Social Determinants of Equity and Social Determinants of ...

1 Social Determinants of EquityandSocial Determinants of HealthLevels of health interventionAddressing thesocial Determinants of healthPrimary preventionSafety net programs and secondary preventionMedical care and tertiary preventionBut how do disparities arise? Differences in the quality of care received within the health care system Differences in access to health care, including preventive and curative services Differences in life opportunities, exposures, and stresses that result in differences in underlying health statusDifferences in exposures and opportunitiesDifferences in access to careDifferences in quality of care(ambulance slow or goes the wrong way)Addressing thesocial Determinants of Equity :Why are there differencesin resourcesalong the cliff face?

2 Why are there differencesin who is foundat different parts of the cliff? Determinants of healthIndividual behaviorsDeterminants of healthSocial Determinants of health (contexts)Individual behaviorsDeterminants of healthDeterminants of health and illness that are outside of the individualBeyond genetic predispositionsBeyond individual behaviorsSocial Determinants of health (contexts)Individual behaviorsDeterminants of healthDeterminants of health and illness that are outside of the individualBeyond genetic predispositionsBeyond individual behaviorsSocial Determinants of health (contexts)Individual behaviorsThe contexts in which individual behaviors ariseDeterminants of healthIndividual resourcesEducation, occupation, income, wealthSocial Determinants of health (contexts)Individual behaviorsDeterminants of healthIndividual resourcesEducation, occupation, income, wealthNeighborhood resourcesHousing, food choices, public safety, transportation, parks and recreation, political cloutSocial Determinants of health (contexts)

3 Individual behaviorsDeterminants of healthIndividual resourcesEducation, occupation, income, wealthNeighborhood resourcesHousing, food choices, public safety, transportation, parks and recreation, political cloutSocial Determinants of health (contexts)Individual behaviorsHazards and toxic exposuresPesticides, lead, reservoirs of infectionDeterminants of healthIndividual resourcesEducation, occupation, income, wealthNeighborhood resourcesHousing, food choices, public safety, transportation, parks and recreation, political cloutSocial Determinants of health (contexts)Individual behaviorsHazards and toxic exposuresPesticides, lead, reservoirs of infectionOpportunity structuresSchools, jobs, justiceDeterminants of healthSocietal Determinants of context Social Determinants of health (contexts)Individual behaviorsDeterminants of healthDetermine the range ofobserved contexts Societal Determinants of context Determinants of healthDetermine the range ofobserved contextsSocietal Determinants of context Social Determinants of health (contexts)

4 Individual behaviorsDetermine the distribution of different populations into those contextsDeterminants of healthDetermine the range ofobserved contextsSocietal Determinants of context Social Determinants of health (contexts)Individual behaviorsDetermine the distribution of different populations into those contextsInclude capitalism, racism, and other systems of powerDeterminants of healthDetermine the range ofobserved contextsSocietal Determinants of context Social Determinants of health (contexts)Individual behaviorsDetermine the distribution of different populations into those contextsThe Social Determinants of equityInclude capitalism, racism, and other systems of powerAddressing the Social determinantsof health Involves the medical care and public health systems, but clearly extends beyond these Requires collaboration with multiple sectors outside of health, including education, housing, labor, justice, transportation, agriculture, and environmentAddressing the Social determinantsof Equity Involves monitoring for inequities in exposures and opportunities.

5 As well as for disparities in outcomes Involves examination of structures, policies, practices, norms, and values Requires intervention on societal structures and attention to systems of powerWe need to do both Address the Social Determinants of health, including poverty , in order to achieve large and sustained improvements in health outcomes Address the Social Determinants of Equity , including racism, in order to achieve Social justice and eliminate health disparitiesNaming and Addressingthe Impacts of Racismon HealthWhy racism? To eliminate racial disparities in health, need examine fundamental causes Race is only a rough proxy for SES, culture, or genes Race precisely measures the Social classification of people in our race -conscious society Hypothesize racism as a fundamental cause of racial disparities in healthWhat is racism?

6 A systemWhat is racism?A systemof structuring opportunity and assigning valueWhat is racism?A system of structuring opportunity and assigning valuebased on the Social interpretation of how one looks ( race )What is racism?A system of structuring opportunity and assigning value based on the Social interpretation of how one looks ( race ) Unfairly disadvantages some individuals and communitiesWhat is racism?A system of structuring opportunity and assigning value based on the Social interpretation of how one looks ( race ) Unfairly disadvantages some individuals and communities Unfairly advantages other individuals and communitiesWhat is racism?

7 A system of structuring opportunity and assigning value based on the Social interpretation of how one looks ( race ) Unfairly disadvantages some individuals and communities Unfairly advantages other individuals and communities Saps the strength of the whole society through the waste of human resourcesSource: Jones CP, Phylon 2003 Reactions to Race module Six-question optional module on the Behavioral Risk Factor Surveillance System Piloted by six states in 2002 Now available to all statesStates using Reactions to Race Arkansas2004 California2002 Colorado2004 Delaware200220042005 District of Columbia2004 Florida2002 Michigan2006 Mississippi2004 Nebraska2008 New Hampshire2002 New Mexico2002 North Carolina2002 Ohio20032005 Rhode Island20042007 South Carolina20032004 Virginia2008 Washington2004 Wisconsin200420052006 States using Reactions to Race module on 2004 BRFSSA rkansas, Colorado, Delaware.

8 District of Columbia, Mississippi, Rhode Island, South Carolina, WisconsinSocially-assigned race How do other people usually classify you in this country? Would you say: White Black or African-American Hispanic or Latino Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Some other groupGeneral health status Would you say that in general your health is: Excellent Very good Good Fair excellent or very good healthpercent of respondentsGeneral health status by socially-assigned "race", 2004 BRFSSG eneral health status by socially-assigned "race", 2004 excellent or very good healthpercent of respondentsGeneral health status by socially-assigned "race", 2004 excellent or very good healthReport fair or poor of respondentspercent of respondentsGeneral health status and race White Social experience associated with better healthSelf-identified ethnicity Are you Hispanic or Latino?

9 Yes NoSelf-identified race Which one or more of the following would you say is your race? White Black or African-American Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Other Which one of these groups would you say best represents your race?Self-identified race /ethnicity Hispanic Yes to Hispanic/Latino ethnicity question Any response to race question White No to Hispanic/Latino ethnicity question Only one response to race question, White Black No to Hispanic/Latino ethnicity question Only one response to race question, Black American Indian/Alaska Native No to Hispanic/Latino ethnicity question Only one response to race question, AI/AN WhiteBlackHispanicAIAN.

10 White26, , measures of race How usually classified by othersHow self-identifyTwo measures of race How usually classified by othersWhiteBlackHispanicAIAN..White26, , , self-identifyTwo measures of race How usually classified by othersWhiteBlackHispanicAIAN..White26, , , self-identifyGeneral health status, by self-identified and socially-assigned "race", 2004percent of excellent or very good healthHispanic-HispanicHispanic-WhiteWhi te-WhiteGeneral health status, by self-identified and socially-assigned "race", of respondentsHispanic-HispanicWhite-WhiteT est of H0: That there is no difference in proportionsreporting excellent or very good healthHispanic-Hispanic versus White-Whitep < excellent or very good of respondentsReport excellent or very good healthHispanic-HispanicHispanic-WhiteTes t of H0.