Post on 17-Dec-2015
1
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
3
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
4
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
5
Achieving Health Equity
Moving the dialog beyond access to health careto social determinants of health and health equity.
6
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
7
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
8
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
9
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
10
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
11
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
12
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
13
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.
14
Why get involved?
The most effective interventions of the past came about as a result of changes in public health practices and social reforms.
15
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
16
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
17
Tackling Health Inequities
Develop the workforce
Scan your environment
Foster leadership
Plan communications
Build non-traditional partnerships
Research “promising practices”
18
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
19
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
20
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
21
Complete Communications Planning
Educate stakeholders
Develop consistent messages
Use common definitions
Practice plain talk
Reframe the message
Use audience-centered health promotion
22
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
23
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
24
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
25
Health Equity Council
“Eliminating Health Disparities through Social Justice”
26
Health Council Workgroup Social Determinants of Health Cultural Competency Advocacy
27
28
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
29
Unnatural Causes: Is Inequality Making us Sick?
PBS Series - DVD
Action Toolkit
Discussion Guide
Policy Guide
Handouts
www.unnaturalcauses.org
30
Health Equity Council Resources
Website Enhanced tool kit Success stories template Promising Practices resources Cultural Competency assessment tool Networking & partnership opportunities
31
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
32
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
33
“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
34
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
35
Policies that diminish adverse consequences
36
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
37
Recreation
Increase access to facilities through construction support
Promote policies to open schools evenings and weekends
38
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
39
Environment
Affordable housing Zoning to restrict noise
and pollution Lead abatement
ordinances Traffic safety Reduce violence and
crime
40
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
41
Some Policies Affect the Ladder
42
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
43
Income
Adequate income through minimum wage increases
Income supports to families for newborns
Earned income tax credits Secure pension plans and
increase savings incentives
44
Training
Access to opportunities for new or enhanced job skills training on the job, in community college and other venues
45
We can choose…
Policies that lessen
health risks associated with position on the ladder
AND
Policies that impact
fundamental components of the ladder
46
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
47
Contact Us
For more information contact Jerrica Mathis: jmathis@chronicdisease.org
Or visit: www.chronicdisease.org