Social Determinants of Health and Equity: How They Inform Resilience Building Deborah Deatrick, MPH Maine Resilience Building Network October 31, 2019
Objectives 1. Define social determinants of health, health disparities, health inequities, and equity. 2. Identify key factors that contribute to SDOH and equity generally and in Maine. 3. Describe how specific SDOH-related strategies can impact resilience among children and families.
Many factors contribute to our health – our genes, our sense of place, our family history, our values, and so much more. Seeking to understand the power and influence these factors exert is essential to informing our actions to build resilient children, adults, and communities.
Meet Tricia • 47 year old woman, living with her daughter and her two children, ages 4 and 6 • Finished high school, divorced • Has lived in Sagamore Village her entire life, only income is part time work for Housing Authority and off site in-home child care • 200 families in SV, but isolation exists due to language, economic status, age, etc. • Food pantry on site source of most family food • No car, municipal bus is only transportation • No regular source of health or dental care • Very involved in leadership of neighborhood council • Active participant in GSFB classes
Social Determinants of Health • Access to health care • Income/Poverty • Access to resources • Insurance Coverage • Education • Housing • Employment • Racism/Discrimination • Environment • Segregation • Transportation
Social Determinants of Health (SDOH) Conditions in the places where people live, learn, work, and play affect a wide range of health risks and outcomes. These conditions are known as social determinants of health. Healthy People 2020 developed a “place - based” organizing framework, reflecting five key areas of SDOH: • Economic Stability • Education • Social and Community Context • Health and Health Care • Neighborhood and Built Environment Source: USDHHS, Healthy People 2020
ADD Picture of Tree
Health Disparities Differences in the incidence and prevalence ▪ of health conditions and health status between groups, based on: • Race/ethnicity Socioeconomic status • Sexual orientation • • Gender • Disability status Geographic location • Combination of these •
Examples of Health Disparities Diabetes As of 2007, Native Americans and Alaska Natives (17%), African Americans (12%), and Hispanics/Latinos (10%) were all significantly more likely to have been diagnosed with diabetes compared to their White counterparts (7%). 1 Heart Disease In 2000, rates of death from diseases of the heart were 29 percent higher among African American adults than among white adults, and death rates from stroke were 40 percent higher. 2 Infant Mortality In 2002, Sudden Infant Death Syndrome (SIDS) deaths among American Indian and Alaska Natives was 2.3 times the rate for non-Hispanic white mothers. 3 References: 1 CDC (2008), 2 NCHS (2002), 3 NICHD (2007)
Health Inequities ▪ Systematic and unjust distribution of social, economic, and environmental conditions needed for health Unequal access to quality education, healthcare, housing, • transportation, other resources (e.g., grocery stores, car seats) Unequal employment opportunities and pay/income • Discrimination based upon social status/other factors • Reference: Whitehead M. et al
Examples of Health Inequities Education Infants born to African American mothers with only a high school education were 2.2 times more likely to die in the first year of life compared to their White counterparts. Income Low socioeconomic status is associated with an increased risk for many diseases, including CVH, arthritis, diabetes, chronic respiratory diseases, cervical cancer and frequent mental distress. 1 Access to resources Lower income and racial/ethnic minority communities are less likely to have access to grocery stores with a wide variety of fruits and vegetables. 2,3 References: 1 Pleis, Lethbridge-Cejku (2006), 2 Morland, et al (2002), 3 Baker, et al (2006)
Equality vs Equity ▪ Equality – everyone gets the same thing, equal taxes, equal rights, etc. ▪ Equity – more “real”; focus on outcomes and root structures, and the things that contribute to those outcomes and structures ▪ Key question: how is POWER operating? ▪ What are the positive outcomes we want to see? ▪ “ The Curb Cut Effect ” by Angela Glover Blackwell in Stanford Social Innovation Review , Winter 2017 (see resource list)
Health Equity ◼ The opportunity for everyone to attain his or her 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 Reference: Whitehead M. et al
Comparison of Definitions Health Disparities Health Inequities Health Equity SDOH Differences in the Systematic and The opportunity for Life-enhancing incidence and unjust distribution of everyone to attain resources whose prevalence of health social, economic, his or her full health distribution across conditions and and environmental potential. populations health status conditions needed effectively No one is between groups for health. determines length disadvantaged from based on: and quality of life. achieving this potential • Unequal access to because of his or her quality education, • Race/ethnicity • Food supply social position or other healthcare, housing, • Socioeconomic status • Housing socially determined transportation, other • Sexual orientation • Economic circumstance. resources (e.g., grocery • Gender relationships stores, car seats) • Equal access to • Disability status • Social relationships • Unequal employment quality education, • Geographic location • Transportation opportunities and healthcare, housing, • Combination of these • Education pay/income transportation, other • Health Care • Discrimination based resources upon social status/other • Equitable pay/income factors • Equal opportunity for employment • Absence of discrimination based upon social status/other factors
Intersection of Health, Place & Equity Health facilities Access to Schools/ Healthy Child care Food Health Community Housing Safety/ Violence Environment Equity Parks/Open Transportation Space/ Traffic patterns Playgrounds Work environments Reference: PolicyLink
Maine: the most rural state east of the Mississippi* • “Turn left at the red sawmill sign” • Social isolation, even in urban areas is widespread • Culture built on proud Yankee independence • Weather extremes • Transportation depends on cars • Economic necessity means multiple jobs with few or no benefits • Distrust of government is growing * source: 2010 U.S. Census
Rurality in Maine Aroostook Piscataquis Somerset Penobscot Franklin Washington Hancock Waldo Oxford Knox Lincoln York Sagadahoc Androscoggin Cumberland
Maine – America’s Health Rankings
County Health Rankings Model Health Outcomes Rank Current Health Status- Morbidity & Mortality (5 measures) Health Factors Rank Factors that Affect Future Health Status (30 measures) 20
2019 County Health Rankings Health Outcomes Overall Rank – Maine 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Cumberland 3 3 3 2 3 2 2 1 1 1 Sagadahoc 7 4 1 3 2 1 1 2 2 2 Healthiest Hancock 2 1 2 1 1 3 6 5 5 3 Knox 6 7 5 5 6 6 3 3 3 4 York 5 6 4 4 4 4 4 4 4 5 Oxford 16 16 15 12 10 7 10 10 6 6 Lincoln 4 5 7 11 9 5 5 9 9 7 Kennebec 8 9 9 7 5 8 9 7 7 8 Waldo 9 8 6 10 12 12 8 8 10 9 Franklin 1 2 8 8 8 9 7 6 8 10 10 11 10 9 11 11 12 11 11 11 Penobscot Androscoggin 11 12 11 6 7 13 13 13 12 12 Piscataquis 12 10 13 16 16 15 11 14 14 13 Least Healthy Somerset 14 14 14 15 15 16 14 12 13 14 Aroostook 13 13 12 13 13 14 15 15 15 15 Washington 15 15 16 14 14 10 16 16 16 16 21
Maine County Health Rankings- 2019
Health Outcomes Linked to SES Factors % of adults who reported their physical health % of adults who reported their mental health was not good during 14+ of the past 30 days was not good during 14+ of the past 30 days (2016) (2016) All Adults (18+ y.o.) All Adults (18+ y.o.) Female Female Male Male 18-24 * * 18-24 * 25-34 * 25-34 35-44 35-44 45-54 45-54 55-64 55-64 65-74 65-74 75+ 75+ Less than $15,000 Less than $15,000 $15,000- 24,999 $15,000- 24,999 $25,000- 49,999 $25,000- 49,999 $50,000- 74,999 $50,000 - 74,999 $75,000 or more * $75,000 or more Less than H.S. Less than H.S. H.S. or G.E.D. H.S. or G.E.D. Some post-H.S. Some post-H.S. College graduate College graduate 0% 10% 20% 30% 40% 50% 0% 10% 20% 30% 40% 50% Data source: Behavioral Risk Factor Surveillance System *Not enough responses to calculate an estimate
Poverty Across Maine % of adults & children living in poverty (2012-2016)
Poverty vs. Education Level Across Maine % of adults & children living in poverty (2012-2016)
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