Transcript social determinants of health

Drivers of Health Care in
Hawaii
Hawaii Economic Association
Virginia Pressler, MD, MBA, FACS
Director, Hawaii Department of Health
June 4, 2015
Life Expectancy: A Basic Health Outcome
About 3 years
OECD, World Bank
The US Health Care Return on Investment
OECD, Commonwealth Fund, World Health Organization
Health and Social Spending, Total, % of GDP (2012)
50
45
40
35
30
25
For each $1 in health care,
about $1 is spent on social
services in the US.
20
15
10
For each $1 in health care,
over $2 is spent on social
services, on average in
OECD countries.
5
0
Health
Social
OECD
Hawaii is the Healthiest State in the Country
• Strengths
• Relatively low prevalence of obesity
• Relatively low rate of preventable
hospitalizations
• Relatively low rate of cancer deaths
• Challenges
• High prevalence of binge drinking
• High incidence of infectious disease
• Low immunization coverage among
children
www.americashealthrankings.org
But Disparities Persist…
Rank
County
1
Honolulu (HO)
2
Maui (MA)
3
Kauai (KU)
4
Hawaii (HA)
www.countyhealthrankings.org
Based On Where You Live in Hawaii…
www.healthtrends.org
Your Access to Health Care…
Hawaii Primary Care Data Book, 2012
Other Social Determinants of Health…
County /
Uninsured Rate
(Clinical Care)
Adult Smoking
(Health Behaviors)
Unemployment
(Social & Economic)
Housing Shortage
(Physical
Environment)
Honolulu
7%
15%
4.3%
27%
Maui
9%
15%
5.1%
32%
Kauai
8%
16%
5.7%
28%
Hawaii
10%
19%
6.8%
28%
Especially NH/PI…
Hawaii’s betterthan-average
health status is not
shared by Native
Hawaiian and
Pacific Islander
populations.
5x
3x
2x
The breast cancer
death rate is five times
higher
The colon cancer
death rate is three
times higher
The obesity rate is
twice as high
4x
3x
The heart disease
death rate is four
times higher
The stroke death rate
is three times higher
3x
The suicide death rate
is at least three times
higher
Most chronic diseases are
strongly associated and
causally linked with four
particular risk factors
World Health Organization
Word Cloud from Hawaii’s 2013 Assessment
Healthcare Association of Hawaii
Length of Life
Health Outcomes
Quality of Life
Uninsured rate
Clinical Care
(15%)
Quality of care
Access to care
Tobacco use
Diet & exercise
Health Factors
Health Behaviors
(30%)
Genetic Predisposition
(10%)
Substance use
Sexual activity
Unemployment
Social & Economic
Factors
(40%)
Education
Income
Family & social support
Community safety
Policies and Programs
Physical
Environment
(5%)
Housing & transit
Built environment
Air & water quality
The “social
determinants
of health”
A Hawaii Model for Social Determinants
• Upstream “root causes” are
socio-economic, political and
other factors that influence
living conditions and social
circumstances that support or
impede health
• Downstream results are effects
or outcomes of the root causes.
A New State Health Improvement Plan
Community Health
Needs Assessment
(2013)
Health in All Policies
Public Health, and
Human Services
Private Sector
Private Health Care
System
Individuals and
Families
Chronic disease and
health risk behavior
drive poor outcomes
Sugar Sweetened
Beverage tax
Behavioral health and
chronic disease
integration
Establish corporate
culture of health and
wellness
Pay-for-Quality
Improved family
health literacy
Certain groups and
places are impacted
disproportionately
Safe Routes to School
policies
Implement SNAP
bonus for fruits and
vegetables
Food Desert
distribution and retail
reform
Hospital Community
Benefit Planning
Improved family
planning behaviors
Cultural and language
barriers inhibit
interventions
Adopt and enforce
CLAS standards
Certify medical
interpreters
Corporate diversity
education programs
Reimburse
Community Health
Workers
Healthy ethnic recipes
and substitutes
Limited access to care
or healthy alternatives
Worksite Wellness
program incentives
Expand telehealth
infrastructure
Healthy workplace
eating and vending
policies
Health information
exchange
Chronic disease selfmanagement program
participation
Community-based
solutions are key
assets
Reintroduce
nutritional education
and physical
education
School health
integration
Participate in Blue
Zone initiatives
FQHC/DOE schoolbased sealants project
Establish ethnic
community gardens
Root Causes
Public Policy
Collaboration
Improved Outcomes
Public Health Milestones in Hawaii
Outbreaks of
plague, small pox,
tuberculosis, etc.
Public health
nursing established,
TB sanitoriums,
plantation health.
Pre-Paid Health
Care Act
Plantation housing
and sanitation
standards
Statehood
www.healthtrends.org
The Department At A Glance
• Four Administrations
• General Administration, Behavioral Health, Environmental Health, Health
Resources
• Attached Agencies
• Aging, Health Planning, Disabilities Advocacy, Environmental Quality,
Language Access, Hawaii Health Systems Corporation
• Approximately 2,500 employees and $890,000,000 budget
General Powers and Duties
• Section 321-1, Hawaii Revised Statutes: (a) The department of
health shall have general charge, oversight, and care of the health and
lives of the people of the State, and shall pursue as a goal, the
achievement of health equity. The department shall consider social
determinants of health in the assessment of state needs for health.
• The mission of the Department of Health is to protect and improve
the health and environment for all people in Hawai‘i.
• Over 2,500 employees, 75 programs, and $890M budget
Resources
• http://www.hawaiihealthmatters.org/
• http://www.healthyhawaii.com/
• http://www.hhdw.org/
• http://health.hawaii.gov/physical-activity-nutrition/choose-healthynow/
• http://hah.org/reports-data/hah-reports/
Mahalo for Contributing to
Our Community’s Health