Social Determinants of Health - Department of Public Health

1 4/4/20121 Social Determinants of Health1 Los Angeles County Department of Public Health Expert Speaker Webinar April 5, 2012 Jonathan E. Fielding, , of Public Health and Health OfficerLos Angeles County Department of Public HealthPresentation Overview Definitions and Importance of Social Determinants in Public Health Practice Key Social Determinants Income and PovertyEdid El Education and Employment Housing Communication Environment Community/Place Safety Conclusions and Implications for DPH2 Polling Question #1 How confident are you in your understanding of the Social Determinants of Health ?

2 A)CfidA)Very Confident B)Somewhat Confident C)Not Confident at All 34/4/20122 What produces Health ? Individual health4 Family Health Community healthOne Model of Population Health5 County Health Rankings Model. Copyright 2010 UWPHID efinition: Societal Determinants of Health Conditions in the Social , physical, and economic environment in which people are born, live, work, and age. They consist of policies,6gyp ,programs, and institutions andother aspects of the Social structure, including the government and private sectors, as well as community factors.

3 Healthy People 2020: An Opportunity to Address Societal Determinants of Health in the , Objectives for 2020, July 11, 2010. Top photo credit: New York Times, Beatrice de Gea, Oct 19, Definition: Social Determinants of Health The complex, integrated and overlapping Social structures and economic systems that are responsible for most Health inequities. qSocial Determinants of Health are shaped by the distribution of money, power, and resources throughout local communities, nations, and the world. 7 Commission on Social Determinants of Health (CSDH), Closing the gap in a generation: Health equity through action on the Social Determinants of Health .

4 Final report of the Commission on Social Determinants of Health . 2008, World Health Organization: and Concave by MC Escher8 Image credit: New Frontier of Public Health Traditional Public Health practice centered on shaping Health behaviors and providing access to care for underserved communities. The new frontier of Public Health requires that we address environmental influences. Failure to transform our practice to address modern problems will represent a failure of Public People with quality education, stable employment, safe homes and neighborhoods, and access to preventive services tend to be healthier throughout their lives and live longer.

5 10 Of all the forms of inequality, injustice in Health is the most shocking and the most inhumane. DM iLh Ki-Dr. Martin Luther King at the 2ndNational Convention of the Medical Committee for Human Rights. March 25, 196611 Photo credit: The Seattle Times Company 2011. News Special - Martin Luther King Jr. and the Civil Rights People 2020 An overarching goal of Healthy People 2020 is to create Social and physical environments that promote good Health for all. 12 HP 2020 recognizes that Social Determinants influence population heath and limit the ability of many to achieve Health equity.

6 Koh, H., Pitrowski J., Kumanyika S., Fielding J. Healthy People: A 2020 Vision for the Social Determinants Education & Behavior, Dec 2011, 38(6) 551-557. 4/4/20125 Behavioral outcomes Specific risk factors, diseases& conditions Policies Programs InformationInterventionsOutcomesSocial Determinants of Health13 Injuries Well-being & Health -related Quality of Life Health equityAssessment, Monitoring, Evaluation & DisseminationAction Model to Achieve Healthy People 2020 Overarching Goals Some Examples of Social Determinants : Availability of resources to meet daily needs Eg.

7 Safe housing Access to educational, economic and job Exposure to crime, violence and Social disorder Social norms and attitudes Eg. discrimination, racismS iiditieconomic and job opportunities Access to Health care services Quality of education and job training Social support14 Socioeconomic conditions Eg. concentrated poverty Language/Literacy Availability of jobs that pay living wageHealthy People 2020 Overview - Social Determinants of HealthAccessed at: and Social Determinants The mechanisms through which these Determinants cause ill Health are still being explored.

8 Examples: violence; lack of formal educational attainment; low Health literacy While they are important there are relatively few While they are important, there are relatively few evidence-based interventions to address Social Determinants . Intermediate measures (like HS graduation) are relied on heavily to demonstrate a communities Social health154/4/201262011 County Health Rankings: Health Outcomes Health outcome rankings are based on mortality and morbidity measures LA County ranks 26thout of 5616 Health factor rankings include Health behavior, clinical care, Social and ifd2011 County Health Rankings.

9 Health Factors economic factors and physical environment measures LA County ranks 38thout of 56172011 County Health Rankings: Social and Economic Factors LA County ranks 42ndout of 5618 High school graduation (% of ninth grade cohort that graduates in 4 yrs) is a leading Health indicator for HP 2020; the US HP2020 target is Social Determinant:Income and Poverty19 Polling Question #2 How does Los Angeles County s poverty rate compare to California as a whole?A)hC lifiA)Lower than California B)About the Same as California C)Higher than California 20 poverty US, CA, LA County: All in poverty 2110111213% of Census Bureau, Small Area Income and poverty Estimates Program, November 2011 Accessed at: US, CA, LA County: Under Age in poverty 2212141618% of Census Bureau, Small Area Income and poverty Estimates Program, November 2011 Accessed at.

10 Household Income$54,828$60,39256,00058,00060,00062 ,000LA County23$51,42546,00048,00050,00052,0005 4,000 Median Household Income 2005-2009 CaliforniaUnited Census Bureau, 2005-2009. 5-Year American Community SurveyFamily Economic Self-Sufficiency Standard How much income is needed for a family to adequately meet its minimal basic needs without Public or private assistance? Self-sufficiency standard is based on the costs families face on a daily basis Housing, food, child care, out-of-pocket medical expenses, transportation, and other necessary Center for Community Economic Development.