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Welcome to

Social Determinants of Health:

Utilizing Community Health Indicators To Drive Your Program Planning

Chronic Disease Academy 2009 2

Social Determinants of Health 101

Presenters:

Names of presentersDate

Audience

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Definitions

Health Disparity

….difference in disease prevalence,

outcomes, or access to care

Health Inequity

….difference that is unnecessary,

avoidable, unfair and unjust

Social Determinants of Health

….economic & social conditions

that influence health

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Framework for Addressing Health Inequities

Health Care Determinants

factors that can be addressed

by the health care system

Social Determinants of Health

racial discrimination, economic and social conditions that influence health

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Achieving Health Equity

Moving the dialog beyond access to health careto social determinants of health and health equity.

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Social Determinants of HealthFactors in the social environment that contribute to or

detract from the health of individuals and communities:

Income and education Socioeconomic position Environment Discrimination Access to services Stress

Source: cdc.gov/sdoh

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Social Position Matters Income and education

are markers of socioeconomic position

Lower socioeconomic position results in worse access to healthcare

AND social position influences

exposure to health risks, or

resources to buffer health risks

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Where a person is on the social ladder determines whether a person is surrounded by things that make it easy or difficult to maintain healthy behaviors.

Place Matters

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Racial discrimination contributes to uneven distribution of income, education, neighborhood poverty, and access to health care.

Racial discrimination creates chronic stress and contributes to poor health independent of these factors.

Race Matters

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Chronic stress is toxic affecting physiologic processes that can trigger diabetes, asthma, and heart disease.

People with lower socioeconomic position have higher levels of chronic stress—and fewer resources to deal with stress.

Stress Matters

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In Short….

“Poorer people live shorter lives and are more often ill than the rich. This disparity has drawn attention to the remarkable sensitivity of health to the social environment.”

Source: Social Determinants of Health, The Solid Facts. World Health Organization, 2003

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Why talk about Health Equity?

American life expectancy currently ranks 30th

worldwide Illness costs American business over $260

billion a year in lost productivity Yet, we spend more on health care than any

other industrialized country

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Why get involved?

We know health inequities exist yet we are preoccupied with individual approaches to risk reduction and health promotion.

Instead we need to focus on social determinants of health and move towards health equity.

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Why get involved?

The most effective interventions of the past came about as a result of changes in public health practices and social reforms.

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Challenges

Understand root causes of health inequity Talk about racism openly Choose where and how to focus efforts Identify champions in high places Develop, implement and evaluate solutions

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Benefits of Achieving Health Equity

Healthier people need less medical care Less medical care decreases burden on our

health care system Healthier people are more productive people Healthier people live longer ALL of us experience improved quality of life

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Tackling Health Inequities

Develop the workforce

Scan your environment

Foster leadership

Plan communications

Build non-traditional partnerships

Research “promising practices”

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Develop Your Workforce

Raise staff awareness

Develop orientation for new staff

Provide on-going training

Require viewing of Unnatural Causes

Use consistent language about health equity

Teach about SDOH into schools of public health

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Scan Your Environment

Review state and local data on inequities

Develop cross program goals and objectives

Track health equity work across the organization

Identify priority populations

Build opportunities for networking

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Foster Leaders

Identify champions early

Seek senior management commitment Show Unnatural Causes, discuss, and supply

state & local data

Reframe your message

Emphasize – health equity is our work

Don’t give up

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Complete Communications Planning

Educate stakeholders

Develop consistent messages

Use common definitions

Practice plain talk

Reframe the message

Use audience-centered health promotion

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Build Non-Traditional Partners

Start early – trust takes time

Seek community leaders as messengers Educate partners about social determinants of

health Assume public health cannot do this work alone See health equity work as the foundation of

public health

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Research Promising Practices

Turning Point Initiative

Louisville, KY Center for Health Equity

Connecticut Health Equity Action Team

Ingham County, MI Social Justice through Dialog

King County, WA Equity & Social Justice Initiative

OK State Health Equity & Resource Opportunities Division

Boston, MA Mayor's Task Force to Eliminate Racial and

Ethnic Disparities

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Selecting specific interventions...

Know your audience What works for urban might not work for rural residents What works for one ethnic group may not work for

another

Know your setting What works in a health department clinic may not work in

a managed care setting What is successful in the workplace may not succeed in

a community center

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Health Equity Council

“Eliminating Health Disparities through Social Justice”

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Health Council Workgroup Social Determinants of Health Cultural Competency Advocacy

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Priority Areas

Expand and integrate awareness efforts

Develop advocacy plan

Assist NACDD Board with implementation of

CC recommendations

Identify best and promising practices

Complete Skills Assessment

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Unnatural Causes: Is Inequality Making us Sick?

PBS Series - DVD

Action Toolkit

Discussion Guide

Policy Guide

Handouts

www.unnaturalcauses.org

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Health Equity Council Resources

Website Enhanced tool kit Success stories template Promising Practices resources Cultural Competency assessment tool Networking & partnership opportunities

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Alternative Ten Steps for Staying Healthy

1. Don't be poor. If you can, stop. If you can't, try not to be poor for long.

2. Don't have poor parents.

3. Own a car.

4. Don't work in a stressful, low paid manual job.

5. Don't live in damp, low quality housing.

6. Be able to afford to go on a foreign holiday and sunbathe.

7. Practice not losing your job and don't become unemployed.

8. Take up all benefits you are entitled to, if you are unemployed, retired or sick or disabled.

9. Don't live next to a busy major road or near a polluting factory.

10. Learn how to fill in the complex housing benefit/asylum application forms before you become homeless and destitute.

Source: Raphael and Rieder, Community Action for Heart Health: Equity not Exercise

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Societies Structured Like a Ladder

Some societies ensure people at the bottom have a safety net

Others make little effort to distribute resources apart from what people can do on their own

In the US the ladder is both long and steep

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“Rungs represent resources that determine whether

people can live a good life…

or a life plagued by difficulties.”

Reaching for a Healthier Life:

Facts on Socioeconomic Status and Health in the US

MacArthur Foundation Research Network on Socioeconomic Status on Health

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Definitions Promising Practices – show potential and have

some data with positive outcomes

Best or Evidence-Based Practices – is shown, through research & evaluation, to be effective in achieving positive outcomes

Practice-Based Evidence – engages partners, uses evidence-based as a framework, and tailors interventions for participants & their environments

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Policies that diminish adverse consequences

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Nutrition

Ban sale of soft drinks and junk food in school

Modify school lunch programs to improve nutrition

Provide incentives for farmers’ markets and grocery stores selling fresh produce

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Recreation

Increase access to facilities through construction support

Promote policies to open schools evenings and weekends

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Cigarettes & Alcohol

Ban smoking in public areas and subsidize treatment programs

Increase excise tax on cigarettes, alcohol and junk food using proceeds to fund prevention

Control advertising of tobacco and alcohol

Limit concentration and operating hours of stores selling alcohol

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Environment

Affordable housing Zoning to restrict noise

and pollution Lead abatement

ordinances Traffic safety Reduce violence and

crime

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Work

Limit exposure to hazards Opportunities for control over work

demands Reduce disruptive shift changes

and extended work hours Working parents with sufficient

leave to attend sick children Minimize work-family conflict

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Some Policies Affect the Ladder

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Education…

High quality early childhood education

Reform financing to equalize access to quality education in K-12

Reduce financial barriers preventing students from attending college

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Income

Adequate income through minimum wage increases

Income supports to families for newborns

Earned income tax credits Secure pension plans and

increase savings incentives

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Training

Access to opportunities for new or enhanced job skills training on the job, in community college and other venues

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We can choose…

Policies that lessen

health risks associated with position on the ladder

AND

Policies that impact

fundamental components of the ladder

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Bootstraps

“…it is all right to tell a man to lift himself up by his own bootstraps, but it is a cruel jest to say to a bootless man to lift himself by

his own bootstraps…”

Rev. Dr. Martin Luther King Jr., 1968

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Contact Us

For more information contact Jerrica Mathis: jmathis@chronicdisease.org

Or visit: www.chronicdisease.org