Looking Inward, Looking Outward

Looking Inward: How we measure and use Vital Signs
‘Hæmostaticks’ and the History of Blood Pressure
In the early years of the 18th century, Stephen Hall began experiments involving horses, brass pipes, and eight foot lengths of glass tubing, that allowed him to measure the force exerted by the horse’s heart with each beat.  These somewhat gruesome experiments would lead to what we know today as the measurement of blood pressure.  Several hundred years of experimentation with various invasive and non-invasive measures and machines ultimately led us to the modern Sphygmomanometer, which provides accurate measures of blood pressure without the inconvenience of spurting blood and the accompanying mess.
Blood pressure is a common Physical Vital Sign, measured routinely in physicians’ offices, hospitals, and even in patient homes for routine blood pressure monitoring.  The standard Sphygmomanometer, with glass tubing and mercury, is quickly being replaced with digital devices that quickly provide accurate measurement.  We understand how a person’s age, weight, body temperature, and even body positioning impact blood pressure.
Just as important as accurate measurement, this information is actionable.  
Blood pressure is a common and critical measure of a person’s physical health and we’ve developed detailed goals and treatment plans that include include both pharmacological and nonpharmacological approaches.  We know when a person is prehypertensive, we know when to expect elevated results (after trauma or while smoking), we know how much medication to give at certain levels of hypertension, and when it can be reasonably controlled with diet and exercise.
It has been 300 years in the making, but we’ve gotten very good at using this important Physical Vital Sign.
Looking Outward: How can we measure and use Community Vital Signs?
We’re now on the cusp of a new direction in healthcare, by looking outward at the community where an individual lives, works, plays, and travels.
We know that poverty is an important community vital sign that impacts a person’s health, but we have much to learn.  Are we measuring poverty correctly?  Should we focus on individual/household poverty, or poverty level of their community?  What IS community?  Is community their immediate neighborhood, their city, their county?  When we measure poverty, do we really want to know availability of economic resources, better measured by wealth?  Is economic capital more or less important than social capital — the intangible, usable social networks a family can take advantage of?  What about walkability?  Residential segregation?  More comprehensive summary measures in the Social Deprivation Index developed by researchers at Australian National University and the Robert Graham Center?
We’ve learned a lot in recent decades, but we have along way to go, before we can match the success of Stephen Hale and his original ‘Hæmostaticks’ research.
Where do we go from here?
This is not meant to be at all discouraging.  This is an incredibly exciting time to be doing research on social determinants of health, or what we refer to as Community Vital Signs.  We’re collaborating with organisations like the Robert Graham Center and OCHIN to tackle this field of study, by creating innovative tools like the HealthLandscape Geoenrichment API, which can be used to geocode and enrich patient records to include a host of Community Vital Signs
We’re also developing web-based applications that present the Community Vital Signs data in clinical environments to help healthcare providers integrate the social and medical needs of patients, to improve community and patient care.
Mark Carrozza
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