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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 5 Georgia’s Health Ranking Among States: 2010 2010 Rank 28 2008 Rank 40 2007 Rank 38 2003 Rank 36 High School Graduation (Percent of incoming 9th graders) 45 48 48 49 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) 47 40 46 47 41 50 46 40 50 46 37 47 44 41 40 37 41 40 40 40 43 41 43 - DETERMINANTS - Personal Behaviors Prevalence of Obesity (Percent of population) DETERMINANTS - Community and Environment 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) 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 Physical Environment Economic Environment Service Environment Social Cohesion & Trust Housing & Neighborhood Conditions Employment Health & Human Services Collective Efficacy Transportation Home Ownership Public Safety & Emergency Services Civic Engagement HEAL Promoting Structures Local Business Development Education Cultural Characteristics & Norms Natural Resource Quality Product Availability 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 = insufficient evidence 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 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 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 3rd graders at-level in math & English language arts – 97% of 8th graders at-level in math • vs 7% avg for Black 8th 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 • Individual Providers • Incentives for Collaboration • Change the System/ Policy/Environment Opportunities for Leverage Strategic Alignment Triple-Layer Chess National State Local Visit www.gsu.edu/ghpc or follow us on Facebook for more information and resources.