey of Walkable Urban Places in the Top 30 U.S. Metropolitan Areas,” December 2007, and Now Reading: Economic Promise, Social Equity, and Health of Walkable Places in Washington, DC | Ted Eytan, MD). It lives in my own personal and professional sweet spots that include (a) walking and (b) Washington, DC. Need I say more:

What was perceived as a niche market is becoming the market. This research takes a deep look at Washington, D.C., a national pioneer in walkable urban places, to identify where development has and will take place—and the economic and social impact it will have.

Why DC is modeling it

He states that DC is approximately 40 years ahead of the rest of the nation in creating the most beneficial built environment, and his arguments, based on actual data, are convincing. What’s off-the-charts impressive about this is that it’s mostly happened since 1990. If you talk to anyone who lived or spent time in Washington, DC during this period, they’ll tell you it was a very different place.

Just look at it now, in this little collage I made.

The rationale for the 40-years-ahead statement is based on the trajectory of the education level of the population here (highest per-capita, in the United States). It is a parallel line with the next 5 most walkable areas and with the least walkable areas, with 20 years separating each, with the hypothesis that an educated population will drive demand for WalkUPs, that in turn attract more educated, creative people.

In terms of the walking itself, Washington, DC is the most walkable city in the United States, and the only metropolitan area that has an example of the 6 types of WalkUPs. What does that translate into?

  • WalkUPs have higher performing real estate, including office, hotel, and residential
  • New development is shifting toward WalkUPs, most notably 12 % of apartments were in walkable urban locations, this number has gone up to 42 % today
  • WalkUPs with the highest level of economic performance also tend to have the lowest housing/transportation costs, the most accessible jobs, and the highest ethnic diversity

The social equity is where this work is extremely interesting/leading edge. Leinberger looked at the economic performance and social equity levels of WalkUPs in Washington, DC, to start an important conversation about what “performance” is for a WalkUP neighborhood, and this work includes community values that are important in addition to real estate values. 

Walk score is estimated to account for 67 % of the increase in economic performance of WalkUPs. Adding job density and education levels of a workforce brings that number to 90 %.

The data assessed to produce this study is extensive, and what’s interesting to me is that the report doesn’t really touch on the health benefits of walking. It stands on its own. What a perfect Total Health connection then, between this work, the work championed by AmericaWalks in the policy space, and the work championed by the (a) health system in the health space.

And it’s all related to walking. With Washington, DC, as the example. What could be more perfect.