Population health studies have shown research results whereby socioeconomic (SES) factors play the role of a 'risk factor' (1, 2). A question now relevant is whether low income should be included in population health studies? There has been much debate. Yet, even if we know about low income, how do you change this? People cannot easily shift their income to make it higher en masse and run a study. That would be nice! When starting RADECT, our team was presented with this issue.
We were challenged by a mock case file which motivated our software and solution. We describe this mock case file herein.
A mock person is middle aged, living in a poor neighborhood with his mother, and on Medicaid. He does not have a relationship with other family members. He has one friend that recently moved away. They keep in touch through social media and playing virtual reality video games.
The middle-aged person has held multiple jobs in the past several years. A lack of decent job prospects led him to lower income jobs managing retail stores. He has trouble keeping jobs because he gets bullied at work in the past. He received a community college associates degree in sports management but has struggled to find work in this field. He enjoyed community college by taking additional classes. His grades were high. This was twelve years ago. His mother expects him to support the family with his income.
The middle-aged person has low-self-esteem. He presents himself with anxiety from his living environment. His general view is ‘do not trust, everyone wants to take advantage’. His income is well enough to sustain. To escape, he plays virtual reality games. This is his outlet for social connection. He enjoys watching and talking about football and sports. He feels he is a loser. He says he did not receive any positive reinforcement growing up. He only receives criticism. He feels the world and system is against him.
This person does not exercise and diet. He is overweight. His diet consists of fast food and fried foods as a stressor relief. He feels he has no purpose in life. He is conscious, believing people perceive him negatively when he does exercise. The middle-aged person used to play basketball outside courts. His last physical exam three years ago bloodwork labeled him as pre diabetic. He has asthma. He does not smoke or drink alcohol.
The middle-aged person does not trust the healthcare system. He cannot make an appointment when trying. He is told to go to urgent care if there is an issue. When he did go to a community health center, it has been every three years, and he does not follow through. He says there is a cultural belief that healthcare will not help him. His sleeping patterns are poor. He has signs of depression.
His father had major depressive disorder. He committed suicide when Middle aged person was young. Family is multigenerational in the U.S. and can trace roots back to slavery. His mother is angry, attributed to PTSD, anxiety, and past trauma. Mother has hypertension and peripheral artery disease (PAD).
The middle-aged person is a pleasant individual when conversing. He is respectful and kind. He has no past social work needs or legal issues.
How do you manage such a person? How do you scale their health and wellness needs and do so economically? How do you improve his social, environmental, and behavioral factors? How does he manage his mother? This mock case presents a complexity that the RADECT and our software and system are to solve.
(1) Tobias M. Social rank: A risk factor whose time has come? Lancet 2017 Jan 31; [e-pub]. (http://dx.doi.org/10.1016/S0140-6736(17)30191-5)
(2) Rolheiser, Lyndsey, et al. "Do health trajectories predict neighborhood outcomes? Evidence of health selection in a diverse sample of US adults." Health & place 73 (2022): 102713.