Post on 17-Jul-2015
The Doctor is Out: Health happens where you live, learn, work & play
Douglas Jutte, MD, MPHUC Berkeley School of Public
HealthSOCAP13
1
Health ≠ Healthcare
Medical care
Physical Environment
5%
Genetics30%
Medical care10%
Behavioral choices
40%
Social Circumstances
15%
Source: McGinnis JM, Russo PG, Knickman, JR. Health Affairs, April 2002.
“Actual Causes” of Premature Death
World Health Organization definition of Health
“Health is a state of complete physical, mental and social well-being and not merely the absence
of disease or infirmity”
Source: Preamble to the Constitution of the World Health Organization, June 1946
“Certainly maldistribution of healthcare is one of the social determinants of health...”
“(T)he high burden of illness… arises… because of the conditions in which people are born, grow, work, and age.”
WHO 2008 Commission on Social Determinants
of Health
Retrieved from: www.smartcitymemphis.com/cartoon/toxic-stress/
“Toxic Stress”
The Socioeconomic Gradient in HealthMortality rate per 1000 - age 40 to 64 years
(Whitehall II study - Marmot & Shipley 1996 BMJ)
4.7
17.6
12.4
7.3
0
5
10
15
20
Administrative Professional andExecutive
Clerical Semi-skilled andUnskilled
British Civil Service Class
Mo
rtal
ity
rate
per
100
0
12
Global Life Expectancies (in years)
Source: Adapted from Global Education Project. (2004). Human conditions: World life expectancy map.
13
Washington, D.C.
Source: Robert Wood Johnson Foundation, Commission to Build a Healthier America
72 YEARS
14
New Orleans
Source: Robert Wood Johnson Foundation, Commission to Build a Healthier America
15
Minneapolis & St. Paul,
Minnesota
Source: Robert Wood Johnson Foundation, Commission to Build a Healthier America
16
addresses social injustice
“Reducing health inequities is an ethical imperative. Social injustice is killing people on a grand scale.”
WHO 2008 Commission on Social Determinants
of Health
yields a Health ROI
18
thrives on disruption
addresses social injustice
$2.8 Trillion ACA
Aging population
People in the U.S. over 65 will double in the next 40 years
20
:
HEALTH Welcome
yields a Health ROI
21
thrives on disruptionACA
$2.8 Trillion
Aging population
addresses social injustice