Health is pervasive. It is not content to reside solely in a hospital, or to restrict itself to sick people. Health is found in families, in food, sports, entertainment, health is even found in technology.
Different manifestations of health are some of the things that the Health for America program has been exceptional at exploring.
Language is one home for health that people do not often consider. For those who learned English as a second language health is much harder to manage, with both access and outcomes suffering.1 As a designer it is imperative that you consider as many of your potential users as possible, but it is equally as important to imagine as many aspects of their lives as possible.
Of all the factors that affect population health, grocery access has been one of the major battlefields. Many, if not most, medical diagnosis are accompanied by dietary recommendations and restrictions. However people have disproportionate access to diverse foods. Entire communities rely on 7/11 or other corner stores due to lack of other viable options. This has been a huge problem that we have encountered in Washington DC.
As a team we quickly picked up a piece of vernacular from the local medical community, “over the river”. The other, more descriptive term, is “South-East”. One of the reasons that the local medical community references this area is because over time they have learned that the South East corner of the District has fewer grocery stores. The District, to its credit has aggressively pursued a more even distribution for the past 15 years, but maps still show that the densely populated southeast corner of the district has a less dense cluster of grocery stores.
A community with fewer grocery stores creates a vicious cycle, especially in diabetes. Fewer grocery stores result in more barriers to fresh produce and medications, this leads to people having incentive to eat fast food and other “low barrier” options. More people eating unhealthy means that more people get sick, in this case with type 2 diabetes. This costs more money and also means that more people need medications and fresh produce, the lack of these resources leading to more people getting sicker and having worse health outcomes.
One solution to this is grocery delivery. On the surface it seems like a perfect fit, regardless of where a person lives they can have groceries delivered to their home. Although there is a delivery fee, over time as the userbase grows that number should become more and more manageable. Some services even offer groceries with as low as a $5 delivery fee already.
This was one of the reasons we were excited to start working on Well Rooted. With thoughtful partnerships and defined purpose a grocery delivery service could be the perfect tool for a hospital to combat bad health outcomes due to food access. This doesn’t even have to be just for chronic care, it can include homebound patients, or those with limited mobility.
The problem is that much like grocery stores, grocery delivery services mostly cover the highest socio-economic communities and neglect those communities with lower average incomes. Dozens of similar services have been growing over the past decade to deliver everything from prepared meals to groceries, but all of them follow a very similar distribution map. Using DC as an example, they start in Georgetown (just West of center), expand towards the more suburban northwest and creep towards Columbia Heights and Petworth. After establishing their brand the service expands into Virginia, covers the northeast and then maybe, and only if they are doing well, will they finally turn their attention to the southeast.
I am not writing this to shame startup companies. Startups operate in a field of ambiguity, searching for sustainable models, and their geographic existence is far from malicious. But there are many partners who can change this trend. Hospitals, local businesses, government, churches all do work to improve the communities they reside in. Maybe in the 21st century community service may look like partnering with startups to provide financial security in return for services for the community.
1) Flores, Glenn. "Language Barriers to Health Care in the United States." New England Journal of Medicine N Engl J Med 355, no. 3 (2006): 229-31. Accessed May 31, 2016. doi:10.1056/nejmp058316.