Socioeconomic Determinants of Health

1. Socioeconomic Determinants of Health Pam Silberman, JD, DrPHNorth Carolina Institute of Medicine Barbara Pullen Smith, MPH Office of Minority Health and Health Disparities Louisa Warren NC Justice Center

2. Health Equity • Racial and ethnic minorities generally experience poorer health outcomes than non-minorities • A person’s income, wealth, educational achievements, workplace and community can also have profound health effects • Health equity is the attempt to achieve the best possible health outcomes for everyone, targeting those who have been marginalized in the past Healthy People 2020. Subcommittee on Health Equity and Health Disparities. Draft criteria. May 1, 2008

3. Racial and Ethnic Disparities • Racial and ethnic minorities comprised 29% of North Carolina’s population in 2007 • Minorities have lower life expectancies than whites, living on average about 4.5 years less (72.1 years for minorities, 76.8 for whites) • Minorities are less likely to have insurance coverage and more likely to report access barriers

4. Risk of Mortality by Race/Ethnicity

5. Health Disparities • Racial and ethnic disparities in health outcomes persist, even after adjusting for other socioeconomic factors • Its not just poverty or lack of insurance coverage that creates these differences! • People of color may have a distrust of the traditional health care system because of a past history of discrimination

6. Task Force Recommendations • Public and private funders that fund prevention activities should promote the use of evidence-based strategies that take into account the racial, ethnic, cultural, geographic and economic diversity of the group to be served • Funders should expand support for community-based participatory research targeting health disparities • DPH should involve trusted community members in prevention activities

7. Socioeconomic Disparities • Income is positively related to health. • Higher income people can generally afford health insurance coverage, live in healthier communities, and have more opportunities to eat healthy foods and exercise • North Carolinians are more likely to have low incomes (<200% FPG) than nationally (NC: 35.1%, US: 30.6%) (2007)

8. Socioeconomic Disparities • Substandard, unhealthy, overcrowded and unaffordable home environments contribute to health problems • Substandard housing can create health hazards (ie, mold, allergens, unintentional injuries) • Living in overcrowded conditions makes it easier to transmit certain infectious diseases • Paying excessive housing costs leaves less for food and health related costs • Neighborhood characteristics can adversely affect health

9. Socioeconomic Disparities • Educational achievement is strongly correlated to health—those with less education have more chronic health problems and shorter life expectancies • Less than 3/4ths of North Carolina high school students graduate high school • Education shapes both health behaviors and health outcomes

10. Task Force Recommendations • Priority Recommendations: • Increase the state Earned Income Tax Credit • Increase enrollment in the Supplemental Nutrition Assistance Program (formerly Food Stamps) • Increase the high school graduation rate • Other recommendations: • Increase funding to build affordable housing • Expand opportunities for high quality early childhood education and health programs