“Understanding Social Determinants
of Health: A Prosperity Strategy”
Renée Branch Canady, PhD, MPA
Ingham County Health Dept.
December 9/10, 2013
• Many of us think that if we want to stay
healthy, we simply need to eat our
vegetables, get our exercise and sleep
and go to the doctor from time to time. But
there are many other factors besides
personal behavior that shape our health.
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• For example, the way your neighborhood
is built can affect your health.
• The condition of your business district can
affect your health.
• Other peoples’ behavior in your
neighborhood can affect your health.
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• Building conditions affect our health.
Whether structural, plumbing…
• Paint…
• … or indoor air quality. Some of us live in
multi-unit dwellings, where a neighbors’
smoke can affect our indoor air quality.
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• Your health might also be different
depending on the view from your
backyard…
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• It might also be different depending on what
school you attend. The picture on the upper left
is of a new, environmentally-friendly certified
school. The picture on the lower right is of a
school in Central Florida built next to the jail.
You can’t tell from the photo which is the school
and which is the jail. The school is referred to by
the locals as the “House of Brats” because of the
high juvenile delinquency rate. Some people
theorize that when you put people in buildings
that look like jails, they might act like inmates.
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• Your health is also affected by the kind of
work you do, and other factors related to
who you are and where you live.
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Learning a New Language…
Health Disparity
“A disproportionate difference in
health between groups of
people.”
By itself, disparity does not
address the chain of events that
produces it.
Health Inequity
“Differences in population health
status and mortality rates that are
systemic, patterned, unfair, unjust,
and actionable, as opposed to
random or caused by those who
become ill.” Margaret Whitehead
I have the audacity to believe that peoples everywhere
can have three meals a day for their bodies, education
and culture of their minds, and dignity, equality, and
freedom for their spirits.
Martin Luther King, Jr.
• Clinical determinants of health
– 1800s black babies
– 1900s black babies
• Social Determinants of Health Inequities
Social Determinants of Health:
the missing link…
Social Structure
Power and Wealth Imbalance
Safe
Affordable
Housing
Living
Wage
Social Determinants of Health
Quality
Education
Transportation
Availability
of Food
Job
Security
Social
Connection
& Safety
Psychosocial Stress / Unhealthy Behaviors
Disparity in the Distribution of Disease, Illness, and Wellbeing
Moving beyond business as usual:
Shifting a Mindset
We must change the way we think about PH
problems
Applying a Health Equity Lens to our
Work
Instead of only asking:
Why do people smoke?
Perhaps we should also ask:
What social conditions and economic
policies predispose people to the
stress that encourages smoking?
Applying a Health Equity Lens to our
Work
Instead of only asking:
Who lacks access to healthy food
options and why?
Perhaps we should also ask:
What policy changes would
redistribute healthy food resources
more equitably in our community?
Applying a Health Equity Lens to our
Work
Instead of only asking:
How can we create more green space, bike
paths, and farmer’s markets in vulnerable
neighborhoods?
Perhaps we should also ask:
What policies and practices by government and
commerce discourage access to transportation,
recreational resources, and nutritious food in
neighborhoods where health is poorest?
Imagining Health…
• My role
• Your role
• Our roles
“The Healthiest Nation”
• What is health? Are we a healthy community/nation?
• Are we a healthy nation? What demonstrates that we are
or are not?
• What would we look like if we were indeed the Healthiest
Nation?
• Do you believe we can do what is needed to improve our
health? If not, what’s stopping us? If so, how do we
proceed?
If you want to build a ship, don't drum up people
to collect wood and don't assign them tasks and
work, but rather teach them to long for the
endless immensity of the sea.
Antoine de Saint Exupery