1. Social Determinants of Health: New approaches & new solutions
Douglas Jutte, MD, MPH
Healthier Kids Foundation
4th Annual Symposium
May 29, 2014

2. Started out as a regular pediatrician.

3. Defining Health
Health
Health Care

4. Health Health Care Medical Care
Defining Health
Health
Health Care
Medical Care

5. Contributions to premature death
Environmental Exposure 5%
Health Care
10%
Social Circumstances
15%
Behavioral Patterns
40%
Genetic Predisposition
30%
We focus nearly all of our efforts on a very small piece of the health pie.

6. Health and Community Development
9.9.13

7. SOCIAL DETERMINANTS Of health
Talk about SDOH being what EPA residents deal with. Where you live, learn, work & play.
THEN talk about toxic stress – lack of control.
Then talk about it getting under the skin and actually influencing your biology!!! Immune system, stress response, brain development
Source:

8. Toxic Stress & Neuro- development
Talk about SDOH being what EPA residents deal with. Where you live, learn, work & play.
THEN talk about toxic stress – lack of control.
Then talk about it getting under the skin and actually influencing your biology!!! Immune system, stress response/inflammation, brain development

9. Socioeconomic gradient in health

10. Health disparities Global Life Expectancies

11. Health disparities Short distances: Large Differences Washington, DC
Babies born to mothers in Maryland’s Montgomery County and Virginia’s Arlington and Fairfax Counties can expect to live six to seven years longer than babies born to mothers in Washington, D.C.—just a few subway stops away.
Source: Robert Wood Johnson Foundation, Commission to Build a Healthier America

12. Health disparities Short distances: Large Differences New orleans
The average life expectancy for babies born to mothers in New Orleans can vary by as much as 25 years across neighborhoods just a few miles apart.
Treme neighborhood next to the French Quarter
Source: Robert Wood Johnson Foundation, Commission to Build a Healthier America

13. Health disparities Short distances: Large Differences Minneapolis – St
Health disparities Short distances: Large Differences Minneapolis – St. Paul
Source: Robert Wood Johnson Foundation, Commission to Build a Healthier America

14. In Determining Your health…
95117

15. Community development is in the zip code improvement business
The biggest margin of improvement is to do this for those with the most challenge.
WE CAN INCREASE OPPORTUNITIES FOR ALL AMERICANS

16. Pruitt-Igoe, St. Louis, MO
Community development PAST
Pruitt-Igoe, St. Louis, MO
1956 to 1972

17. Affordable Housing & Supportive Housing

18. Small business & community infrastructure

19. COMMUNITY DEVELOPMENT ATTACKS THE CORROSIVE EFFECTS OF POVERTY THAT LEAD TO POOR HEALTH & REDUCED LIFE CHANCES
Gulfton-Sharpstown neighborhood in Houston, TX
One of the city’s poorest, with a 26.7% poverty rate and 52.4% of benchmarked median family income.
Founded in 1907, Neighborhood Centers, Inc. is the largest not-for-profit organization (in terms of total income) in Houston, TX.
Through 58 strategically located centers and educational facilities, the organization serves more than 400,000 neighbors across a 46-county region in Texas. By working hand-in-hand with the residents of underserved neighborhoods, Neighborhood Centers helps them discover and develop the necessary strengths and skills to become productive, self-sufficient individuals.

20. The status quo is stupid and expensive
WE SPEND MONEY ON THE WRONG THINGS
PRISON vs
PRESCHOOL
SPECIAL EDUCATION vs
TUTORS
Putting a teen in Riker’s Island isn’t as expensive as a year at Harvard. It’s 3X as expensive.
We spend a ton of money on the poor but on the wrong things – prison, special education, emergency room visits, police – and could be spending THE SAME AMOUNT OF MONEY on preschool, tutors, summer camps, job training, etc) that gets us a much better outcome.
Tell Len Syme parable.
EMERGENCY ROOM VISITS vs
SUMMER CAMPS
POLICE vs
JOB TRAINING

21. Community Development and health Work Side-by-side

22. Community development and health Could be a powerful team…
We can save money in health care if we do more investment in community development.
Right now there is not enough overlap

23. …but we need more coordination & integration
COMMUNITY
DEVELOPMENT
HEALTH

24. And we need more partners
PUBLIC SAFETY
EDUCATION
COMMUNITY
DEVELOPMENT
HEALTH
This movement is much bigger than just that.  Improving health is an all hands on deck activity that will require the integration of not just community development and health but also education, public safety, economic development, community empowerment, etc.  (an emphasis here is that “place based approaches” such as community development must better coordinate with “people based approaches” such as education and social support services).
ECONOMIC
DEVELOPMENT
COMMUNITY
EMPOWERMENT

25. It requires all hands on deck
PUBLIC SAFETY
EDUCATION
COMMUNITY
DEVELOPMENT
HEALTH
This movement is much bigger than just that.  Improving health is an all hands on deck activity that will require the integration of not just community development and health but also education, public safety, economic development, community empowerment, etc.  (an emphasis here is that “place based approaches” such as community development must better coordinate with “people based approaches” such as education and social support services).
ECONOMIC
DEVELOPMENT
COMMUNITY
EMPOWERMENT

26. New ideas New partners New Resources

27. RWJ Foundation’s Commission to build a healthier America
Focus on early childhood
Integrate community development & health
Bridge health & health care

28. Community Quarterbacks
Investing in what works for america’s communities
whatworksforamerica.org
Community Quarterbacks

29. Community Quarterback
Eastlake: Little Vietnam because it was a war zone
1400 extremely low income residents  2100 mixed income
13% employment  70% employment
Schools worst in metro area  4th best in metro area

30. Focus on 3 things: education, housing & public safety,
It is a health return on investment
PB is not just community coordinators, but health coordinators. All without a single clinic
Tackling such complex, deeply rooted issues as intergenerational poverty, unsafe environments, high crime, and failing schools presents many challenges. A coordinated holistic approach based on quality and focused on sustainability is the basis for the Purpose Built Communities model.

31. Social entrepreneurship & impact investing
City Health Works in NYC
June 25-26th, 2014
New York City

32. Pay for success models & social Impact bonds
Bridge loans from investors to social service agencies
Social savings to the government are shared with the investors as a Return on Investment or ROI
Outcomes include: Juvenile recidivism, Special education, Asthma
Google: “Federal Reserve”
& “Pay For Success”

33. Build Healthy Places Network
BUILDHEALTHYPLACES.ORG

34. Bright eyes

35. Social Determinants of Health: New approaches & new solutions
Douglas Jutte, MD, MPH School of Public Health, University of California, Berkeley