1. Determinants of Health Catalysts Towards Community Health June 2, 2008

3. Biological Determinants Genes: much to learn Immunities or disposition Varying estimates of “nature”- effect on longevity. Age

4. US Mortality by Age Source: National Center for Health Statistics,CDC: 2005 (per 100,000)

5. Health Care Determinants CDC estimates that 10% of premature mortality is due to inadequate health care. 98% of health $$$ are for health care instead of prevention. Increasing differences in access based on deductibles, co-pays, etc. Lower access to tests, specialty care for low income patients.

6. Environmental Determinants Biochemical effects (lead paint, diesel fumes.) Often overlooked rural-based pollutants New interest in the effects of the “Built Environment”: the use, layout & design of a community’s physical structures –Urban: high crime and traffic –Suburban: pedestrian “unfriendly” –Rural: ?

10. Behavioral Determinants Tobacco (400,000 deaths) Nutrition and Physical Activity (325,000) Alcohol (85,000) Violence What is the origin or cause of behavior? Source: Mokdad, et. al. JAMA

11. Cigarette Smoking by Education

12. Physical Activity Blacks (19%), Hispanics (24%) and Asians (38%) less likely to engage in physical activity than Whites. Men 30% more likely than women. Married individuals 19% less likely than single individuals.

13. Physical Activity/Nutrition Source: USDA, 2006

14. Social Determinants Gender Race Marital status Physical abilities (also biological) Education

15. U.S. Mortality by Gender Source: National Center for Health Statistics, CDC, 2005 (per 100,000)

16. U.S. Mortality by Race National Center for Health Statistics, CDC, 2005 (per 100,000)

17. Social Determinant: Education Source: National Health interview Survey,2001-05 Robert Wood Johnson Foundation, 2008

18. Education and Mortality

19. Parent Education and Children’s Health

20. “The Big Sort” Social and geographic segregation People have migrated to socially isolated areas. Divided by race, income, social perspectives. Possible adverse health effects?

22. Economic Determinants Intersection between social (e.g. job) and economic (income) determinants is fuzzy. Concept of “social class” is less accepted here. Social status is more than income, though income is an important determinant. “Status Syndrome” (Marmot)

23. Premature mortality by Income

24. Health and Wealth

25. Income Gap Widens

27. Income Changes

28. Effects of Disparities Complex relationship between determinants and outcomes. Some “determinants” are likely outcomes of others. Parental income associated with educational attainment and health of child. Low education associated with high tobacco use. Tobacco use associated with…..

29. Social effects of Disparities Discrimination? Stress? Low self-esteem? High-risk behaviors ??