Social Determinants of Health Equity and Levels of Potential Impact in the System:

Opportunities for Leverage

Karen J. Minyard, Ph.D.

Executive Director Georgia Health Policy Center Georgia State University

Georgia Health Policy Center

A Research Center at Georgia State University

• Provides evidence-based research, program development, and policy guidance locally, statewide, and nationally • Focuses on solutions to the most complex issues facing health care today including: insurance coverage, children’s health, health care reform, and the development of urban and rural health systems • Works in more than 200 communities across the U.S.

Health

How Healthy Are Georgians?

Health Status by County

Georgia’s Health Ranking Among States: 2010 DETERMINANTS - Personal Behaviors

Prevalence of Obesity (Percent of population)

DETERMINANTS - Community and Environment

High School Graduation (Percent of incoming 9 th graders) Infectious Disease (Cases per 100,000 population) Children in Poverty (Percent of persons under age 18) Air Pollution (Micrograms of fine particles per cubic meter)

DETERMINANTS - Public and Health Policies

Lack of Health Insurance (Percent without health insurance)

HEALTH OUTCOMES

Infant Mortality (Deaths per 1,000 live births) Cardiovascular Deaths (Deaths per 100,000 population)

2010 Rank 28 45 47 40 46 44 41 40 2008 Rank 40 2007 Rank 38 48 47 41 50 41 40 40 48 46 40 50 40 43 41 2003 Rank 36 49 46 37 47 37 43 -

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Factors Influencing Health Status

Schroeder, Steven A., We Can Do Better -- Improving the Health of the American People, N Engl J Med 2007 357: 1221-1228

Social Determinants of Health Equity

Health Disparities

The unequal burden in disease morbidity and mortality rates experienced by ethnic/racial groups as compared to the dominant group.

Source: Healthy People 2010, US HHS, 2000

Social Determinants of Health

The conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices.

Source: World Health Organization, 2008

Community-Level Determinants of Health Equity Social Environment

Social Cohesion & Trust Collective Efficacy

Physical Environment

Housing & Neighborhood Conditions Transportation

Economic Environment

Employment

Service Environment

Health & Human Services Civic Engagement Cultural Characteristics & Norms HEAL Promoting Structures Natural Resource Quality Home Ownership Local Business Development Product Availability Public Safety & Emergency Services Education Community-based Organizations Aesthetics Cultural/Artistic Opportunities

Source: Grantmakers in Health, 2009; Institute of Medicine, 2008; PolicyLink, 2002; Prevention Institute, 2003

Health Equity Best Practices

CDC’s The Community Guide:

– Community Preventive Services Task Force – Identified 200 community-based interventions in six areas – • • • Reviews in three areas complete Early childhood development = effective Affordable and safe housing = effective Access to culturally competent healthcare systems = evidence insufficient

Evidence-based interventions:

– Housing Mobility Policies – Early Childhood Development

Source: Anderson et al., 2003; CDC, 2009; Williams et al., 2008

National Examples of Early Childhood Development Best Practices

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Nurse-Family Partnership

Nurse home visit program for low-income, first-time parents Significant outcomes: – – – – – – Reduced risks for antisocial behaviors for children Reduced childhood injury Reduced child abuse, maternal crime & substance abuse Improved prenatal outcomes Increased school readiness for children Increased maternal employment & father involvement ROI=$5 for every $1 spent

Source: http://www.nursefamilypartnership.org

National Examples of Early Childhood Development Best Practices

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Harlem Children’s Zone

97 block-area in Central Harlem, New York Promise Academy Charter schools & 22 birth-to-college community programs – Baby College, The Three Year Old Journey, Get Ready for Pre-K, Harlem Gems Significant outcomes: – 100% of Harlem Gems school ready for 6 consecutive years – 97-100% of 3 rd graders at-level in math & English language arts – 97% of 8th graders at-level in math • vs 7% avg for Black 8 th graders – Closing Black-White achievement gap

Source: Dobbie & Fryer, 2009

A Lesson in North Karelia

• In the 1970’s, North Karelia, Finland was plagued by exceedingly high deaths from cardiovascular disease •

“It was a question of general lifestyle of the community - not just some people with high risk factors. The whole environment had to change - the food industry, restaurants, cafeterias, supermarkets.”

Pekka Puska, Project Director

A Lesson in North Karelia

What they did: – Towns were pitted against each other in cholesterol-lowering competitions. – – Food-labeling laws were changed The national school-lunch program got a major overhaul – They convinced bread companies to use less salt and replace butter with vegetable oil – They made sure walking paths were clear – They passed laws to provide facilities for their citizens to get exercise Results: – The smoking rate dropped from 52% to 31% – Coronary heart disease mortality fell by 73% – Lung cancer mortality dropped by 71% – All-cancers mortality dropped by 49% – Overall mortality declined 45% – 6 to 7 extra years of life expectancy were added

Levels of Impact

Sustainability Institute, adapted from other versions from the organizational learning field

Philanthropic Collaborative for a Healthy Georgia

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Individual Providers

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Incentives for Collaboration

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Change the System/ Policy/Environment

Opportunities for Leverage

Local

Strategic Alignment

Triple-Layer Chess

National State

Visit www.gsu.edu/ghpc or follow us on Facebook for more information and resources.