1. Barriers to Health Equity: Social Determinants: Why should we care? LISA K. STATEN, PHD MAY 2, 2016

2. Activity

3. Source: County Health Rankings; Income data from U.S. Census Bureau’s Small Area Income and Poverty Estimates (SAIPE)

4. Overview  What do we mean by social determinants of health and how does that connect to place  Explore some evidence linking place to health  Discuss how social determinants can be addressed in the clinical setting.  Share Health Leads as one example.

5. Upstream vs Downstream Approaches

6. WHO Definition – Social Determinants “The social determinants of health are 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.”

7. http://www.cdc.gov/nchhstp/socialdeterminants/faq.html#c

8. SOURCE: RWJF (2009). Prepared for the Robert Wood Johnson Foundation by the Center on Social Disparities in Health at the University of California, San Francisco. © 2008 Robert Wood Johnson Foundation. www.commissiononhealth.org. Cited in: IOM (2012).www.commissiononhealth.org

9. Life Expectancy

10. A Short Distance to Large Disparities in Health: Washington, D.C.

11. How does Indiana life expectancy compare? Weathers TD, Leech TGJ, Staten LK, Adames EA, Colbert JT, Comer KF (2015) Worlds Apart: Gaps in Life Expectancy in the Indianapolis Metro Area. Available from the SAVI Community Information Systems at: www.savi.org. www.savi.org

12. Weathers TD, Leech TGJ, Staten LK, Adames EA, Colbert JT, Comer KF (2015) Worlds Apart: Gaps in Life Expectancy in the Indianapolis Metro Area. Available from the SAVI Community Information Systems at: www.savi.org. www.savi.org

13. Why do these differences exist?

14. Examples of social determinants  Availability of resources to meet daily needs (e.g., safe housing and local food markets)  Access to educational, economic, and job opportunities  Quality of education and job training activities  Language/Literacy  Access to health care services  Availability of community-based resources in support of community living and opportunities for recreational and leisure-time  Public safety  Transportation options  Access to mass media and emerging technologies (e.g., cell phones, the Internet, and social media)  Culture HP 2020

15. Examples of social determinants (cont)  Social support  Social norms and attitudes (e.g., discrimination, racism, and distrust of government)  Residential segregation  Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of cooperation in a community)  Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it) HP 2020

16. Education

18. SOURCE: Braveman (2010) in IOM (2012).

19. Role of CHCs in Addressing Social Determinants Roots of Community Health Centers ◦Dr. Jack Geiger ◦Founded first two Community Health Centers ◦Bolivar County, Mississippi ◦Columbia Point Public Housing Project in Boston, MA, ◦Not only provided medical care but considered social determinants important aspects of medical care ◦Access to healthy food, poverty, unemployment, malnutrition, and environmental health issues. ◦http://wearepublichealthproject.org/interview/jack-geiger/http://wearepublichealthproject.org/interview/jack-geiger/

20. What are we doing to address social determinants?

21. Possibilities  Integration into electronic medical records  Community Health Worker programs  What else?

22. Health Leads ONE EXAMPLE OF HOW TO ADDRESS SOCIAL DETERMINANTS IN A CLINICAL SETTING

23. Health Leads – Better Health One Connection at a Time Connect patients to services through Health Advocates Recruit and train undergraduate college students as Health Leads Advocates Sites ◦Baltimore, Boston, Chicago, New York, Providence, Washington, DC TED MED – Rebecca Onie – CEO http://blog.tedmed.com/?p=3854http://blog.tedmed.com/?p=3854 https://healthleadsusa.org/

25. Outcomes Robert Wood Johnson Foundation has invested $6.5 million. CEO has received numerous awards including the MacArthur Fellow and New Frontier Award. Harriet Lane Clinic, Johns Hopkins Children’s Center ◦1059 families in 2.5 years ◦Mean of 2.1 needs identified (employment, housing, child care, health insurance, food) ◦50% enrolled in at least one service within 6 months ◦85% providers received an update from HL volunteers Additional research still needed to assess health outcomes.

26. Wrap up

27. How does your socioeconomic status influence the life of your children?

28. Paper color - White In the Trash can – (Pink Card)  Upper SES  Parents both college graduates  Parents both employed full-time  Parents married  Birthweight – 7 lbs, 3 oz ( 39 weeks) Not in Trash can – (Green card)  Upper SES  Parents both college graduates  Father employed, mother not employed  Parents Married  Birthweight – 8 lbs, 4 oz (38 weeks)

29. Beige or Blue in Trash Can (Purple) Middle or lower SES Mother some college, father completed vocational training Parents – Divorced Mother works full-time and part-time job Birthweight – 6 lbs, 3 oz. (38 weeks)

30. Not in Trash Can Beige - (Yellow card)  Middle to low SES  Parents’ education – mother GED, father unknown  Mother employed part-time  Parents not married  Birthweight 6 lbs 3 oz (36 weeks) Blue paper – (Blue card)  Low SES  Parents’ education – high school grads  Mother – unemployed  Father – incarcerated  Parents not married  Birthweight – 3 lbs, 5 oz (26 weeks)

32. Wrap up: Why should we care? Making the Connections: Our city, our society, our healthMaking the Connections: Our city, our society, our health

33. Questions/ Thoughts? CONTACT INFORMATION: LISA STATEN LKSTATEN@IU.EDU