‘Hot-spotting,’ how gun violence spreads, and living in America on $2 a day

Ichiro Kawachi, chair of the Department of Social and Behavioral Sciences, and Emily Franchett, SM '17, at the Forum for Population Health Equity's poster session for emerging researchers

1,000 experts converge to examine how to improve the health of society’s most vulnerable

November 2, 2016 – In Camden, New Jersey—one of the poorest cities in the U.S.—a unique coalition of health care providers and community representatives has developed a successful technique called “hot-spotting” to provide better care to some of the area’s sickest people while reducing their high rates of hospitalizations and emergency room use.

Describing this technique at the 2016 Forum on Population Health Equity, a two-day event hosted by Harvard T.H. Chan School of Public Health on October 18-19, 2016, keynote speaker Jeffrey Brenner described his efforts as a medical doctor in Camden to build a coalition of health care providers and social service agencies—the Camden Coalition of Healthcare Providers—to help manage complex health problems among low-income patients. The “hot-spotting” technique uses data to figure out which patients are in and out of hospitals the most. Brenner and his colleagues developed a strategy to address not only these patients’ medical needs but also a host of other problems they may face, such as unemployment, addiction, lack of insurance, housing issues, or family problems.

The work of the Camden Coalition was featured in a 2011 New Yorker article by Harvard Chan School’s Atul Gawande.

Social contagion and gun violence

Brenner’s talk was followed by a panel on using social network interventions to address health equity. Yale’s Andrew Papachristos discussed how data shows that gun violence spreads through a process of “social contagion”—a person’s risk of being shot is much higher the more closely he is socially connected to someone else who has been shot. Greater understanding of these epidemic-like patterns of gunshot victimization could be useful in developing interventions to reduce gun violence, Papachristos said.

Ichiro Kawachi, John L. Loeb and Frances Lehman Loeb Professor of Social Epidemiology, who organized the conference along with a team from Harvard Chan School’s Department of Social and Behavioral Sciences, noted that Brenner and Papachristos had never met before, but, during the Forum event, they became interested in each others’ work. “Now they’re going to try to collaborate,” said Kawachi. “That’s exactly the kind of thing we hoped would happen when we planned this Forum.”

Nancy Krieger, professor of social epidemiology, was one of the keynote speakers at the event

The event was made possible through support from the Aetna Foundation. Noting that both this year’s and last year’s Forum—the inaugural event—drew 1,000 attendees, Kawachi said, “I think we’ve really tapped into a need for people to come together on these pressing issues of health equity.”

The poorest of the poor

Kathryn Edin, a poverty researcher from Johns Hopkins University and co-author of a bestselling 2015 book, $2.00 a Day: Living on Almost Nothing in America, discussed in her keynote address the roughly 2 million people in the U.S. living with little available cash. While the “poorest of the poor” do get pseudo-cash—some get Supplemental Nutrition Assistance Program (SNAP) cards for food, some get a small federal housing subsidy, and some get government-funded health insurance—they sometimes need money for emergencies. So they’ve developed survival strategies, such as selling their SNAP cards at a discount outside grocery stores. Plasma donations in return for cash have also skyrocketed in recent years, Edin said.

The Forum was launched last year to bring together researchers, policymakers, medical providers, health administrators, community health workers, and students to focus on issues of health equity. The goal was not only to share research but also to discuss how to apply research findings in communities, Kawachi said. The event featured six “nano courses,” three keynote addresses, a student poster session, and panel discussions.

Harvard Chan faculty who made presentations at the Forum included Nancy Krieger, professor of social epidemiology, who gave the third keynote address; and J.P. Onnela, assistant professor of biostatistics. Krieger discussed the problems inherent in attempts to quantify how much specific determinants of population health—such as social and economic factors or health behaviors—contribute to health outcomes.

Karen Feldscher

photo of Ichiro Kawachi and Emily Franchett courtesy Department of Social and Behavioral Sciences

photo of Nancy Krieger: Whitney Waddell