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Going Upstream: More Tips for Finding Health Stories in the Built Environment

Going Upstream: More Tips for Finding Health Stories in the Built Environment

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Below are more tips from the Health and the Built Environment Webinar: What Makes a Healthy Environment?, presented by Center for Health Journalism Digital. Click here for the first three on my list.

Trace the hot spotters to their heat source. “The sickest and costliest neighbors often have unmet needs in the social and built environment,” Manchanda said. How costly? The U.S. Agency for Healthcare Research and Quality found that for 2009 and 2010 just 5% of the patients account for half of all U.S. health spending. The agency also found that some of those really sick people continue to account for a huge percentage of spending year after year. Here’s what the agency wrote:

In both 2009 and 2010, the top 5 percent of the population accounted for nearly 50 percent of health care expenditures. Among those individuals ranked in the top 5 percent of the health care expenditure distribution in 2009 (with a mean expenditure of $40,682), approximately 34 percent retained this ranking with respect to their 2010 health care expenditures.

Then focus on what really will reduce the heat. How do we drive those costs down? Manchanda pointed to a 2011 Health Affairs study by Bobby Milstein at the U.S. Centers for Disease Control and Prevention and others that found increased coverage is important, but what the authors called “social protection” reduces deaths and costs even more. What’s included in protection? Things like reducing tobacco use and secondhand smoke exposure, lowering the consumption of saturated and trans fats, increasing physical activity, and limiting exposure to air pollution. Milstein and his coauthors found:

Only protection slows the growth in the prevalence of disease and injury and thereby alleviates rather than exacerbates demand on limited primary care capacity. When added to a simulated scenario with coverage and care, protection could save 90 percent more lives and reduce costs by 30 percent in year 10; by year 25, that same investment in protection could save about 140 percent more lives and reduce costs by 62 percent.

Ask for the HIA in your 411. English encouraged writers to ask their local governments for copies of their most recent health impact assessments (HIA). Not every city is going to have conducted one, but those that have will provide you with a richly detailed road map for where your next story could go. Philadelphia was planning on spending $400 million on extending its subway by just one stop. The impetus? A growing suburban job hub known as the Navy Yard, home to Urban Outfitters and GlaxoSmithKline. Would that money pay off in better health for people by encouraging them to use the subway and ride their bikes to and from subway stops rather than driving. The HIA mapped where people who worked in the Navy Yard lived and found that, given the job growth, the city was poised to see a massive increase in vehicle miles.

Did you tune in? Do you have your own ideas to share? Send them to me at or via Twitter @wheisel.

Image by Tall Chris via Flickr

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