My #walkwithadoc and patient, exploring the determinants of health in Washington, DC Ward 8

So much beer. View on Flickr.com

What struck me most on reviewing my photographs (see below) was the amazing amount of beer in one store.

I took them on a walking tour of Ward 8, known as Anacostia, with another physician Pierre Vigilance, MD, MPH ( @PierreVigilance ) and a patient champion, Kait Roe ( @kaitbr ). Kait and I went because we were curious about the environment that supports an obesity rate of 42%, higher than the highest rate of any state (Mississippi, at 34.4%), and also happens to have a low usage rate of Washington’s bike sharing program, Capital Bikeshare (@bikeshare). You can read the blog post and the comments that got us here: Quantified Community: Visualizing the health and illness of Washington, DC through open data and art | Ted Eytan, MD.

We wanted to go because there’s only so much you can learn from Google and looking at data. We were fortunate that Pierre, who also has the distinction of having been the Director of the Department of Health for Washington, DC, saw my briefing information online and offered to come with us (you can view it here as well: Social Determinants of Health Tour Link Cloud – Ward 8 Washington,DC). In the end, he was way more than that to us : our chauffeur, guide, and discussant of what we saw. Pierre is currently a Visiting Professor for Practice at the George Washington University School of Public Health & Health Services.

We started on Martin Luther King Boulevard, where we stopped into a corner store that happens to be a partner in the Healthy Corners program. We found the Healthy Corner food, and talked with the manager, who has been managing this store for 28 years (!). He told us there is currently a beer price war as well as a tobacco price war in the area. There are further pressures on cigarette prices because some individuals are traveling to Virgina where taxes are lower and reselling cigarettes on the street. If you look at my photos, you can get a sense of what “beer price war” looks like. Beer. Everywhere. As well as just about any household good a person would want, from wigs to stationery.

We walked to the Anacostia Bikeshare station and I took photographs of the area, to try and get a sense of why trips from this station are significantly more sparse than from other stations. I’m going to write a separate post about that, since it’s a more complex issue.

We did some more walking to understand the neighborhood better. There were lots of churches. Lots of cell phone stores. We did see a beautiful new library with its own bikeshare station, as well as a new Safeway grocery store on the other side of Anacostia. At the same time, Anacostia looks like parts of Detroit, with lots of abandoned houses.

On our way back to the heart of Washington, DC, we had such a great conversation, which I recorded (podcast coming). I had so many questions – what is the role of public health? How do people living in this neighborhood feel about their health? What is the role of a physician in this situation? Kait asked wonderful questions – what kinds of interventions is this neighborhood open to – do they want the environment or specific health traits of a Ward 2 resident? How well do we understand that in addition to environment that are a host of other social determinants, like race, gender, and sexuality that modulate health?

I left feeling that there were aspects of a vicious circle at play. This was intensified later that day when I walked into a convenience store in Ward 2 (obesity rate, 13%, lower than the lowest State in the Union, Colorado, at 19%) and saw the difference. Same thing when I photographed the bikeshare station at Dupont Circle for comparison (all the photos are below).

At the same time, there is much understanding about the health disparities that result from social determinants, and Pierre’s work at Department of Health was extremely influential for me.

His Department created the Obesity report that I first blogged about that changed my perception about DC’s State of Health. His Department also released DC’s first ever Preventable Causes of Death report, in 2010, which also hugely changed perceptions about what our most significant health problems are. I am grateful for both as a physician and a resident of this community. Uninsurance is #10 on the list at 0.6 %, by the way. This is why it was so great to have him with us, engaging the residents and pointing out the significant issues of the neighborhood that he was aware of.

My photographs are below – feel free to peruse them and ask, “how different is this from my neighborhood?” “What do I notice that could be contributing to poor or good health?”

I know there is so much excitement about the use of technology to promote good health and behavior change, so I wanted to bring these photos to the attention of people so that we can understand what the problems are.

Thanks, Kait, and Pierre for your innovative spirit. It sounds like the next #walkwithadoc should be in Ward 5. Are you game?

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