Social Determinants of Health
Equity and Levels of Potential
Impact in the System:
Opportunities for Leverage
Karen J. Minyard, Ph.D.
Executive Director
Georgia Health Policy Center
Georgia State University
Georgia Health Policy Center
A Research Center at Georgia State University
• Provides evidence-based research,
program development, and policy
guidance locally, statewide, and
nationally
• Focuses on solutions to the most complex issues facing health
care today including: insurance coverage, children’s health,
health care reform, and the development of urban and rural
health systems
• Works in more than 200 communities across the U.S.
Health
How Healthy Are Georgians?
Health Status by County
5
Georgia’s Health Ranking Among States: 2010
2010
Rank
28
2008
Rank
40
2007
Rank
38
2003
Rank
36
High School Graduation (Percent of incoming 9th graders)
45
48
48
49
Infectious Disease (Cases per 100,000 population)
Children in Poverty (Percent of persons under age 18)
Air Pollution (Micrograms of fine particles per cubic meter)
47
40
46
47
41
50
46
40
50
46
37
47
44
41
40
37
41
40
40
40
43
41
43
-
DETERMINANTS - Personal Behaviors
Prevalence of Obesity (Percent of population)
DETERMINANTS - Community and Environment
DETERMINANTS - Public and Health Policies
Lack of Health Insurance (Percent without health
insurance)
HEALTH OUTCOMES
Infant Mortality (Deaths per 1,000 live births)
Cardiovascular Deaths (Deaths per 100,000 population)
Factors Influencing Health Status
Schroeder, Steven A., We Can Do Better -- Improving the Health of the American People, N Engl J Med 2007 357: 1221-1228
Social Determinants
of Health Equity
Health Disparities
The unequal burden
in disease morbidity and mortality rates
experienced by ethnic/racial groups
as compared to the dominant group.
Source: Healthy People 2010, US HHS, 2000
Social Determinants of Health
The conditions in which people
are born, grow, live, work and age,
including the health system.
These circumstances are shaped by
the distribution of money, power and resources
at global, national and local levels,
which are themselves influenced
by policy choices.
Source: World Health Organization, 2008
Community-Level Determinants of Health Equity
Social
Environment
Physical
Environment
Economic
Environment
Service
Environment
Social Cohesion &
Trust
Housing &
Neighborhood
Conditions
Employment
Health & Human
Services
Collective Efficacy
Transportation
Home Ownership
Public Safety &
Emergency
Services
Civic Engagement
HEAL Promoting
Structures
Local Business
Development
Education
Cultural
Characteristics &
Norms
Natural Resource
Quality
Product
Availability
Community-based
Organizations
Aesthetics
Cultural/Artistic
Opportunities
Source: Grantmakers in Health, 2009; Institute of Medicine, 2008; PolicyLink, 2002; Prevention Institute, 2003
Health Equity Best Practices
CDC’s The Community Guide:
– Community Preventive Services Task Force
– Identified 200 community-based interventions in six areas
– Reviews in three areas complete
• Early childhood development = effective
• Affordable and safe housing = effective
• Access to culturally competent healthcare systems = insufficient
evidence
Evidence-based interventions:
– Housing Mobility Policies
– Early Childhood Development
Source: Anderson et al., 2003; CDC, 2009; Williams et al., 2008
National Examples of Early Childhood
Development Best Practices
Nurse-Family Partnership
• Nurse home visit program for low-income, first-time parents
• Significant outcomes:
–
–
–
–
–
–
Reduced risks for antisocial behaviors for children
Reduced childhood injury
Reduced child abuse, maternal crime & substance abuse
Improved prenatal outcomes
Increased school readiness for children
Increased maternal employment & father involvement
• ROI=$5 for every $1 spent
Source: http://www.nursefamilypartnership.org
National Examples of Early Childhood
Development Best Practices
Harlem Children’s Zone
• 97 block-area in Central Harlem, New York
• Promise Academy Charter schools & 22 birth-to-college
community programs
– Baby College, The Three Year Old Journey, Get Ready for Pre-K,
Harlem Gems
• Significant outcomes:
– 100% of Harlem Gems school ready for 6 consecutive years
– 97-100% of 3rd graders at-level in math & English language arts
– 97% of 8th graders at-level in math
• vs 7% avg for Black 8th graders
– Closing Black-White achievement gap
Source: Dobbie & Fryer, 2009
A Lesson in North Karelia
• In the 1970’s, North Karelia, Finland was plagued by
exceedingly high deaths from cardiovascular disease
• “It was a question of general lifestyle of the
community - not just some people with high risk
factors. The whole environment had to change - the
food industry, restaurants, cafeterias, supermarkets.”
- Pekka Puska, Project Director
A Lesson in North Karelia
What they did:
– Towns were pitted against each
other in cholesterol-lowering
competitions.
– Food-labeling laws were changed
– The national school-lunch
program got a major overhaul
– They convinced bread companies
to use less salt and replace
butter with vegetable oil
– They made sure walking paths
were clear
– They passed laws to provide
facilities for their citizens to get
exercise
Results:
– The smoking rate dropped
from 52% to 31%
– Coronary heart disease
mortality fell by 73%
– Lung cancer mortality
dropped by 71%
– All-cancers mortality dropped
by 49%
– Overall mortality declined 45%
– 6 to 7 extra years of life
expectancy were added
Levels of Impact
Sustainability Institute, adapted from other versions from the organizational learning field
Philanthropic Collaborative for
a Healthy Georgia
• Individual Providers
• Incentives for
Collaboration
• Change the System/
Policy/Environment
Opportunities for
Leverage
Strategic Alignment
Triple-Layer Chess
National
State
Local
Visit www.gsu.edu/ghpc
or follow us on Facebook
for more information and
resources.