the social determinants of health: why “place ma,ers”
TRANSCRIPT
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TheSocialDeterminantsofHealth:Why“PlaceMa,ers”
AaronJDiehr,PhD,CHES
DepartmentofHealthEduca-on&[email protected]
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• Howdowedefinehealthin2016?
– Astateofcompletephysical,mental,andsocialwell-being,andnotmerelytheabsenceofdiseaseorinfirmity.
– Healthdispari.esrefertodifferencesacrossracialandethnicgroupsinhealthcondi-ons,riskandprognoses.
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• However,theabilitytoachieveop-malhealthinvolvesmanyfactorsbeyondjustindividualdecisions.
• The“condi-onsinwhichpeopleareborn,grow,work,live,andage,andthewidersetofforcesandsystemsshapingthecondi<onsofdailylife”haveapowerfuleffectonhealthinmanydifferentways(WHO,2016).
Ø Socialdeterminantsofhealth
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HEALTH
MedicalCare
PersonalBehavior
Living&WorkingCondi.onsinHomes&Communi.es
Economic&SocialOpportuni.es&Resources(e.g.
Income,educa.on,racialinequality)
Robert Wood Johnson Foundation Commission to Build a Healthier America www.commissiononhealth.org
The Social Determinants of Health: The “causes of the causes”
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DOWNSTREAM:Nearwherehealtheffectsareseen
UPSTREAM:Atornearthesourceofacauseofillhealth
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• ThefieldofpublichealthisshiZingfocus.– Individualbehavior?
or– Popula-onhealth?
• Publichealthresearchersarenowable(andexpected)tolookatawidevarietyofvariablesthatimpactpopula-onhealth(i.e.,thesocialdeterminantsofhealth).
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• Myresearchinvolvesvariousissuesrelatedtothesocialdeterminantsofhealth:– Theroleofstateofficesofminorityhealth,includingins-tu-onalandpoli-calbarriers– Theroleofstate-levelracialsegrega<ononvic-m-offenderracialconcordanceforhomicides(i.e.,“blackonblackcrime”)
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• Racialsegrega-oninmanymajorAmericanci-es,includingNewYork,Chicago,MilwaukeeandDetroit,approachesthatofSouthAfricaunderapartheid.
• OnestudybyGaleaandothers(2011)foundthat,in2000,176,000deathswereaaributabletoracialsegrega<on.– Inperspec-ve,thatnumberishigherthanthenumberofdeathsfromCOPD,the#3leadingcauseofdeath.
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• Alongwithacolleagueofmine(arecentPhDgraduatefromourprogramhereatSIU),wehavefound:– Greaterlevelsofstatewideracialsegrega-onarepredic-veofgreaterlevelsof“blackonblack”crime,evenaCer“controllingfor”variablessuchasincome,propor-onofminoritypopula-on,andeduca-onlevel.
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• However,theconnec-onbetweenracialsegrega-onand“blackonblack”crimebecomesfarlessprominentwhenstatesscorehigheronacommunitypolicingindex.
• Whatdoesthismean?– It’sverydifficult(nottomen-on-me-consuming)tofixaproblemlikesegregatedcommuni-es.
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• Ourresearchsuggeststhatmorecommunitypolicingmightleadtolowerlevelsof“blackonblack”crime.Someexamplesinclude:– Mee-ngsbetweenpoliceandadvocacygroups,businessgroups,churches,neighborhoodassocia-ons.
– Collabora-veproblem-solvingteamsincommuni-es.– Developmentofacommunitypolicingplan.
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• IwouldliketoacknowledgemycolleagueJus-nMcDaniel,PhD,MBA,AssistantProfessoratCharlestonSouthernUniversity.
• Currentlyintheprocessofpreparingmul-plepresenta-onsandamanuscripttopresentthisimportantresearch.
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• Howcanyouhelp?– Thesocialdeterminantsare,bydefini-on,socialissues.– Thatmeans,withoutinputandhelpfromthecommunity,researchersalonewillneverbeabletosolvetheseissuesandhelpbuildasocietyinwhicheverybodyhasequalopportunitytoliveahealthy,happylife.
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• Iwelcomeyourinput,sugges-ons,andhelp:
AaronJ.Diehr,PhD,CHES(618)[email protected]
Thankyou!