Racine LIHF
Social Determinants of HealthJune 25, 2010
Pull yourself up by your bootstraps?
Economic & SocialOpportunities and Resources
Living & Working Conditionsin Homes and Communities
PersonalBehavior
Medical Care
HEALTH
A conceptual framework for addressing disparities: Broadening the focus
Robert Wood Johnson Foundation Commission to Build a Healthier America www.commissiononhealth.org
A Life Course Approach: Overarching Strategies (Lu, Kotelchuk, Hogan, Jones, Jones, Halfon, 2008)
Improve Heath Care for African American Women
Strengthen African American Families and Communities
Reduce Allostatic Load
Improve Health Care for African American Women Provide
Interconception care for women with prior adverse outcomes
Increase access to preconception care
Improve the quality of prenatal care
Expand healthcare access over the life course
Strengthen African American Families and Communities Strengthen father
involvement Enhance systems
coordination and integration for family support services
Create reproductive social capital in African American communities
Invest in community building and urban renewal
Reduce allostatic load
Close the education gap
Reduce poverty among African American families
Support working mothers and families
Undo racism
Public Views: Determinants of Health (Robert, Booske, Rigby, Rohan, 2008, WMJ)
WI public believes that health practices, access to health care and health insurance are the most important factors affecting health.
WI public believes that health insurance should be a high government priority.
Social determinants seen as less important to health and public may be less likely to support government policies to improve social determinants.
External Factors Vs. Right Choices(Aubrun, Brown, Grady, Research Report for the Louisville Center for Health Equity, 2007)
Qualitative evaluation to understand what “average” Louisville residents think about health, health disparities and needed actions.
Sought to understand discrepancies between what PH wants people to understand, and what the public currently believes.
Right choices = People’s health --outcomes are determined by their own choices and actions
ABC’s for Healthy Babies
Campaign designed to ignite a paradigm shift in how individuals & communities respond to disparities in birth outcomes
Funded by DHFS with support from WPP
Focus groups in 5 local areas with highest AA Infant Mortality
65% mothers, 23% fathers, 11% grandmothers
Key Findings Mothers and fathers believe that
during pregnancy the role of the father is to help reduce stress in the mother’s life.
Fathers in Milwaukee believe that jobs/employment are important changes needed to help African American women have healthier babies.
Joint Center For Political and Economic Studies
Prevention is more than access to healthcare
“Everyone is focused on health behaviors these days, but the environment people are constrained within far exceeds the effect of any individual change. Our program can link kids to asthma specialists and ensure they have the right medicines and resources like bed covers, but at the end of the day, if they go home to neglected buildings that are roach infested, and moldy housing, we will not be able to stabilize their asthma.” Jacqueline Martinez, Northern Manhattan Community Voices
Joint Center for Political and Economic Studies
What really makes us healthy? Environmental quality Built Environment and
Infrastructure Public safety Geographic Access to
Opportunities throughout a region
Health Services Community and Public
Support Services
Employment, Income, Wealth and Assets
Neighborhood Economic Characteristics
Cultural Characteristics Social Support and
Networks Community Leadership
and Organization Reputation of the
Neighborhood
Preventive Care is: Creating Compassionate and Reciprocal Environments (CARE)
Emphasis must be on CARE Rebuilding bonds between people is
a powerful tool to promote health and well being
Definitions: Compassionate and Reciprocal
-Compassionate: Deep awareness of the suffering of another coupled with the wish to relieve it; sympathetic consciousness of others' distress together with a desire to alleviate it (Merriam-Webster Online. 15 September 2009)-Reciprocal: Shared, felt, or shown by both sides
100 Acts of Intentional Acts of Kindness: Building Reproductive Social Capital in Los Angeles (Jones, Lu, et al. 2010)
Maternal stress is an important risk factor for LBW and preterm birth
Social support has been proposed as a strategy to offset maternal stress, but has shown only mixed outcomes
Social capital extends support to include networks, civic engagement, local identity and solidarity and trust/reciprocal help
Jones, Lu et al Ethnicity and Disease 2010
Reproductive Social Capital
The features of social organization that facilitate reproductive health in a community
The degree of social connectedness of the pregnant woman to her community
The quantity and quality of social connections
Methods 55 pregnant or postpartum AA women in
Los Angeles, CA were recruited from local clinics, CBO’s and FBO’s
6 focus groups for initial discussion and 9 focus groups for confirmation of themes and final selection
Participants were asked to “name 5 things you wish someone close to you would do (would have done) to make your pregnancy better and 5 things a strange could do…”
Results About half (53%) wished that someone
close, particularly their husband or partner, could be more supportive
Requests for support also included attendance at prenatal appts (22%), walking (16%), talking (15%), or massages (9%)
Instrumental support was requested including meal prep (26%), housecleaning (22%), transportation (22%) and childcare (11%)
Dissemination Posters and fans with 100 Acts of
Intentional kindness printed and distributed to churches, beauty and barber shops and clinics.
100 Acts for New Mothers and 100 Acts Toward Oneself were completed using similar methods.
Feedback from community conference attendees indicated 86% endorsement
APA 2008 Survey Stress in America
How do we experience stress in our bodies?
PARENTING AND STRESS Mothers report higher stress levels and poorer
stress management skills than fathers. More than half of all mothers (54 percent)
report extreme stress levels during periods of high stress compared to 46 percent of fathers.
Two-thirds of mothers (69 percent) say family responsibilities are a significant source of stress compared to 52 percent of women without children.
“Race/Ethnicity” and Stress
Hispanics and Blacks are more likely than Whites to say the economy, housing costs and job stability are significant sources of stress.
Whites are more likely to say they manage their stress extremely well (31 percent versus 24 percent of Hispanics and 27 percent of Blacks)
Part 3: Some ideas Ask me how was my day Ask me is there anything I need Be supportive and faithful Don’t stare at other girls in front of me Don’t offer me extra food Don’t talk about my weight Fix me a meal Take me to the doctor Don’t break up with me during my pregnancy Let me sit down at the bank until its my turn at
the teller line
OHanlon, B (2009 - Positive Psychology Practical Apps)
Keys to Happiness Social Connections: Having 5 or more
friends beyond immediate family Optimism: Optimistic explanatory styles Appreciation: Gratitude, expressing
appreciation, and savoring/mindfulness Purpose: Having a life purpose,
especially one that is broader than self.
Seligman et al
3 Good Things
Participants are asked to write down three things that went well each day, every night, for one week. Participants are asked to provide a causal explanation for each good thing.
The Buddha is reported to have said
"It is possible to travel the whole world in search of one who is more worthy of compassion than oneself. No such person can be found."
Step Back/Step Forward
DISCUSSION What has the exercise demonstrated about
the starting line? What does the exercise reveal about the
role of government in wealth accumulation? How does the exercise help me rethink my
own beliefs about my economic status and that of my family?
What connections can I make between health and wealth now?
Work-related resources and opportunities
Physical and
mental health
Physical aspects of work and the
workplace
Stress
Access to nutrition, physical activity, housing,
medical care
Psychosocial aspects of work and how work
is organized
Exposure to hazards
How work shapes health
RWJ Social Determinants Commission
How income shapes health
Income represents resources and opportunities:
Medical care Nutrition & physical activity Housing and neighborhood conditions Social support Ways to reduce/buffer stress Children’s education
Educational attainment
Educational attainment
HEALTHHEALTH
Exposure to hazards Control / demand imbalance Stress
Work-related
resources
Housing Neighborhood environment Nutrition Stress
Work
Health insurance Sick leave Retirement benefits Other benefits
Working conditions
Income
HEALTHHEALTH
HEALTHHEALTH
How education shapes health Nutrition Exercise Drugs & alcohol Health/disease management
Educational attainment
Educational attainment
Sense of control Work-related factors Health-related behaviors Stress
Social standing
Social support
Social & economic resources Stress
Social & economic resources Health-related behaviors Family stability Stress
HEALTHHEALTH
Health knowledge, literacy & behaviors
Educational attainment
Educational attainment
RWJ Social Determinants Commission
How social advantage shapes health in childhood and later in life
Higher levels of parents’
education
Healthier behaviors by
parents
Good role models for children and
lower exposure to unhealthy
conditions such as secondhand smoke
Better jobs and increased family
income
Higher levels of parents’ education
Affordability of good housing, a safe
neighborhood with access to
recreational opportunities and
nutritious diet
Increased family income
Resources to cope with stressors (e.g.,
child care, transportation,
health insurance
Decreased levels of chronic stress
experienced by children
Positive effects on neuroendocrine
systems that can lead to lesser risks for
developing chronic disease such as heart disease and diabetes
What’s missing?
Assets and wealth
RWJ Social Determinants Commission
Considering income and education is not enough: the impact of racism
Structural racism tracks people by race into different socioeconomic opportunities
Job opportunities Educational opportunities Options for where to live schools, jobs, housing
quality In addition, living in a society with a legacy of
discrimination can harm health through pathways involving stress
Not only overt incidents Constant vigilance
Levels of Racism
Internalized Personally Mediated Institutionalized: structures, policies,
practices, and norms resulting in differential access to the goods, services, and opportunities of society by “race.” Institutionalized racism is normative, sometimes legalized, and often manifests as inherited disadvantage.
Jones CP. Confronting Institutionalized Racism. Phylon 2003;50(1-2):7-22.
KEYS TO SUCCESS Trust Empowerment Culture and History Focus on Causes Community Investment and Expertise Trusted Organizations Community Leaders Ownership Sustainability Hope
Reach U.S. -Finding Solutions to Health Disparities, CDC 2008
Decline of the Manufacturing Sector
Between 1970 and 1990, Black were just as likely as other racial/ethnic groups to have manufacturing jobs.
Since the early 1990’s and by 2007, Blacks were 15% less likely to have a job in manufacturing.
Simply put…
Love is patient; love is kind; love is not envious or boastful or arrogant or rude. It does not insist on its own way; it is not irritable or resentful; it does not rejoice in wrongdoing, but rejoices in the truth. It bears all things, believes all things, hopes all things, endures all things, love never fails. (1 Corinthians 13: 4-7)