Cracking the ZNA code
Dr Francis Collins, NIH director, recently tweeted that our ZIP code at birth is our “ZNA, “the blueprint for our behavioral and psychosocial make-up,” critical determinants of health.
Recent technological advances in geographic information systems (GIS), including digital software, maps and longitudinal data sets on socioeconomic and environmental factors, can be used to describe multiple aspects of an individual’s community and environment. Just like we can sequence a person’s DNA, we could use this data to sequence our “ZNA” from birth to death.
As electronic health records (EHR) become more common, it is possible to link new data collected about environment with patient medical records. And that link has relevance to clinical care and research, and perhaps most importantly, allows an increased focus on prevention.
We spend more on treating disease than on preventing it
In the US, health spending accounts for 17% of gross domestic product, among the highest of any country in the world. But US health outcomes rank in the middle of the pack for western industrialized economies. This disconnect between health care spending and outcomes has often been explained as the difference between clinical medicine and public health.
We spend much more on delivery of clinical services, often at the end of life to very sick patients, than we do on public health. Public health focuses on the health of a whole population, and often on preventing illness from happening in the first place. In trying to achieve its goals, public health considers social determinants of health and social and physical environments.
That’s because the causes of disease are often more strongly rooted in factors outside the health care system – like where we live, what we eat, the air we breathe. But the health care system and its providers do not know about these community, economic, environmental, behavioral and social causes of disease. Right now information is not typically collected nor sought about them.