The University of Houston and its resources could prove a key component in improving health outcomes. UH has opened three new health clinics in the Houston region since September 2021, including the Family Care Center. Located on campus and staffed by faculty physicians from the medical school, patients can receive care regardless of their ability to pay.

But Houston remains a city in which geography, for many residents, is destiny. In 2019, the city’s health department issued a report on health disparity that found people in wealthier ZIP codes have life expectancies a full 10 years longer than people in the poorest ZIP codes. There is much work to be done.

For HCC participants, that work starts with addressing people’s real-world problems — which, for those who lack sufficient insurance coverage, often come down to dental and vision care, says Dr. Claudine Johnson, the course director who oversees the program and a clinical associate professor in the Department of Clinical Sciences at the Fertitta Family College of Medicine.

But the community’s health needs are wider even than those that sufficient medical insurance could cover. “Food assistance, rental assistance, access to primary care and other medical specialties, transportation assistance,” Johnson says — “those are probably the biggest ones. Some people work multiple jobs. Or they’re not able to take off in the middle of the day to go to a medical appointment, because they will lose income if they are away from work. And for some of the adults, I will say that they will make sure that their children get to the pediatrician, but they may skip their own health care visits.”

Even when patients do make it to a clinic, care providers may not come to understand a person’s full situation. Those visits may be rushed or impersonal. Or a person may not share seemingly mundane details of their lives, because they don’t see a connection between an environmental issue and their health, Johnson explains.

A diabetic patient may not disclose that their refrigerator is broken, which would prevent her from being able to store insulin. A man with emphysema may make return visits to the emergency room in the summer without explaining that his air conditioning is broken, leaving him in heat that makes breathing difficult. A mother could bring an asthmatic child to the hospital in acute crisis — one that will simply recur so long as unchecked roaches and mice continue leaving waste in their apartment. A patient without a car may have no practical way to pick up prescriptions.

Any medical treatment in these situations is undermined by the circumstances of people’s lives. HCC tries to put students in a position to understand that full reality. As more and more student teams fan out in their neighborhoods, they may be able to notice patterns that, Johnson hopes, could lead to higher-level efforts to address systemic problems.

On one home visit Johnson made, she and an HCC team met with an older woman whose yard had poor drainage that left standing water around her home. That, in turn, brought mosquitos. As a result, she stayed inside more, alone. Isolation might not in itself warrant a hospital visit, but knowing how important it is for people’s health to be able to go outside and socialize, the team started thinking along different dimensions. Could they call the city to spray for mosquitos? Could they contact a city council member to address the poor drainage? And could they eventually make informed recommendations to policymakers to improve infrastructure, pollution levels, access to grocery stores, public transit or other larger-scale solutions?

“[We’re looking at] things you would only observe or know about if you’re at the home,” Johnson says. “But they might need to be addressed at a higher level than just individually.”

Forty years ago, when Dr. Stephen J. Spann was a family physician in rural North Carolina, he made a point of making a home call to meet with the family of every baby he delivered or took care of in the hospital newborn nursery. Two weeks after the birth, he would arrive, often down some remote county backroad, to check the infant, to talk the family through the best ways to care for the baby and to get a sense of the environment where the child would grow up.

Now the founding dean of the Fertitta Family College of Medicine and the vice president for medical affairs at the University of Houston, Spann speaks about those visits with a note of genuine nostalgia for the insights he could glean from a half-hour spent sitting on a family’s living room floor, answering questions and giving guidance.

“You can learn more in a house call than you can in 10 office visits,” he says. “Man, there was no substitute. You just learned so much about context, about social determinants, about family structure and function in those visits. And in the long run, it saves you time, and it helps you take better care of people.”

To Spann, HCC is a venue for his medical students to understand the value of that in-home context. Some 80% of preventable disease and death in the U.S. is related to what the medical community calls social determinants of health, or SDOH. Those include circumstances such as income, education, insurance, employment, proximity to crime and access to quality housing, nutritious food and transportation. They also include behaviors such as exercise, diet, drinking, smoking, worship and interpersonal relationships.

The U.S. Office of Disease Prevention and Health Promotion has made improving SDOH a pillar of its national Healthy People 2030 public health initiative, which aims to measure and boost the social, physical, and economic environments that lead to healthier lives. A well-worn saying by now in public health circles holds that, in the U.S., your ZIP code is a better predictor of your lifespan than your genetic code.

Understanding and intervening to improve adverse social determinants of health upstream, before they begin to cause disease, can result in better downstream health and reduced costs of care, Spann says. “The relationship between doctor and patient is a powerful diagnostic and therapeutic tool,” Spann explains. “Carefully listening to the patient’s history and understanding the context of the illness can decrease the number of diagnostic tests needed and referrals to other specialists.”

Key to this equation is the proven connection between a patient’s trust in their physician and their resulting health outcomes. (The placebo effect alone explains part of that benefit — patients tend to see some health improvement when they have faith in the treatment, no matter what that treatment is.) Physicians who connect empathetically with their patients not only see better outcomes but are also happier and more satisfied in their careers.

This approach is core to the philosophy at the Fertitta Family College of Medicine, which gifts incoming students a copy of the 2019 book “Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference,” by Stephen Trzeciak and Anthony Mazzarelli, two physicians and educators.