Q&A with Jared Rutledge, Fresno County’s Senior Epidemiologist
Earlier this month, the California HealthCare Foundation (CHCF) hosted its 6th California Health Data Brown bag. At the event, our colleagues and partners in the California Health and Human Services Agency (CHHS) got to hear from health leaders in Sacramento and Fresno (two of our pilot cities), about the projects they’re currently working on with the state’s health data.
At the event, Jared Rutledge, a senior epidemiologist Fresno’s Department of Public Health spoke about an interactive map application the department has been working on to map the county’s health issues.
Below is a Q&A with Jared and our Fresno health ambassador, Tim Nightingale.
Tell us a little bit about yourself.
I am the senior epidemiologist for Fresno County Department of Public Health. I supervise the epidemiologists for Fresno County and I keep surveillance on diseases and deaths within Fresno County. I am also a part time lecturer and adjunct professor for several different colleges and universities within the Central Valley. I teach biology, epidemiology, statistics, research methods, infectious disease, and microbiology courses. I have a PhD in Public Health with an emphasis in Epidemiology.
What does an epidemiologist do?
Traditionally, there are two divisions to our discipline. These divisions are descriptive and analytic epidemiology. Descriptive epidemiology concerns itself with the monitoring and surveillance portion of the discipline. This is similar to taking vitals (blood pressure, temperature, height, weight etc) when you go to a doctor’s visit. However, our vitals are at the population level and the measurements we take are counts and proportions of selected communicable diseases and causes of death.
In my current role, I guide the surveillance of diseases and deaths within the County of Fresno boundary. I investigate rare diseases and deaths, educate local providers, conduct research, and describe the patterns of disease and death in terms of three indicators:
· Person (age, race/ethnicity, and other demographic characteristics)
· Place (address, census tract, zip code, school district, etc.)
· Time (day, month, season, annual trends)
If patterns are noted in descriptive epidemiology (person, place, and time) then we as a department investigate. If the diseases are communicable (spreadable) then we utilize our communicable disease investigators to collect information and conduct surveys with the ill residents. The investigators input this information into an electronic system that the epidemiologists can pull data from for formal statistical analysis of the patient information in an aggregated form.
Why do these patterns matter?
People are prone to make assumptions regarding causation. They observe relationships where there may not be relationships. Our discipline keeps fastidious records regarding patterns or trends in disease. Then when someone thinks they are observing an increase we have the historical and quantitative evidence to suggest that there is an issue or there is not an issue.
Ideally, epidemiologists will detect disease clusters early in their development. The goal is to intervene as early as possible to prevent the spread of the disease. However, as our disease priorities shift to chronic disease instead of communicable diseases our methods have shifted.
Epidemiology is the fundamental science of public health. It is how public health develops data and data systems to target and evaluate public health interventions. Ideally, epidemiological data should inform and direct policy so that the policy is data driven.
Tell us about the Fresno mapping project you’re working on now.
Many communicable diseases are mandated reportable according to the California Code of Regulations Title 17. When a person is diagnosed with the disease a confidential morbidity report is generated and their information is sent to the Department of Public Health for investigation and education of the patient. As our patterns of mortality shift from communicable disease to chronic disease, our methods must shift, as mentioned previously.
Chronic diseases are not mandated reportable. A report is not sent to the County of Fresno each time someone is diagnosed as having hypertension, obesity, or type II diabetes. Also, chronic diseases do not often have one cause or source as many communicable diseases have one major cause, which is the organism. Chronic diseases have a multitude of issues that can predict the development of disease.
The mapping project is a project designed to look at co-occurring health issues within communities. We are creating maps at the census tract, zip code, and school district boundary to highlight communities who are dying prematurely, suffering from disproportionate pre-term birth, polluted, and dying with underlying preventable illnesses such as obesity, hypertension, and diabetes.
For the first time, the County of Fresno is looking at all of these layers to discover where the communities in most need are and using resources to support the communities in most need.
What were the primary motivating factors for developing this map?
I have been mapping Fresno County’s health issues for several years. I started noticing similar silhouettes. The same communities appeared to have poorer health indicators than other communities across communicable diseases and chronic diseases. With limited funds public health is motivated to be as lean as possible and to provide services to the most in need. This map is a result of that need to be lean and prioritize resources.
Who was involved in developing what information should be on it?
FCHIP was responsible for looking at the data sources the County of Fresno has available and listening to what each data source represents. An FCHIP sub-workgroup did most of the work at triaging and targeting what measures might be most useful using the frame work of the Center for Disease Control and Prevention’s Community Improvement Plan tool.
How can it be used?
Hopefully, the map is used not only by Fresno County Department of Public Health but also community members, grant writers, and other parties interested in improving the health of the community. If a CBO wants to target asthma, I have a map for that. If a NGO wants to look at uncontrolled diabetes deaths, I have a map for that. I am here to make this data available to ensure that we are working in the communities most in need.
What relationship will the map have to health of the county? Now? In 20 years?
The map right now will hopefully serve to highlight areas that need help. As we continue to invest in these communities, we want to see change or improvement. We will be tracking these indicators in these communities as we invest. Hopefully, we will see improvement.
Who can use it?
Right now the map can only be used by those who request it. It is a fixed document that is on a desktop, but soon the map will be made available for everyone to use via an online map. A person can enter his or her address and they will be shown the health of his or her community.
If there is one thing people should know after reading this (about the map) what is that one thing?
Diseases and death do not occur by random chance. There are patterns and trends that can be described. Bad events will still inevitably occur, but through the study and evaluation of these events we can create environments that are strongly conducive to health and healthy life styles. However, we will not be able to do this until the information is set free and given to those people who are making the decisions. This is one small piece of a much larger movement that should lead to more informed choices.
