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Assistant Professor Laura Rosella uses big data to explain the links between health-care costs and social factors such as food, housing and workplace.

Do our social circumstances and where we live play a part in how often we visit clinics and emergency rooms? According to Dalla Lana School of Public Health professor Laura Rosella, the answer is yes.

How poor health is linked to your income, education, neighbourhood, workplace

Lower levels of income and education have long been associated with high-cost users—those who more frequently visit a doctor or local hospital. But Rosella’s study demonstrated that those who struggle to afford enough food were also more likely to use more health care. The neighbourhood someone lives in, and their home and work environment, also influence who makes those trips to see health professionals.

As health-care costs escalate, understanding factors that contribute to these costs is critical. “A lot of my work focuses on broadening the perspective on who uses health care,” Rosella explains. “This means that policy-makers can start addressing some of the root causes, and preventing these trajectories before they begin.”

Why data from thousands of people can help individuals

For this research, Rosella employed a “big-data” approach that brings together information from various sources to provide a more comprehensive picture. In the case of health, big data allows scientists to draw conclusions about populations with the goal of understanding where they are coming from in a more comprehensive way to ultimately help people live healthier lives. For one source, Rosella’s team used the database that records all health-care encounters covered under the Ontario Health Insurance Plan, including hospital admissions, same-day surgeries, emergency room visits, physician visits, rehabilitation needs and prescription drugs for some groups.

Canadian health surveys provided another data source, including whether respondents could afford to eat balanced meals and whether they reduced the size of their meals because they couldn’t afford to buy adequate food that month. By integrating results from the OHIP database with Canadian health surveys, Rosella’s team established a broad range of upstream determinants of health-care utilization, including the factor that those who lack access to basic food needs end up seeking health care more frequently.

Helping families get enough food to eat helps our health-care system

While certain people will always use the health-care system more than others, Rosella feels it’s important to note who is using services most and why.

We need a sustainable health-care system. We need one that is equitable as well.

“Health-care issues are disproportionately affecting people who are disadvantaged, and that’s what we need to address,” she says. “Not only because we need a sustainable health-care system. We need one that is equitable as well.”

By providing affordable housing or stable income support to ensure continued access to basic needs such as food to those who are struggling, policy-makers could help stem the problem and mitigate its long-term effects on the health-care system. Rosella’s research indicates that such a preventive approach would improve the health of those most likely to become high-cost users, and by reducing their clinic and hospitals visits, leave the Canadian health-care system in better shape too.