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SOCIAL DETERMINANTS SOCIAL DETERMINANTS
OF HEALTH OF HEALTH
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Figure 2

Location, Location, Location:

Associating Physical Environment with Health Outcomes

By Teresa Samson, OMS-III at UIWSOM

Less than twenty years ago, the completion of The Human Genome tonio children to grow up.
Project galvanized a deeper understanding of the human genetic code The outdoor aspects of neighborhoods have a similarly profound
and became a cornerstone in medicine. Applications of this knowl- effect on community health. Parks and playgrounds provide safe out-
edge, such as genetic screening for disease, gene therapies and door areas for all age groups to exercise, socialize, or for leisure; ac-
CRISPR-Cas9 gene modifications have revolutionized approaches to tivities that all have known health benefits. It is therefore
healing disease. Yet, science remains far from discovering a panacea. unsurprising that areas with fewer recreational spaces have increased
two examples of organizations that help patients access medical care proportionate lack of healthcare facilities. As practicing physicians, Strikingly, it is now well-known that a person’s ZIP code may be a bet- rates of cardiovascular disease. An intriguing study revealed a strong
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through flexible transportation. Others can be found at the San An- one strategy we can deploy is that of satellite offices. These timeshare ter predictor of health outcomes than their deciphered genetic code. 1 relationship between residential greenspace and childhood behav-
tonio Community Resource Directory at www.sacrd.org. or part-time leasing options allow for a low risk, low incremental cost Despite scientific advances, health continues to be a multifaceted con- ioral outcomes, correlating exposure to greenspace with decreased
When patients are able to access care is another variable we have a opportunity for a large return in terms of patient access. Using my cept and healthcare practitioners now must consider what external risk for conduct disorder-like behaviors at age 7 and anxiety, depres-
lot of flexibility to control. There’s the option for us to keep our prac- practice as an example, we rent part-time space in 5 different offices factors affect patient outcomes. Housing, parks and playgrounds, sion, and somatization-like behaviors at age 12. In the entire USA,
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tices open even an hour later into the evening or perhaps conduct one throughout San Antonio, conducting 2 to 4 clinics per month within safety, transportation, walkability and ZIP code are all aspects of one’s 54% of Americans live within a 10-minute walk of a park, while only
evening clinic per week or per month. Keep in mind that ANY devi- each. There are logistics to consider for this “pack-in, pack-out” model physical environment that have an important role in determining com- 38% of Bexar County residents have this luxury. Most of these green
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ation of our practice hours that extends beyond the normal 8am-5pm for transportation of supplies and staff, but these are easily customiz- munity health. 2 spaces are concentrated within Loop 410 and are primarily located
Monday-Friday schedule CREATES access to care. A Saturday clinic able for the needs of any given office. Housing conditions became a focus of health maintenance in the near the more pedestrian-friendly areas of San Antonio, thus poten-
makes an enormous impact on access to care. Consider reducing or 1990s as the U.S. Department of Housing and Urban Development tially decreasing the physical and psychological wellbeing of the
closing a clinic on a Monday following a Saturday clinic to offset your Conclusion took initiative in lowering the incidence of acute lead encephalopathy other half of San Antonians without easy park access. Accordingly,
additional stress. This may feel like a zero-sum game with regard to There’s no doubt that the course of history has stacked the deck in pediatric patients. Their efforts have since resulted in a 70% reduc- access to safe, well-maintained parks and playgrounds are a commod-
our own personal time, but the positive impact of a Saturday clinic against the utopian desire for equitable access to healthcare for all of tion in lead cases. Older or ill-maintained homes provide the primary ity for the wellbeing of San Antonio residents and should remain a
available to our patients can far outweigh the loss of a subsequent our people. This history, however, should not discourage us from using exposure to lead, which, even at low blood levels, has been shown to priority for city planners.
weekday. Another variable within the when patients access care is our collective resources as physicians to initiate the changes we desire. negatively impact cognitive and behavioral development in children. Beyond neighborhood infrastructure, the safety of a neighborhood
being more flexible with our “next-available-appointment” definitions. For as much as the current status of patient access to care is the result Other poorly regulated aspects of the home include exposure to car- can alter community health outcomes in both direct and indirect
For example, if a new patient has an acute problem or an established of both the intended and unintended consequences of deliberate and bon monoxide, tobacco and radon through the air as well as the ab- ways. While an individual’s feeling of “safety” may be influenced by
patient has an urgent change of their symptoms, consider allowing purposeful historical planning (i.e. segregation, redlining, etc.). We sence of heating and cooling systems, poor water quality, mold, and a number of subjective factors, crime and traffic fatality rates are
them to come in at their next convenience instead of the office’s next must deliberately and purposefully invest in correcting the status quo. ambient noise. These aspects are known to have similar deleterious ef- measures that can help quantify the objective safety of a neighbor-
convenience. I frequently remind my staff that satisfying our patients’ Thankfully, our chosen profession as physicians often allows us both fects on childhood neurological development and also jeopardize res- hood. Beyond induction of stress, crime – most notably gun-related
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needs far outweighs the acute inconvenience we may feel by adding a the professional and financial latitude to make such investments. Ac- piratory and immunologic health. Housing conditions are similarly crime – has been shown to reduce park use, potentially decreasing
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patient to a full schedule. cess to healthcare is a problem we can solve together if we each take an important factor in the health of the San Antonio community, rates of physical activity up to one year after each incident. Simple
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Finally, we can review the where component of the patient access steps toward this goal. where almost 50% of houses were built prior to the reduction of lead adjustments, such as increasing street lighting, could be redeeming.
problem. Investment in physical healthcare facilities has largely fol- use in paint and gasoline, and where inadequate waste removal in cer- Such changes have been associated with increased physical activity,
lowed the same overarching trends of housing and commercial invest- Lyssa N. Ochoa, MD is board certified in Vascular Surgery tain neighborhoods compromises the health and safety of the area. 4 decreased apprehension, and fewer traffic accidents. Furthermore,
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ment: that is to say mostly north and far-west sides of town. That leaves and General Surgery and is an elected member of the Board of Without regular maintenance, renovation, and imposition of building awareness and fear of local crime has shown a 40% increase in prob-
a large geography of densely populated urban San Antonio with a dis- Directors of the Bexar County Medical Society. standards, homes could become the most dangerous place for San An- ability of respiratory illness. With this in mind, crime reduction is
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18 SAN ANTONIO MEDICINE • January 2021 Visit us at www.bcms.org 19