Social Determinants of Health and Environmental …

1 Social Determinants of Health and Environmental JusticeMarch 2016 The Colorado Commission on Affordable Health Care22 Health is a state of complete physical, mental and Social well-being and not merely the absence of disease or ,NewYork,19-22 June,1946;signedon22 July1946bytherepresentativesof61 States(OfficialRecordsoftheWorldHealthOr ganization, , )andenteredintoforceon7 April1948. Socialdeterminantsofhealtharetheeconomic andsocialconditions,andtheirdistribution amongthepopulation, Relatedtosocialdeterminantsofhealthisthe conceptofenvironmentaljustice,whichtheEn vironmentalProtectionAgencydefinesas.

2 Thefairtreatmentandmeaningfulinvolvement ofallpeopleregardlessofrace,color,nation alorigin,orincomewithrespecttothedevelop ment,implementation,andenforcementofenvi ronmentallaws,regulationsandpolicies. Five Key Areas for Social Determinants 3 What Are Social Determinants ? Americaspendsmoremoneypercapitaonhealthc arethananyothernation,yettheoverallhealt hofthepopulationlagsbehindthatofmostindu strializedcountriesduetocontinuingandgro wingdisparitiesinmortality,morbidity, ,suchaslandfills,toxicchemicaldisposal,p ollutions, ,decreasedproductivity,andanoveralldispa rateuseoffederal, University of Maryland report; University of Wisconsin Population Health Institute4 What is the Problem?

3 ,inparticular,touchesnearlyallaspectsofa family shousing,theavailabilityofnutritiousfood s,transportationtohealthcareproviders,an daccesstosafe, , :AstudybyaUniversityofCalifornia, ,researchteamfoundthatforlow-incomepatie ntswithdiabetes, (SNAP,formerlyknownasfoodstamps)runningo utbeforemonth Does This Problem Contribute to Cost?Inareviewoftheliterature,thecommonf actorsassociatedwithsocialdeterminantsof healthandenvironmentjusticeinclude:Incom einequality therelationshipofwealthandhealth Indicatingunemployment,underemployment,p overty,andsingleparenthouseholds. Whichinturnaffectsstresslevels,exposuret ocrime,contactwithtoxins,fewereducationa lprospects,difficultyinfindingsafeandaff ordablehousing,accesstohealthcareservice s,affordabilityofnutritiousmeals,accesst ofullservicegrocerystores, ,diabetes, Does the Research Say?

4 Socialandcommunityinequity notbelongingtoanextendednetworkofsupport Indicatingracial,genderandsexualdiscrimi nationandbias,isolation,incarceration,in stitutionalization,andthosewhodonotspeak Englishastheirprimarylanguage. Affectscohesionwiththecommunity,civicpar ticipation,accesstoeducationalopportunit ies,accesstotimelyandcomprehensivehealth care,involvementinrecreationalandleisure timeactivities,havingpersonalemotionalsu pport, Health Organization , F. Ferraro, Childhood Disadvantage and Health Problems in Middle and Later Life: Early Imprints on Physical Health ? American Sociological Review8 Research $1,000-$500$0$500$1,000$1,500$2,000$2,50 0-2-1012345 Change in Cumulative Discounted Costs ($Billions)Cumulative Deaths Prevented (Millions)Deaths Prevented & Change in Healthcare Costs for Three Intervention Scenarios at 10 and 25 YearsCumulative Deaths Prevented (Millions)Change in Cumulative Discounted Costs ($Billions)ResultsThrough Yr.

5 10 ResultsThrough Yr. 25 Research , B et al. (2011) Why behavioral and Environmental intervetnion are needed to improve Health and lower cost; Health AffairsInareportpublishedbytheAssociatio nofStateandTerritorialHealthOffices,they notethatinvestinginpreventionandpubliche althnotonlysaveslives, :10 Promising Practices from the Literature Forevery$1spenton:Wesave:Water fluoridation$38 in dental treatment costsPreconception care program for women with diabetes$ by preventing costly complications in both mothers and babiesSchool-based HIV/STD and pregnancy prevention programs$ in medical and Social costs11 Nurse Family Partnership Partnershighly-trainednurseswithvulnerab lefirsttimemothersandtheirbabies.

6 Over18,000familiesservedinColoradosince1 999 Duringpregnancya21% insmoking;29% inalcoholuse ROI:Every$1spentsavingsof$ ;$ Savingsachievedthroughloweruseofgovernme ntprogramssuchasfoodstampsandTANFE arly Childhood Interventions: Proven Results, Future Promise. RAND Corporation. 2005. Early Childhood Investments Researchshowsthatearlylifeexposuresaffec tcognitiveandnon-cognitivedevelopment,wh ich,inturn,affectstimepreferencesandself -controlskills,whicharemajordeterminants ofriskyhealthbehaviors. FindingsfromtheFederalReserveBankofMinne apolisthatforevery$1investedinearlychild hoodyields$ Relative Contribution of Multiple Determinants to Health Outcomes, Health Affairs, August 2014 Promising Practices Cont.

7 The New Academy of Medicine & Trust for America s Health ; 2013 A Compendium of Proven Community Based Prevention Programs Asthma Injuries and violence Cardiovascular disease, stroke & diabetes Alcohol use Tobacco use Sexually transmitted infections and AIDSThe study estimated that an investment of $10 per person per year in community-based programs to increase physical activity, improve nutrition, and prevent smoking would save the US more than $ billion annually within five yearsFor every $1 invested ROI = $ Practices13 What Are Other States Doing?There are many efforts and pilots going on across the country these are a few highlights: Housing UPMCforYouservesalargeMedicaidpopulation inPennsylvania-UPMC developeda shelterpluscare programthroughamulti-partypartnership(ap rimarycarepractice,thelocalHUDauthority, andCommunityHumanServices).

8 UPMC paysforthehealthcareservicesprovided, A23%reductioninoverallper-member-per-mon th(PMPM) ,enrolleesaveragedPMPM costsofroughly$4,100versusPMPM costsofroughly$3,200whileintheprogram; PMPM costreductionsoccurredinallmedicalservic ecategoriesexceptprescriptiondrugs,where aslightincreaseoccurred;and Thevastmajorityofenrolleesremainedstably housed. SeveralstatesincludingNewYorkareusingthe DeliverySystemReformIncentiveProgramtore visittheroleMedicaidcanplayregardinghous ing. ArisingoutofextensivenegotiationswithCMS ,theNewYorkDSRIP isan$ ,$ Requiredtoincludeabroadarrayofproviders, reflectingthestronginterestinNewYorkinmo vingcareintocommunity-basedorganizations .

9 NewYorkhasbeenabletotacklesomesocialdete rminantsofhealth, , States Cont. Hotspotting: CamdenCounty, ,isoneexamplewhereunderstandingthesocial determinantsandcreatingcarecoordinationm adealargedifferenceinthe"high-flyers" ,theuseofservicescamedownandtherewereimp rovedclinicalmeasuresalongwithreducedtot alcostsofthepatients. MassachusettsGeneralHospitalinBostonhad2 ,600chronicallyhigh-costpatients,whotoge theraccountedfor$ ,in19privatepractices, ,thenursessawthemforlongervisits,madesur veillancephonecallsand,inconsultationwit hthedoctors, ,hospitalstaysandtripstotheEDhavedropped bymorethan15%.

10 15 Investments in Early Childhood ProgramssuchastheIncredibleYears,TripleP (PositiveParentingProgram) Asthma: Urban,low-incomepatientswithasthmafromfo urzipcodeswereidentifiedthroughlogsofEme rgencyDepartment(ED)visitsorhospitalizat ions, , , , $25, ,andanydaysoflimitationofphysicalactivit y,fewermissedschooldays, ,andareturnoninvestmentof$ Compendium of Proven Community-Based Prevention Programs, TheTrust for America's Health (TFAH) and New York Academy of Medicine Injury Prevention ThefederalSafeRoutestoSchool(SRTS)progra mallocatedfundsforstatedepartmentsoftran sportationtobuildsidewalks,bicyclelanes, andsafecrossings,improvesignage, ,from2001-2010,annualpedestrianinjuryrat esper10, Compendium of Proven Community-Based Prevention Programs, TheTrust for America's Health and New York Academy of MedicineOther States IslanderAfrican American/BlackHispanic/LatinoAm.