Social Determinants of Health Notes

June 1, 2010 by Charlene Julien

04/27/2010

Health Equity and the Social Determinants of Health

Courtney Boen, Rebekah Gowler and Meghan Patterson
 Center for Health Equity and Social Justice, Boston Public Health Commission.
 1.        Objectives:
·         Define health disparities, health equities, and the social determinants of health.
·         Understand a health equity framework
·         Identify the social determinants of health
·         Articulate the impact racism has on shaping the social determinants of health
·         Identify how to use community assessments to shape practice.
 
2.        What are health disparities? / What are health inequities?
 
·         Health disparities: differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.
·         Health inequities: differences in health status and mortality rates across population groups that are systemic, avoidable, unfair and unjust.
 
3.         Disparities, Inequality and Inequity
 DISPARITY= INEQUALITY and implies differences between individuals or population groups
INEQUITY refers to differences which are unnecessary and avoidable and, in addition, are also considered unfair and unjust.
 
4.        Health Equity
 The opportunity for everyone to attain their full health potential.
  No one is disadvantaged from achieving this potential because of his or her social position or other socially determined circumstance
 Distinct from health equality or health disparities
 
5.        What explains these inequities in health?  - A look at the social determinants of health
 Segregation:
·         Racial segregation concentrates poverty and excludes and isolates communities from mainstream resources.
·         Segregation did not materialize naturally
·         Today segregation is maintained by economic inequality.
           Economic opportunity:
·         ‘Poverty Tax”: residents in poor neighborhoods pay more for the exact same consumer products than those in higher income neighborhoods.
·         Higher rates of asthma sleep disorders and lead toxicity are more likely in sub-standard housing.
·         Food environment: Food desert are areas with no or distant grocery but with many choices of fast-food, convenience stores and liquor stores. Research show that residents in food desert suffer worse diet-related health outcomes, including diabetes, cancer, heart disease and premature health.
·         Physical environment (fewer parks, recreational centers, swimming pools, and less walkable areas)
·         Education: correlated with health outcomes and life expectancy.
·         Social mobility, public safety,….
 
6.        The stress of racism
 
·         Creates structural barriers to health and well-being
·         Stress associated with racism and discrimination takes a toll on the body: a study shows that Black women who reported they had been victims of racial discrimination were 31% more likely to develop breast cancer than those who did not. ( + reference to the movie “Unnatural causes: when the bough breaks”).
 
A health equity framework:
                                                       Social capital
                                                       Transportation
                                                       Education
                                                       Employment
                                                       Food access
 
RACISM     <--------------            Socioeconomic Status        --------------->HEALTH OUTCOMES                             -
 
                                                      Environmental exposure
                                                      Health behaviors
                                                     Access to health services
                              Housing
                              Public safety
 
Health and the built environment are inextricably linked: where you live impacts how you live.
         

7. How do you work to eliminate health inequities?

 We often say…. “I know my work is connected because….”
      
                                      Degree of impact
Low                                                                                                High
                                                                                      
 
We don’t                             We serve a                            We plan our work
Discriminate                        vulnerable                             in such a way to ensure it
 Against anyone                   population                          addresses the factors
                                         impacted by these                     leading to disparities
                                           disparities
 
 How can we all get here?                           
 
 Low                          Degree of impact                                           High
                                                                                           
We don’t                             We serve a                         We plan our work
discriminate                        vulnerable                        in such way we ensure it
 against anyone                   population                         addresses the factors
                                       impacted by these                 leading to disparities
                                           disparities
  What can we do?

• Consider “upstream approaches”
• Aim for sustainable change in policy and practice: policy with long term consequences impacts the economic, social, physical and service environments.
• Engage staff and partners at all levels
• Ask questions differently:

 Ex:   How can we promote healthy behavior?
How can we target dangerous conditions and reorganize land use and transportation policies to ensure healthy spaces and places?
 

8. Conduct a community assessment of the social determinants of health.

• Goal: Identify the key social determinants of health and racial disparities in the community, map assets and resources for addressing the identified needs, use results to shape and develop community-based strategies.

 Proposed phases:
1.        plan the assessment: review existing data, convene a team, develop tools, decide on methods.
2.        conduct the assessment: utilize different methods as focus groups, listening sessions, interviews, paper survey, observations, windshield survey
3.        document discussions and findings
4.        develop an action plan,
5.        organize the larger community
6.        take action!
  

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