1. “Targeting the Social Determinants of Health” Atlanta, GA March 7, 2013 David Satcher, M.D., PhD. Director, The Satcher Health Leadership Institute and The Center of Excellence on Health Disparities Poussaint-Satcher- Cosby Professor of Mental Health Morehouse School of Medicine 16th U.S. Surgeon General Urban Health Disparities Summit Shaping Action to Reduce Disparities Georgia State University

2. Satcher Health Leadership Institute Mission The mission of the Satcher Health Leadership Institute (SHLI) is to develop a diverse group of exceptional health leaders, advance and support comprehensive health system strategies, and actively promote policies and practices that will reduce and ultimately eliminate disparities in health. www.satcherhealthleadershipinstitute.org

3. “ Today, the need for leaders is too great to leave their emergence to chance.” “ Today, the need for leaders is too great to leave their emergence to chance.” Institute of Medicine Report, 1988

4. L EADERSHIP L ESSONS F ROM THE S ATCHER H EALTH L EADERSHIP I NSTITUTE Leadership Responds to Opportunities, Challenges and Crises Leadership Responds to Opportunities, Challenges and Crises Leadership is a Team Sport Leadership is a Team Sport Leadership is Not Position Dependent Leadership is Not Position Dependent Effective Leadership Transforms communities Effective Leadership Transforms communities Leadership Requires a Global Perspective Leadership Requires a Global Perspective Leadership is like a Relay Race Leadership is like a Relay Race

5. Reports of the 16 th Surgeon General Reports of the 16 th Surgeon General Best available science

6. H EALTHY P EOPLE 2010: O VERARCHING G OALS Increase Years and Quality of Healthy Life Eliminate Racial and ethnic Health Disparities

7. HEALTH DISPARITIES H EALTHY PEOPLE 2010 DEFINITION  Differences that occur in health by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation.

8. Infant Mortality Rates By Race and Hispanic Origin, 1999 Infant deaths per 1,000 live births Disparities: Infant Mortality

9. D ISPARITIES : C ARDIOVASCULAR D ISEASE

10. A GE - ADJUSTED TOTAL PREVALENCE OF DIABETES IN PEOPLE AGED 20 YEARS OR OLDER, BY RACE / ETHNICITY — U NITED S TATES, 2002 Source: 1999-2001 National Health Interview Survey and 1999-2000 National Health and Nutrition Examination Survey

11. W HAT I F W E H AD E LIMINATED D ISPARITIES IN THE L AST C ENTURY ? Fewer Black Deaths… In 2000 83,500 overall 24,000 from heart disease 24,000 from heart disease 7,000 from HIV / AIDS 7,000 from HIV / AIDS 4,700 infant deaths 4,700 infant deaths 22,000 from diabetes 22,000 from diabetes 2000 fewer Black women from breast cancer 2000 fewer Black women from breast cancer More Health Insurance Coverage… 2.5 million Blacks, including 620,000 children 2.5 million Blacks, including 620,000 children Source: D. Satcher et al, Health Affairs, March/April 2005

12. W HAT IF WE WERE EQUAL ? Source: D. Satcher et al, Health Affairs, March/April 2005

13. Difference in Child Mortality Rate Changes Under-five mortality rate by region Source: UNICEF 2001

14. CSDH: Fig. 2.2 Under-5 Mortality Rate Per 1000 Live Births by Levels of Household Wealth Source: Gwatkin et al. (2007), using DHS data; WHO Commission Final Report, 2008.

15. Determinants of Health Source: Healthy People 2010

16. Fig. 4.1 D. Satcher, R. Pamies, F. Dunston 2006 Community Factors Associated with Racial and Ethnic Health Disparities Environmental toxins Alcohol or drug addition Substandard education Violence Poverty Substandard housing Poor Health Outcomes

17. H EALTHY P EOPLE 2020: O VERARCHING G OALS Attain high quality, longer lives free of preventable disease, disability, injury, and premature death Achieve health equity, eliminate disparities, and improve the health of all groups Create social and physical environments that promote good health for all Promote quality of life, healthy development, and healthy behaviors across all life stages

18. W HAT ARE THE SOCIAL DETERMINANTS OF HEALTH ? The conditions in which people are born, grow, live, work and age. They are shaped by the distribution of money, power and resources at global, national and local levels. Changes in the Social Determinants of Health often require policy changes.

19. HEALTH DISPARITIES & THE AFFORDABLE CARE ACT  Preventive care  Coordinated care  Diversity and cultural competency  Health care providers for underserved communities  Ending insurance discrimination  Affordable insurance coverage

20. NATIONAL PREVENTION STRATEGY  Establish the National Prevention, Health Promotion and Public Health Council to coordinate federal prevention, wellness, and public health activities.  Establish a Prevention and Public Health Fund for prevention, wellness, and public health activities.  Establish a grant program to support the delivery of evidence-based and community-based prevention.

21. L IFESTYLE I NDICATORS AND THE 16 TH S URGEON G ENERAL ’ S R X

22. “In order to eliminate disparities in health, we need leaders who care enough, know enough, will do enough and are persistent enough.” “In order to eliminate disparities in health, we need leaders who care enough, know enough, will do enough and are persistent enough.”

23. “Targeting the Social Determinants of Health” Atlanta, GA March 7, 2013 David Satcher, M.D., PhD. Director, The Satcher Health Leadership Institute and The Center of Excellence on Health Disparities Poussaint-Satcher- Cosby Professor of Mental Health Morehouse School of Medicine 16th U.S. Surgeon General Urban Health Disparities Summit Shaping Action to Reduce Disparities Georgia State University