Overview of the Social Determinants of Health

Melissa A. Clark Associate Director, AHEC West

Marriott Marquis Washington, DC Hotel

Regrounding our ResponseTo better understand and educate Marylanders, Master Presenters have been trained to deploy information throughout the state.

The Prevention and Health Promotion Administration, Infectious Disease Prevention and Health Services Bureau, &Center for Harm Reduction Services worked together to develop curriculum and trainings.

MISSIONThe mission of the Prevention and Health Promotion Administration is to protect, promote and improve the health and well-being of all Marylanders and their families through provision of public health leadership and through community-based public health efforts in partnership with local health departments, providers, community based organizations, and public and private sector agencies, giving special attention to at-risk and vulnerable populations.

VISIONThe Prevention and Health Promotion Administration envisions a future in which all Marylanders and their families enjoy optimal health and well-being.

2

Regrounding our Response• Understand the 3 waves of the opioid epidemic

• Understand how stigma impacts our ability to respond effectively to the overdose crisis

• Understand the definition of a substance use disorder

• Understand 5 public health concepts and their connection to substance use

• Understand how Regrounding Our Response can help to reduce stigma and improve our response to opioid overdoses

3

Social Determinants of HealthThe social determinants of health are the conditions in which people are born, grow, work, learn, worship, play, and age, and the wider set of forces and systems shaping the conditions of daily life. “These circumstances are shaped by the distribution of money, power, and resources at the global, national, and local levels” (WHO, 2019).

Source: https://www.who.int/social_determinants/sdh_definition/en/

Image: Skye Design, 2019

4

What are Determinants of Population Health?

5

What are some specific Social Determinants of Health?

6

What Are Health Disparities?

• Health disparities are differences in health outcomes and their causes among groups of people.

• Reducing health disparities is a major goal of public health. Achieving health equity, eliminating disparities, and improving the health of all U.S. population groups is one of the goals of Healthy People 2020

7

Examples of Racial and Ethnic Disparities• From 2011 to 2014, Hispanic children and adolescents ages 2 to 19

had the highest prevalence of obesity in the United States (21.9 percent), and Asians had the lowest (8.6 percent)

• Native Americans are twice as likely to have diabetes as whites

• African Americans were 30 percent more likely than whites to die prematurely from heart disease in 2010, and African American men are twice as likely as whites to die prematurely from stroke

• Rate of suicide is highest for male American Indians/Alaska Natives, who are also more likely than other racial and ethnic groups to die by unintentional injury (12.6 percent of all deaths)

Source: https://www.ncbi.nlm.nih.gov/books/NBK425844/

8

U.S. Mortality Statistics

9

10

Source: http://barhii.org/framework/

The Rise in Opioid Related Deaths

11

The Perfect Storm: Causal Factors in the Opioid Crisis• Social and economic factors fundamentally shape risk behavior,

access to resources, and the health of persons who use drugs.

• “…economic hardship and high rates of unemployment consistently characterize vastly different communities hit hard by the opioid crisis such as Appalachia and urban centers in the United States…which sets the stage for opioid use and dependency.”

• “Some researchers suggest that low educational attainment, income, and employment success produces poor social networks, low levels of power, prestige and self-mastery that contribute to illicit drug use.”

Source: https://www.brookings.edu/wp-content/uploads/2018/01/es_20180123_un-burying-the-lead-final.pdf

12

The Perfect Storm: Causal Factors in the Opioid Crisis• “…social conditions such as homelessness or high exposure to violence can

shape health behaviors by increasing opportunities and perceived reasons for engaging in high risk behavior.”

• “Social determinants such as poor housing conditions are often accompanied by neighborhood-level conditions that limit access to health care, risk-reduction information, and treatment alternatives, which are protective resources and can disrupt behaviors that ultimately lead to opioid addiction.

• “…neighborhoods with high economic and social risk factors also experience disproportionately high incarceration rates, shifting segments of the population to prisons where a concentration of drug users heightens risk behaviors.”

Source: https://www.brookings.edu/wp-content/uploads/2018/01/es_20180123_un-burying-the-lead-final.pdf

13

Strategies to Address SDOH

14

Summary• Poor social conditions continue to have a greater impact on

health than genes, biology and health behavior.

• The opioid crisis highlights systemic challenges for under resourced persons that makes them especially vulnerable to misuse drugs and experience adverse health outcomes.

• Addressing the root causes of these inequities is the first step to creating parity for all Americans.

15

Works Cited• https://www.who.int/social_determinants/sdh_definition/en/

• https://www.cdc.gov/nchhstp/socialdeterminants/faq.html

• https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/

• https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

• https://www.ncbi.nlm.nih.gov/books/NBK425844/

• https://www.cdc.gov/nchs/data/databriefs/db328-h.pdf

• http://culturalorganizing.org/the-problem-with-that-equity-vs-equality-graphic/

• http://www.bhcmerced.org/wp-content/uploads/2017/12/COH.CommunitiesInAction.Report.NASEM_.pdf

• http://barhii.org/framework/

• https://www.cdc.gov/drugoverdose/epidemic/index.html

• https://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-raceethnicity/?activeTab=graph&currentTimeframe=0&startTimeframe=18&selectedRows=%7B%22wrapups%22:%7B%22united-states%22:%7B%7D%7D%7D&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22desc%22%7D

• https://www.brookings.edu/wp-content/uploads/2018/01/es_20180123_un-burying-the-lead-final.pdf

• https://www.cdc.gov/nchhstp/socialdeterminants/faq.html

16

17

Thank youThe purpose of RCORP is to support treatment for and prevention of substance

use disorder, including opioid use disorder, in rural counties at the highest risk for substance use disorder.

Melissa A. Clarkmclark@ahecwest.org

301-777-9150This product was supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) under

grant #G25RH33031. The information, conclusions and opinions expressed in this product are those of the authors and no endorsement by FORHP, HRSA, or HHS is intended or should be inferred.