1. Beyond Healthcare: The role of social determinants in promoting health and health equity
James Plumb MD, MPH
Professor, Family and Community Medicine
Jefferson University and Hospital

4. Commission on Social Determinants of Health

5. WHO Commission on Social Determinants of Health
Closing the gap in a generation
Health equity through action on the social determinants of health
“ Reducing health inequities is, for the Commission, an ethical imperative. Social injustice is killing people on a grand scale”

6. WHO Commission on Social Determinants of Health
Three overarching recommendations
Improve daily living conditions
Tackle the inequitable distribution of power, money and resources
Measure and understand the problem and assess the impact of action

7. WHO 1) Improve daily living conditions Equity from the start
Healthy places, healthy people
Fair employment and decent work
Social protection across the lifespan
Universal health care

8. WHO
2) Tackle the inequitable distribution of power, money and resources
Health equity in all policies, systems and programs
Fair financing
Market responsibility
Gender equity
Political empowerment – inclusion and voice
Good global governance

9. WHO
3) Measure and understand the problem and assess the impact of action
The social determinants of health: monitoring, research, and training
Multilateral agencies
WHO
National and local government
Civil society
Private sector
Research institutions

10. Healthy People 2020

11. Economic Stability Poverty Employment Food Insecurity
Housing Instability

12. Education High School Graduation Enrollment in Higher Education
Language and Literacy
Early Childhood Education and Development

13. Social and Community Context
Social Cohesion
Civic Participation
Discrimination
Incarceration

14. Health and Health Care Access to Health Care Access to Primary Care
Health Literacy

15. Neighborhood and Built Environment
Access to Foods that Support Healthy Eating Patterns
Quality of Housing
Crime and Violence
Environmental Conditions

16. 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
Access to health care services
Quality of education and job training
Availability of community-based resources in support of community living and opportunities for recreational and leisure-time activities
Transportation options
Public safety

17. Examples of social determinants
Social support
Social norms and attitudes (e.g., discrimination, racism, and distrust of government)
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)
Residential segregation
Language/Literacy
Access to mass media and emerging technologies (e.g., cell phones, the Internet, and social media)
Culture

18. Proportion of persons living in poverty
Proportion of children aged 0-17 years living with at least one parent employed year round, full time
Proportion of persons living in poverty
Proportion of households that experience housing cost burden (spend more than 30% of income on housing)
Proportion of high school completers who were enrolled in college the October immediately after completing high school

19. https://www. healthypeople
Proportion of children aged 0-17 years who have ever lived with a parent who has served time in jail or prison
Proportion of persons eligible to participate in elections who are registered to vote
Proportion of high school completers who were enrolled in college the October immediately after completing high school

20. Time to Act http://www.rwjf.org/en/library/collections/commission.html
In 2014, the RWJF released Time to Act, which found that to improve the health of all Americans we must:
Invest in the foundations of lifelong physical and mental well-being in our youngest children
Create communities that foster health-promoting behaviors
Broaden health care to promote health outside of the medical system.

22. Time to Act
1) Make investing in America’s youngest children a high priority.
Create stronger quality standards for early childhood development programs, link funding to program quality, and guarantee access by funding enrollment for all low-income children under age 5 in programs meeting these standards by 2025. 
Help parents who struggle to provide healthy, nurturing experiences for their children.
Invest in research and innovation. Evaluation research will ensure that all early childhood programs are based on the best available evidence. Innovation will catalyze the design and testing of new intervention strategies to achieve substantially greater impacts than current best practices.

23. Time to Act
2) Fundamentally change how we revitalize neighborhoods, fully integrating health into community development.
Support and speed the integration of finance, health, and community development to revitalize neighborhoods and improve health.
Establish incentives and performance measures to spur collaborative approaches to building healthy communities. 
Replicate promising, integrated models for creating more resilient, healthier communities. Invest in innovation.

24. Time to Act
3) The nation must take a much more health-focused approach to health care financing and delivery. Broaden the mindset, mission, and incentives for health professionals and health care institutions from treating illness to helping people lead healthy lives.

25. Time to Act
Adopt new health “vital signs” to assess non-medical indicators for health.
Create incentives tied to reimbursement for health professionals and health care institutions to address non-medical factors that affect health.
Incorporate non-medical health measures into community health needs assessments.

26. SIX WAYS TO TALK ABOUT SOCIAL DETERMINANTS OF HEALTH
Health starts—long before illness—in our homes, schools and jobs.
2 All Americans should have the opportunity to make the choices that allow them to live a long, healthy life, regardless of their income, education or ethnic background.
3 Your neighborhood or job shouldn’t be hazardous to your health.
4 Your opportunity for health starts long before you need medical care.
5 Health begins where we live, learn, work and play.
The opportunity for health begins in our families, neighborhoods, schools and jobs.

31. By thinking broadly and investing strategically, hospitals and health systems can be better partners in solving the most pressing issues in their community.

32. Housing and Hospitals
Hospitals and health systems can implement strategies and programs to improve housing stability, such as neighborhood revitalization, home assessment and repair programs, and care transition programs. This guide recommends a step-by-step pathway for hospitals to consider when developing housing programs