Welcome to

1. Welcome to Social Determinants of Health: Utilizing Community Health Indicators To Drive Your Program Planning

2. Social Determinants of Health 101 Presenters: Louise Square NY State Department of Health Gail Brandt WA State Department of Health Chronic Disease Academy 2009

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 Health Factors 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. Income and education are markers ofsocioeconomic position Lower socioeconomic position results in worse access to healthcare AND social position influences exposure to health risks, or resources to buffer health risks Social Position Matters

8. Place Matters 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.

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. Stress Matters 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.

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”

27. Health Council Workgroup • Social Determinants of Health • Cultural Competency • Advocacy

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 • Don't be poor. If you can, stop. If you can't, try not to be poor for long. • Don't have poor parents. • Own a car. • Don't work in a stressful, low paid manual job. • Don't live in damp, low quality housing. • Be able to afford to go on a foreign holiday and sunbathe. • Practice not losing your job and don't become unemployed. • Take up all benefits you are entitled to, if you are unemployed, retired or sick or disabled. • Don't live next to a busy major road or near a polluting factory. • 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. 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 Nutrition

37. Increase access to facilities through construction support Promote policies to open schools evenings and weekends Recreation

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. High quality early childhood education Reform financing to equalize access to quality education in K-12 Reduce financial barriers preventing students from attending college Education…

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