Why This Matters:
A discrepancy among the various health services between urban and rural Illinois can place some people at a disadvantage.

MACOMB — When it comes to population health, healthcare is just the tip of the iceberg.
Dr. Sameer Vohra, executive director of the Southern Illinois University School of Medicine's Office of Population Science and Policy, presented Tuesday evening on the need to bridge the gap between good health and the people who lack the means to get and keep it.
The presentation topic, “Bridging Health Equity Across Communities,” reflected concerns raised during this year's National Minority Health Month about disparities – or great differences – in health outcomes among different groups, including among them people in rural areas. About 50 Western Illinois University students, faculty, staff members and other individuals involved with public health and social issues attended the presentation.
Vohra is a pediatrician and is trained in public policy. He also has a law degree. He described the differences in health outcomes as “systematic and avoidable,” and explained that often environmental and other situations exist that predispose some people and groups more than others to greater suffering.
Using asthma as an example, he said that although children from different economic and racial backgrounds can have it, some are more often exposed to stressors and environmental conditions like mold and exposure to cockroaches, which can worsen their condition.
“If you live in an environment that's pristine, and you have the highest (quality) air purifier for allergens and you wash all your teddy bears and stuff, you're not going to be in a position that you're going to be at risk for having asthma attacks, right? But if you live in an environment of public housing, people aren't changing their filters, cockroaches all over the place, you are being exposed to more environmental causes that worsen that asthma,” he said. “So even if we say that everything else being equal, certain kids are going to have more challenges.”
A person's education, income, community safety, ability to afford or access healthcare and their own health behaviors can all impact health outcomes. He described these as the “social determinants of health” and said that these are increasingly becoming key to solving the inequitable health outcomes many experience.
According to Vohra, healthcare factors such as access to care and the quality of care make up only 20 percent of all the factors that determine how healthy a population is. The remaining 80 percent include factors related to a person's physical environment (10 percent); socio-economic factors like education, income and family and social support (40 percent), and health behaviors such as alcohol use and diet (30 percent).
“That 80 percent needs to be addressed before you even get to healthcare,” he said.
Many people face challenges like not being able to get to a doctor because of a lack of transportation. Many work two jobs, and may not be able to take their children to a doctor because the doctor's clinic hours don't fit when the parent is available to take their children in.
Other social factors play a part even if a person can access healthcare. “Are you being treated the same regardless of your income, or your ethnicity, or your race, or your geography, or do individuals both inside and outside of the system treat you differently?” he said.
Some of the state's worst health outcomes occur in rural areas, which have a number of different issues that predispose people to worse outcomes. Although rural areas only make up 15 percent of the population, more children in rural areas are born into situations where at least one parent is in poor mental health. They also tend to have more poorly-resourced environments, fewer doctors and adverse childhood experiences. Those adverse experiences tend to lead to worse health outcomes.
“In rural areas, one in six children had a mental, behavioral or developmental disorder,” he said.
Early adverse experiences can set up a “domino-effect” of problems including social, emotional and cognitive impairments; the adoption of risky health behaviors; disease, disability and social problems; and potentially early death.
Although more physicians are needed in rural areas, addressing poor outcomes takes more than just adding doctors. “Increasingly, there is an understanding by people across healthcare sectors that if we're really going to be concentrating on improving people's health, we've got to move beyond the individual...We have to go back to the roots of all these challenges and build those environments that are really going to be effective.”
Making small changes like behavior modification hasn't worked, he said. Systemic change that can be sustained is needed.
“It's this idea of achieving health equity (fairness), right?...There's data and research, there's services and programs...changes in institutions, we've got to build the community capacity for that change, and then we've got to link it to policy change,” he said. “All these things really are interconnected. We can't do one without doing another.”
The bigger picture of healthcare should be designed around people, in what is known as “human-centered design. “We've got to stop saying, 'This is a perfect program' and making people change to achieve that,” he said. “(We need to) understand how people live their everyday lives, and adapt our programs and policies around that.”
The Office of Population Science and Policy is in the process of building community coalitions to find solutions to health problems common in their service area, which covers much of rural downstate Illinois and includes over two million people.
Along with conducting research, the office is working on several projects to address health disparities, with the goal of creating working models that can be replicated widely. These include projects on baby brain development, childhood asthma, rural cancer health disparities, STD prevention, and developing supportive services for people with dementia and their caregivers.
For more information, see the website at siumed.edu/popscipolicy or call 217-545-7939.

Reach Michelle Langhout via email at mlanghout@mcdonoughvoice.com or follow her on Twitter@mlanghout1.