Social Determinants of Health

1. Ginger Mckay and Binh Le Social Determinants of Health

2. Social Ecological Model

3. History of the Ecological Transition Early 1900s, the leading causes of death were TB, pneumonia and diarrheal diseases The 1940s, the leading causes of death were heart disease, cancer, and accidents Between 1900 and 1950, 20 years added to life expectancy Rejection of single cause of disease Public health focuses on social environment

4. Social Ecological Model (Stokols, 1995) Based on the broad overarching paradigm that bridges different fields of research The interrelations of the environment with human behavior and its contribution to overall health - Wholism Health not limited to environment, can include genetics, psychological dispositions and behavioral patterns

5. Social Ecological Model - Continued (Stokols, 1995) Incorporates ideas from systems theory to understand the relationships between people and their environments The interdependence of environmental conditions within certain settings Interdisciplinary in the approach to research and development of promotion programs

6. How is it Different? (Stokols, 1995) Degree of fit between people’s biological, behavioral, and sociocultural along with resources Integrate behavioral and environmental strategies Incorporate active and passive interventions across individual, organizational, and community levels

7. Guidelines for Social Ecological Principles (Stokols, 1995) Multifaceted nature of environmental influences Intrapersonal and environmental factors Person-environment fit and perceived environmental controllability Identify behavioral and organizational “leverage points” Interdependencies among a person’s settings and domains Integration of perspectives in the design of health promotion programs

8. Creating Nurturing Environments (Komro, Flay, & Biglan, 2011) • Overall poverty rate in US is 14.3% • Single-parent – 29.9% • African-Americans – 25.8% • Hispanics – 25.3% • Central cities – 18.7% • Risks for child development and health • Mental, emotional, and behavioral disorders • Challenging school environments • Earning a high school diploma can open the doors to new opportunities

9. The Harlem Children’s Zone

10. Harlem Children’s Zone (Komro, Flay, & Biglan, 2011) Network and Strategies: Parenting classes Pre-kindergarten programs Charter schools Afterschool programs Transition to college Tenant and block associations

11. Harlem Children’s Zone

12. Harlem Children’s Zone http://www.youtube.com/watch?v=7SYwR4yuv3A

13. Promise Neighborhoods (Komro, Flay, & Biglan, 2011) HCZ funded these neighborhoods and communities working to improve the outcomes of children living within distressed neighborhoods will benefit from assistance in framing, selecting, and implementing evidence-based and efficient strategies.

14. Creating Nurturing Environments (Komro, Flay, & Biglan, 2011)

16. THE THEORY OF TRIADIC INFLUENCE Levels of Causation Ultimate CULTURAL SOCIAL BIOLOGY/ Causes ENVIRONMENT SITUATION PERSONALITY 1 2 3 4 5 6 a f Social/ Personal Nexus c d e b Sense of Information/ Interpersonal Others’ Social Interactions w/ Self/Control Opportunities Bonding Beh & Atts Competence Social Instit’s Distal Influences 7 8 9 10 11 12 g r p i q h k n m l j o Expectancies & Evaluations Self Skills: Motivation Perceived Values/ Knowledge/ Determination Social+General to Comply Norms Evaluations Expectancies 13 14 15 16 17 18 s x ATTITUDES SOCIAL SELF-EFFICACY u w v t Affect and Cognitions TOWARD THE NORMATIVE BEHAVIORAL BEHAVIOR BELIEFS CONTROL Proximal 19 20 21 Predictors Decisions A G B H C I D E F 22 K Experiences 23 Related Behaviors J Intrapersonal Stream Social/Normative Stream Cultural/Attitudinal Stream Biological/Nature Nurture/Cultural DECISIONS/INTENTIONS Trial Behavior EXPERIENCES: Expectancies -- Social Reinforcements -- Psychological/Physiological 16

17. Social Determinants

18. Social Determinants (Beckfield and Krieger, 2009) “Contextual factors such as political systems and government policies drive population health and health inequities.”

19. Social Determinants • In addition to political systems: • Economic systems • Social institutions (public schooling, Medicare) • Physical Environment (built environment) • Social Environment (culture, war, racism)

20. Social Determinants Hurricane Katrina, 2005 And of course, these can work in tandem.

22. Health Inequity Also called health disparity Social determinants create inequities because populations are effected differently We can see this both on a local and a global scale

23. Health Inequity on a Global Scale http://www.youtube.com/watch?v=jbkSRLYSojo

24. Food Deserts Source: USDA Food Atlas, 2012

25. Poverty Source: USDA Food Atlas, 2012

26. Food Assistance Source: USDA Food Atlas, 2012

27. Activity Level Source: USDA Food Atlas, 2012

28. Health Outcomes Source: USDA Food Atlas, 2012

29. Closing the Gap – the move toward health equity Population level interventions Challenge: Where is our focus?

30. Health Equity Source: WHO, 2008 • The WHO provides 3 ways to focus: • Improve Daily Living Conditions • Tackle the Inequitable Distribution of Power, Money, and Resources • Measure and Understand the Problem and Assess the Impact of Action

31. Are these realistic goals???

32. Healthy Public Policy Primary & Secondary Prevention / Treatment Primary & Secondary Prevention / Treatment Levels of Causation for Health Levels of Causation Interventions Environmental Influences Social Position Organization & Community Interventions Social & Cultural Processes Primary & Secondary Prevention Psychological Processes Biological & Genetic Factors from McKinlay & Marceau (2000). Public health matters. Am J Pub Hlth, 90, 25-33, p. 29.

33. Movements where health promotion has been involved: Anticorporate movement Green movement Organic movement

34. Policy Development and Advocacy What is the role of public health in policy? Is there a role for public health practitioners in advocacy?