Mar 18, 2016


Dr. Jones: So what are the biggest factors that impact our health and what can we do to better address them? I'm Dr. Kyle Bradford Jones, family physician at the University of Utah School of Medicine. And we're talking about this on The Scope.

Announcer: These are the conversations happening inside health care that are going to transform healthcare. The Health Care Insider is on The Scope.

Dr. Jones: Today I'm joined by Dr. Ana Marie Lopez who's an oncologist at the Huntsman Cancer Institute and the Associate Vice President for Heath Equity And Inclusion at the University of Utah Health Sciences. So, Dr. Lopez, there are a lot of factors that impact our health outside of healthcare. What are some of the major factors that influence the health of individuals and populations?

Dr. Lopez: So in fact, probably most of the factors that lead to health or illness take place outside the doctor's office. And I think that's really important for people to be aware of because that means that the individual and the individual's community really have a lot of control over health and illness. So some of those factors can be things that we might not even think about such as education, such as the safety of our streets, such as the food in the grocery store. Lots of factors. In addition, things that we probably think about more, such as our family history, how that predicts, any differing abilities that people might have, any genetic factors.

Dr. Jones: So when you say things like education, and what not, how does that impact health?

Dr. Lopez: A person who has a higher education level is less likely to smoke, for example. And smoking, we know, has tremendous impact on health. I tell women smoking is a risk for cervical cancer. Something we don't even think about. We often think of lung cancer, think of pulmonary illnesses. And a person who has more education, because that person is likely to have more health literacy, a better sense of numeracy is probably also engaging in healthier behaviors overall.

Dr. Jones: And these are often called the social determinants of health. Because of all this in mind, do we over-emphasize healthcare that people receive?

Dr. Lopez: So I like to think of them as the social determinants of illness. I think the way we are in our society right now, we don't even know what really determines health. So if we think about these social determinants of illness and that they really impact us so much outside the doctor's office, outside the regular healthcare system, we can think of it in one of two ways. Either we're over-emphasizing or else the scope of healthcare really needs to expand. And I favor the latter. That as a clinician, as a physician, if I really want to take care of my patients, then I need to partner, for example, with grocery stores to be sure there's healthy food in the grocery store.

Dr. Jones: So keeping this in mind of all these other factors, how does this impact society?

Dr. Lopez: I think that it's actually very helpful. Because it means that as a society, as a population, we can make a difference, we can influence. For example, if the streets aren't safe to walk, let's talk to policy makers, let's talk to legislators. Walking is the most accessible form of exercise that we can have. So if we can work together and partner, we can make a difference in the population's health. And most importantly, in the health of future generations.

Dr. Jones: So with some of those things that could be adjusted by policy, have we been very successful in addressing those?

Dr. Lopez: Well, I think we're really just beginning to think about what that might be. And I think we also have to be aware and think about what forces might be the forces that would resist those changes. So we need to partner and we need to think and we need to see what's important to patients, what's important to families, what's important to communities and then prioritize and work with.

Dr. Jones: And so outside of pubic policy, what types of things are being done or can we do to address the social determinants of illness?

Dr. Lopez: So for example, if we think about fresh fruits and vegetables, that's something that's probably lacking in everybody's regular nutrition. We can work together to develop community gardens. That would be something that's grass roots, very inspiring for people, and so incredible when you see children go in and pick their vegetables for dinner.

Dr. Jones: And many people have said that's an excellent start. How do we take it to the next step? So to make sure, for example, families know what to do with the fruits and vegetables so to speak, and how to prepare those healthy meals?

Dr. Lopez: So a lot of education. I think our schools are such incredible partners and we have the opportunity. Here are buildings that are generally empty in the evenings. Those could be great spaces where communities can come together. Where we have to be thinking who are the partners, what does need to be done. And some of these could be done through telecommunications technology. All the schools in Utah are wired. They're all interconnected. So a program could be done, bring in all the schools, bring in families, do cooking.

A really novel program that's taking place in some programs across the country is to think about training our residents to cook. Residents are early in their career, they're learning how to be in their specialty, and they're often counseling patients about what to eat. And yet our own trainees probably don't eat too well. So to educate our residents and then our residents could educate the communities.

Dr. Jones: And you mentioned how ideally, health care would expand to better address some of these issues. What are some things that physicians and healthcare systems and other healthcare professionals can do to help address some of these issues?

Dr. Lopez: I think we need to partner. We need to partner actively with patients, with communities, with different populations. The population of Utah is increasingly diverse. And to really look at the different communities. The original root word of "doctor" is "teacher." And part of being a good teacher is asking the right questions. So I think we need to be asking those questions and learning from our communities as far as what they need and what they would like.

Dr. Jones: And so thinking of this, as you've mentioned, with broader groups and community efforts, what can individual patients do, or individuals do to help address these in their own life?

Dr. Lopez: So patients really need to be informed. So I really welcome when a patient comes in, is organized with a list of questions and even if the information is wrong, it's a really important teaching opportunity and I always, always, encourage patients to do this. We're at a time where lack of information is not the issue, it's we have a ton of information and how to sift through it. So to be able to educate patients regarding how to do that is really important and to encourage patients. We need patients to be active participants in their own healthcare. And to do that, patients need to educate themselves, we need to educate our patients and we need to become educated about what patients really prioritize.

Dr. Jones: So what do you think are the one or two most important takeaways on this subject, both for healthcare systems as well as individuals?

Dr. Lopez: Listen. I think really active listening on both sides. So that we can really understand each other and work together. We're really at the cusp of tremendous change in healthcare. I'm not sure we can even conceptualize what that means yet. But I really think that there is hope that people, and that our children and their children will have a healthier future.

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