The Social Determinants of Health

HEALTH STARTS WHERE WE LIVE, LEARN, WORK AND

PLAY Marybeth Beall, M.S. Health Instigator and System Developer“It Take a Neighborhood “OPCA /K-P /NWHS

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The 60% Rule: Behavior, social circumstances and environment are responsible for 60% of premature deaths

Social Cir-cumstances

15%Environmental

Exposure5%

Health care10%

Behavioral patterns40%

Genetic predis-position

30%

Source: McGinnis J.M., Williams-Russo P., Knickman J.R. “The Case for More Active Attention to Health Promotion,” Health Affairs 2002; 21(2):78-93.

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National Health Care Expenditures: Only 4% of health care dollars are spent on factors that prevent premature

death

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Medical

Care96%

Prevent-tion4%

Achieve Health Equity…………… Health Equity

Everyone has access to the same opportunities for both good health and a fulfilling and productive life.Muntu Davis, MD, MPH, Alameda County Public Health Officer

Stated another way:All Americans should have the opportunity to make choices that allow them to live a long, healthy life, regardless of their income, education or ethnic background.

……Eliminate DisparitiesHealth Disparities

“…differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions among specific population groups in the Unites States”

NIH Working Group on Health Disparities

Examples: Race/ethnicity; sex; sexual identity; age, disability, social determinants of health.

Stated another way:Giving everyone a chance to live a healthy life

Our opportunity for health starts long before our need medical care.America leads the world in medical research and medical

care, and for all we spend of health care, we should be the healthiest people on earth. Yet on some of the most important indicators, like how long we live, we’re not even in the top 25, and among high income nations, we are 17th (males) and 16th (females). (And 18th in high school graduation rates of the top 24 industrialized nations!) U.S Health in International in Perspective - Shorter Lives, Poorer Health -Institute of Medicine of the National Academy of Sciences; Report Brief, January 2013.

It’s time to stop thinking of health as something we get at the doctor’s office but instead as something that starts in our families, in our schools and workplaces, and in the air we breathe and the water we drink.

The more we view health in this way, the more opportunities we have to improve it.

Marybeth Beall, M.S. Health Instigator and System Developer It take

Healthy People 2020The 12 Leading Health Indicators

 Access to Health Services Clinical Preventive Services Environmental Quality   Injury and Violence Maternal, Infant and Child

Health  Mental Health  

Nutrition, Physical Activity and Obesity

 Oral Health  Reproductive and Sexual

Health Social Determinants of

Health Substance Abuse  Tobacco

The Social and Physical Determinants of HealthExamples of social determinants

Availability of resources to meet daily needs (e.g., safe housing and local food markets)

Access to educational, economic, and job opportunities

Access to health care services Quality of education and job training Availability of opportunities for recreational and

leisure-time activities Transportation options Public safety Social support Social norms and attitudes (e.g., discrimination,

racism, and distrust of government) Exposure to crime, violence, and social disorder

(e.g., presence of trash and lack of cooperation in a community)

Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it)

Residential segregation Language/Literacy Access to mass media and emerging

technologies (e.g., cell phones, the Internet, and social media)

Culture

Examples of physical determinants

Natural environment, such as green space (e.g., trees and grass) or weather (e.g., climate change)

Built environment, such as buildings, sidewalks, bike lanes, and roads

Worksites, schools, and recreational settings

Housing quality and community design

Exposure to toxic substances and other physical hazards

Physical barriers, especially for people with disabilities

Aesthetic elements (e.g., good lighting, trees, and benches)

Stated another way: Health starts where we live, learn,

work and play.

Where we live……your neighborhood shouldn’t be hazardous to your health, nor should your home.

How is it helpful? Is your home warm in the winter, free of mold and lead-based paints? Do you have your own bed to sleep in?

Is their a full service grocery near your home where you can buy fresh produce?

How is it harmful? Poor housing conditions, including overcrowding, have been shown to have a

direct relationship to poor mental health, developmental delay, heart disease and other medical issues.

Children in poverty are 5 times more likely to have higher lead-blood levels, which can lead to neurological damage, learning disabilities, hyperactivity, and other health problems.

Children who experience “food insecurity” – uncertain or limited supplies of nutritious food – are 30% more likely to be hospitalized by age three.

Marybeth Beall, M.S. Health Instigator and System Developer It take

Health and Homeownership What Does Research Say?

About home ownership and health in general   

About home ownership and the immune system   

  About home ownership and mental health 

About housing instability  

   About homeownership and social engagement     

Where we learn……all Americans should have the opportunity to make choices that allow them to live a long healthy life, regardless of their income, education or ethnic background.

How is it helpful? Is participation in sports programs available to

all kidsregardless of income/ability to pay?

Does your children’s school offer nutritious lunch foods and healthy snack options?

Is your child able to walk to school safely? Does your child’s school have up to date text

books and technology resources for learning? Are job training opportunities available to kids

who choose or cannot afford not to go to college?

Where we work……health starts long before illness----in our homes, schools and jobs.How is it helpful?

Do you have access to health insurance for you and your family through your job?

Are you able to earn enough each month to pay for food for your family, housing, gas for your car and your electric bill?

How is it harmful?

Are you exposed to chemicals or pollutants on the job?

Do you work in a high risk of injury job i.e. logging, mining, commercial fishing, construction, farm labor)

Where we play……… the opportunity for health begins in our families, neighborhoods, schools and jobs.How is it helpful? Are the streets in your neighborhood safe to walk or

ride a bike in? Are there park nearby where you and your children

can play?

Can you afford swimming lessons for your kids?

How is it harmful? Do you live in an area with a high rate of crime and

violence?

Is their gang activity where you live?

And perhaps by what we do with our time! A recent news article reported that over 600,ooo Americans commute

more than 50 miles to and from work per day:

Average time in car =1.5 hours each way = 3 hrs. travel time per day

Assume at work 9.5 hours including time to park, arrive to and from the worksite and have a lunch hour

Time remaining at home/away from work = 11.5 hrs/day

In the remaining hours, how much time is left for:

Preparing meals? Eating? Resting? Relaxing? Exercising? Errands? Helping kids with homework? Attending kids activities? Taking care of pets? Household chores?

If sleeping 7 hours, only 3.5 hours per day remain for all of the above!

In Conclusion: Health starts where? Health starts in strong, loving families who live in decent homes that

are in neighborhoods that are safe for walking.

It starts in jobs we can get to without hours of commuting and workplaces free of unnecessary hazards.

Health starts in schools that educate out children for jobs in the 21st century, so that they can compete in the world economy, that feed them healthy meals rather than junk foods, and that send them home safe at the end of the day.

It starts in having the time and financial resources to play at the end of

a hard day’s work because unrelieved stress takes a toll on our hearts and our immune systems.

Health starts when we all can afford to see a doctor but are less likely to need to because it is possible to stay well in the places that we live, learn, work and play.

Marybeth Beall, M.S. Health Instigator and System Developer It take

Activity Instructions Draw a personal profile from the baskets being passed around Gather into groups of 3-5 Introduce your “new self” to your group using the personal profile you

have drawn  After all are introduced, answer the following questions: 1) What factors in each person’s life (where they live, learn, work

and/or play) might help this person’s health? How and why?

2) What factors in each person’s life might harm this person’s health or put them at risk for poor health? What social determinants of health are contributing to these risks?

3) If Raul, Connie, Roger, Steven, Ben, Jessica, Ellen, Alex or Brady were part of a family that had been selected to be a Habitat homeowner, what social determinants of their health might you, in your role with your affiliate, be able to impact in working with this person and/or their family? List these on the flip chart.

QUESTIONS?

Thank you!

Marybeth Beall, M.S. Health Instigator and System Developer. It Takes a Neighborhood