Health Equity and Social Determinants of Health

1. Health Equity and Social Determinants of Health Jennifer Weitzel, MS, RN Public Health Madison & Dane County Original presentation by: Paula Tran Inzeo, MPH, PhD Candidate

2. Overview • Health Equity • What does it mean? • Why does it matter? • Healthiest WI 2020 • Wisconsin Center for Health Equity • What can be done?

3. WHAT MAKES US HEALTHY? (Robert, Booskee, Rigby, & Rohan, 2008)

4. America leads the world in medical research and medical care • For all we spend on health care, we should be the healthiest people on Earth

5. $186/ person 76.9 yrs, ranked 28th $3,300/ person $4,500/ person 77 yrs, ranked 27th 2000, UC Atlas of Global Inequality http://ucatlas.ucsc.edu/spend.php

7. Access to healthy food, exercise/recreation, liquor stores, fast food, crime Providers, quality of care, trust, insurance Socioeconomic Factors ~ 40% of Health Outcomes Where you live and work

9. Working-Age adults

10. HEALTH EQUITY IS NOT ONLY… • Health Disparities: any differences in health outcomes between groups of people • Male babies are generally born at a heavier birth weight than female babies  • Health Inequities: differences in health outcomes between groups of people that are considered preventable or unfair • Babies born to Black women are more likely to die in their first year of life than babies born to White women ASTHO, 2000

11. HEALTH EQUITY, a Vision • “Fairness in the distribution of resources and the freedom to achieve healthy outcomes between groups with differing levels of social status” • Health should not be compromised or disadvantaged because of an individual or population group’s race, ethnicity, gender, income, sexual orientation, neighborhood or other social condition. ASTHO, 2000

12. Principles of Health equity • Health equity is a cross-cutting broad issue associated with fundamental social values and well-being • Health equity is connected to all aspects of public health work and the most basic influences on the health of populations • Working to achieve health equity requires multidisciplinary approaches and a more holistic, comprehensive view of health and coordinated strategies (Troutman, 2009)

13. Health Equity as a Development outcome • The development of a society can be judged by: • The quality of its populations’ health • The fairness in the distribution of health • The degree of protection provided from disadvantage due to ill-health

14. HEALTH EQUITY IS GOOD FOR THE ECONOMY • Costs between 2003-2006 • Combined costs of health inequities and premature death in the U.S.= $1.24 trillion • 30.6% of direct medical care expenditures for people of color were EXCESS costs due to health inequities • Raising the health of all Americans to that of college educated Americans would result in annual gains of over $1 trillion worth of increased health • Healthy workforce = productive workforce. • Raising the health status of employees has a positive impact on individual companies and the economy as a whole (HHS 2011) LaVeist, Gaskin, and Richard, 2009; Dow and Schoeni, 2008

15. “International consensus that health is neither created nor maintained solely within the health sector”

16. Shifting from consequences to root causes • Race, • Class, • Gender, • Disability • Sexual Orientation • Immigration

17. SOCIAL CONDITIONS • Social Determinants of Health (Social and Economic Factors) • Circumstances shaped by distribution of money, power, and resources • All levels: local, state, national, global • Drive health inequities • Where one is born, lives, learns, works, and plays matters (Marmot, 2008) • Unemployment • Stress • Early life • Social exclusion • Work life • Social support • Food • Transport

18. Root Causes Social Determinants

23. Wisconsin Center for Health Equity (WCHE) • Statewide focus • Founded in 2006 by the Milwaukee Health Department • Collaboration with WPHA since 2009 • Strong partnerships • Emphasis on social justice

24. Wisconsin Center for Health Equity • Aims to improve social and economic conditions that influence health through three main strategies: • Education • Policy makers and the general public • Policy Development • Partnerships to improve community civic capacity

25. Take action • Educate public, other professionals, elected officials and the media about what makes a healthy community: Health is beyond the doctor’s office.

26. Take action • Support policies that will create healthier communities • Remember: • education policy is health policy; • economic policy is health policy; • child-care policy is health policy; • housing policy is health policy; • transportation policy is health policy. Harvard Epidemiolgist David WIlliams

27. Take action • Analyze policies that come before you for the potential health impact (both positive and negative), paying close attention to inequitable impacts.

28. Thank you!Question/Comments/Resources Jennifer Weitzel, MS, RN Public Health Madison & Dane County jweitzel@publichealthmdc.com Geof Swain, MPH, MD Chief Medical Officer and Medical Director City of Milwaukee Health Department Gswain@milwaukee.gov Raisa Koltun, PharmD, MPH Associate Director, WI Center for Health Equity Rkoltun@wche.org

29. References • Jones, C. (2009). Social determinants of health and equity: the effects of racism on health [PowerPoint slides]. Retrieved from: http://www.slideshare.net/vahealthequity/social-determinants-of-health-and- equity-the-impacts-of-racism-on-health • MacDorman, M., & Mathews, T.J. (2009). Behind international rankings of infant mortality: how the United States compares with Europe. Retrieved from: www.cdc.gov/nchs/data/databriefs/db23.htm • Organisation for Economic Co-operation and Development. (2008). Per capita total current healthcare expenditures, U.S. and selected countries. Retrieved from: www.oecd.org/health/healthdata • Robert, S.A., Booske, B.C., Rigby, E., & Rohan, A. (2008). Public views on determinants of health, interventions to improve health and priorities for government. Wisconsin Medical Journal 107(3) p. 124-130. • Troutman, A. (2009). Creating health equity; social justice human rights and the social determinants of health [PowerPoint slides]. Retrieved from: http://www.slideshare.net/unitedwaypdx/social-determinants-of-health-dr- adewale-troutman