How They Inform Resilience Building Deborah Deatrick, MPH Maine - - PowerPoint PPT Presentation
Social Determinants of Health and Equity: How They Inform Resilience Building Deborah Deatrick, MPH Maine Resilience Building Network October 31, 2019 Objectives 1. Define social determinants of health, health disparities, health inequities,
Deborah Deatrick, MPH
Maine Resilience Building Network October 31, 2019
inequities, and equity.
and in Maine.
among children and families.
two children, ages 4 and 6
income is part time work for Housing Authority and
language, economic status, age, etc.
Conditions in the places where people live, learn, work, and play affect a wide range of health risks and outcomes. These conditions are known as social determinants of health.
Healthy People 2020 developed a “place-based” organizing framework, reflecting five key areas of SDOH:
Source: USDHHS, Healthy People 2020
ADD Picture of Tree
▪
Diabetes As of 2007, Native Americans and Alaska Natives (17%), African Americans (12%), and Hispanics/Latinos (10%) were all significantly more likely to have been diagnosed with diabetes compared to their White counterparts (7%).1 Heart Disease In 2000, rates of death from diseases of the heart were 29 percent higher among African American adults than among white adults, and death rates from stroke were 40 percent higher.2 Infant Mortality In 2002, Sudden Infant Death Syndrome (SIDS) deaths among American Indian and Alaska Natives was 2.3 times the rate for non-Hispanic white mothers.3
References: 1CDC (2008), 2NCHS (2002), 3NICHD (2007)
▪ Systematic and unjust distribution of social,
transportation, other resources (e.g., grocery stores, car seats)
Reference: Whitehead M. et al
Education Infants born to African American mothers with
more likely to die in the first year of life compared to their White counterparts. Income Low socioeconomic status is associated with an increased risk for many diseases, including CVH, arthritis, diabetes, chronic respiratory diseases, cervical cancer and frequent mental distress.1 Access to resources Lower income and racial/ethnic minority communities are less likely to have access to grocery stores with a wide variety of fruits and vegetables.2,3
References: 1Pleis, Lethbridge-Cejku (2006), 2Morland, et al (2002), 3Baker, et al (2006)
▪ Equality – everyone gets the same thing, equal taxes, equal rights, etc. ▪ Equity – more “real”; focus on outcomes and root structures, and the things that contribute to those outcomes and structures ▪ Key question: how is POWER operating? ▪ What are the positive outcomes we want to see?
▪ “The Curb Cut Effect” by Angela Glover Blackwell in Stanford Social Innovation Review, Winter 2017 (see resource list)
◼ The opportunity for everyone to attain his or
◼ No one is disadvantaged from achieving this
◼ Distinct from health equality
Reference: Whitehead M. et al
Health Disparities Health Inequities Health Equity SDOH Differences in the incidence and prevalence of health conditions and health status between groups based on:
Systematic and unjust distribution of social, economic, and environmental conditions needed for health.
quality education, healthcare, housing, transportation, other resources (e.g., grocery stores, car seats)
pay/income
upon social status/other factors
The opportunity for everyone to attain his or her full health potential.
No one is disadvantaged from achieving this potential because of his or her social position or other socially determined circumstance.
quality education, healthcare, housing, transportation, other resources
employment
discrimination based upon social status/other factors
Life-enhancing resources whose distribution across populations effectively determines length and quality of life.
relationships
Equity Environment
Health
Access to Healthy Food Schools/ Child care Health facilities Community Safety/ Violence Transportation Traffic patterns Work environments Housing Parks/Open Space/ Playgrounds
Reference: PolicyLink
areas is widespread
independence
jobs with few or no benefits
* source: 2010 U.S. Census
York Cumberland Sagadahoc Lincoln Knox Hancock Washington Penobscot Somerset Piscataquis Franklin Aroostook Oxford Waldo Androscoggin
20
Health Outcomes Rank Current Health Status- Morbidity & Mortality (5 measures) Health Factors Rank Factors that Affect Future Health Status (30 measures)
21
Health Outcomes Overall Rank – Maine 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Cumberland 3 3 3 2 3 2 2 1 1 1 Sagadahoc 7 4 1 3 2 1 1 2 2 2 Hancock 2 1 2 1 1 3 6 5 5 3 Knox 6 7 5 5 6 6 3 3 3 4 York 5 6 4 4 4 4 4 4 4 5 Oxford 16 16 15 12 10 7 10 10 6 6 Lincoln 4 5 7 11 9 5 5 9 9 7 Kennebec 8 9 9 7 5 8 9 7 7 8 Waldo 9 8 6 10 12 12 8 8 10 9 Franklin 1 2 8 8 8 9 7 6 8 10 Penobscot 10 11 10 9 11 11 12 11 11 11 Androscoggin 11 12 11 6 7 13 13 13 12 12 Piscataquis 12 10 13 16 16 15 11 14 14 13 Somerset 14 14 14 15 15 16 14 12 13 14 Aroostook 13 13 12 13 13 14 15 15 15 15 Washington 15 15 16 14 14 10 16 16 16 16
Healthiest Least Healthy
0% 10% 20% 30% 40% 50%
College graduate Some post-H.S. H.S. or G.E.D. Less than H.S. $75,000 or more $50,000- 74,999 $25,000- 49,999 $15,000- 24,999 Less than $15,000 75+ 65-74 55-64 45-54 35-44 25-34 18-24 Male Female All Adults (18+ y.o.)
% of adults who reported their physical health was not good during 14+ of the past 30 days (2016)
Data source: Behavioral Risk Factor Surveillance System
0% 10% 20% 30% 40% 50%
College graduate Some post-H.S. H.S. or G.E.D. Less than H.S. $75,000 or more $50,000 - 74,999 $25,000- 49,999 $15,000- 24,999 Less than $15,000 75+ 65-74 55-64 45-54 35-44 25-34 18-24 Male Female All Adults (18+ y.o.)
% of adults who reported their mental health was not good during 14+ of the past 30 days (2016)
*
*Not enough responses to calculate an estimate
* * * *
% of adults & children living in poverty (2012-2016)
% of adults & children living in poverty (2012-2016)
% of households that lack access, at times, to enough food for an active, healthy life for all households members or that have limited or uncertain availability of nutritionally adequate food. (Feeding America: Map the Meal- 2015)
Total Population Youth
10 20 30 40 50 60
Montana Alaska Wyoming New Mexico Idaho Utah South Dakota West Virginia Arkansas Colorado Nevada North Dakota Kansas Oklahoma Oregon Maine New Hampshire Missouri Vermont Arizona Kentucky Washington Tennessee Alabama Indiana South Carolina Wisconsin Hawaii Louisiana Iowa Mississippi Pennsylvania Ohio Nebraska North Carolina Michigan Florida Minnesota Georgia Texas Virginia Rhode Island Delaware Illinois California Connecticut Maryland Massachusetts New Jersey New York
Maine: 3rd largest increase
community (e.g., air pollution, high concentration of fast food restaurants, lack of jobs that provide a living wage)?
community?
care services) distributed within your community?
factors?
two children, ages 4 and 6
income is part time work for Housing Authority and
language, economic status, age, etc.
could be the focus?
sought?
place?
Invest Health Project at Sagamore Village
people from intergenerational poverty
donations
care resources
jobs.
that allow them to live a long, healthy life, regardless of their income, education or ethnic background.
health.
medical care.
neighborhoods, schools, and jobs.
Robert Wood Johnson Foundation, 2010 (see resource list)
content/uploads/2019/01/MLTC-Leadership-BCHO-SDOH-and- Reslience-Final.pdf
talk-about-the-social-determinants-of-health.html
Many factors contribute to
sense of place, our family history, our values, and so much more. Seeking to understand the power and influence these factors exert is essential to informing our actions to build resilient children, adults, and communities.
Thanks to MaineHealth for sharing the Health Index slides!
dadeatrick@gmail.com