Marybeth Beall, M.S.
Health Instigator and System Developer
“It Take a Neighborhood “OPCA /K-P /NWHS
2
The 60% Rule: Behavior, social circumstances and environment
are responsible for 60% of premature deaths
Social
Circumstances
15%
Genetic
predisposition
30%
Environmental
Exposure
5%
Health care
10%
Behavioral
patterns
40%
Source: McGinnis J.M., Williams-Russo P., Knickman J.R. “The Case for More Active Attention to Health
Promotion,” Health Affairs 2002; 21(2):78-93.
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National Health Care Expenditures: Only 4% of health
care dollars are spent on factors that prevent premature
death
100%
90%
80%
70%
Medical
Care
96%
60%
50%
40%
30%
20%
10%
0%
4
Achieve Health Equity……………
 Health Equity
Everyone has access to the same opportunities for both
good health and a fulfilling and productive life.
Muntu Davis, MD, MPH, Alameda County Public Health Officer
 Stated another way:
All Americans should have the opportunity to make
choices that allow them to live a long, healthy life,
regardless of their income, education or ethnic
background.
……Eliminate Disparities
 Health Disparities
“…differences in the incidence, prevalence, mortality and burden
of diseases and other adverse health conditions among specific
population groups in the Unites States”
NIH Working Group on Health Disparities
Examples: Race/ethnicity; sex; sexual identity; age, disability,
social determinants of health.
Stated another way:
 Giving everyone a chance to live a healthy life
Our opportunity for health starts long
before our need medical care.
 America leads the world in medical research and medical care, and for
all we spend of health care, we should be the healthiest people on
earth. Yet on some of the most important indicators, like how long we
live, we’re not even in the top 25, and among high income nations, we
are 17th (males) and 16th (females). (And 18th in high school graduation
rates of the top 24 industrialized nations!) U.S Health in International in Perspective - Shorter
Lives, Poorer Health -Institute of Medicine of the National Academy of Sciences; Report Brief, January 2013.
 It’s time to stop thinking of health as something we get at the doctor’s
office but instead as something that starts in our families, in our
schools and workplaces, and in the air we breathe and the water we
drink.
 The more we view health in this way, the more opportunities we have to
improve it.
Healthy People 2020
The 12 Leading Health Indicators
 Access to Health Services
 Clinical Preventive Services
 Environmental Quality
 Injury and Violence
 Maternal, Infant and Child
Health
 Mental Health
 Nutrition, Physical Activity and
Obesity
 Oral Health
 Reproductive and Sexual Health
 Social Determinants of
Health
 Substance Abuse
 Tobacco
Marybeth Beall, M.S. Health Instigator and
System Developer It take
The Social and Physical Determinants of Health
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Examples of social determinants
Availability of resources to meet daily needs
(e.g., safe housing and local food markets)
Access to educational, economic, and job
opportunities
Access to health care services
Quality of education and job training
Availability of opportunities for recreational
and leisure-time activities
Transportation options
Public safety
Social support
Social norms and attitudes (e.g.,
discrimination, racism, and distrust of
government)
Exposure to crime, violence, and social
disorder (e.g., presence of trash and lack of
cooperation in a community)
Socioeconomic conditions (e.g., concentrated
poverty and the stressful conditions that
accompany it)
Residential segregation
Language/Literacy
Access to mass media and emerging
technologies (e.g., cell phones, the Internet,
and social media)
Culture
Examples of physical determinants

Natural environment, such as green space
(e.g., trees and grass) or weather (e.g., climate
change)
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Built environment, such as buildings,
sidewalks, bike lanes, and roads
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Worksites, schools, and recreational settings
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Housing quality and community design
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Exposure to toxic substances and other
physical hazards
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Physical barriers, especially for people with
disabilities
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Aesthetic elements (e.g., good lighting, trees,
and benches)
Stated another way:
Where we live……your neighborhood shouldn’t be
hazardous to your health, nor should your home.
How is it helpful?

Is your home warm in the winter, free of mold and lead-based paints?
Do you have your own bed to sleep in?
Is their a full service grocery near your home where you can buy fresh produce?
How is it harmful?

Poor housing conditions, including overcrowding, have been shown to have a
direct relationship to poor mental health, developmental delay, heart disease and
other medical issues.
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Children in poverty are 5 times more likely to have higher lead-blood levels,
which can lead to neurological damage, learning disabilities, hyperactivity, and
other health problems.
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Children who experience “food insecurity” – uncertain or limited supplies of
nutritious food – are 30% more likely to be hospitalized by age three.
Health and Homeownership
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What Does Research Say?
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About home ownership and health in general
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About home ownership and the immune system
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About home ownership and mental health
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About housing instability
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About homeownership and social engagement
Marybeth Beall, M.S. Health Instigator and
System Developer It take
Where we learn……all Americans should have the
opportunity to make choices that allow them to live a long healthy
life, regardless of their income, education or ethnic background.
How is it helpful?

Is participation in sports programs available to all kids
regardless of income/ability to pay?

Does your children’s school offer nutritious lunch foods and
healthy snack options?
Is your child able to walk to school safely?
Does your child’s school have up to date text books and
technology resources for learning?
Are job training opportunities available to kids who choose
or cannot afford not to go to college?
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Where we work……health starts long before illness---in our homes, schools and jobs.
How is it helpful?
 Do you have access to health insurance for you and your family through
your job?
 Are you able to earn enough each month to pay for food for your family,
housing, gas for your car and your electric bill?
How is it harmful?
 Are you exposed to chemicals or pollutants on the job?
 Do you work in a high risk of injury job i.e. logging, mining,
commercial fishing, construction, farm labor)
Where we play……… the opportunity for health
begins in our families, neighborhoods, schools and jobs.
How is it helpful?

Are the streets in your neighborhood safe to walk or ride a bike
in?
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Are there park nearby where you and your children can play?
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Can you afford swimming lessons for your kids?
How is it harmful?
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Do you live in an area with a high rate of crime and
violence?
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Is their gang activity where you live?
And perhaps by what we do with our time!
 A recent news article reported that over 600,ooo Americans commute
more than 50 miles to and from work per day:
 Average time in car =1.5 hours each way = 3 hrs. travel time per day
 Assume at work 9.5 hours including time to park, arrive to and from the
worksite and have a lunch hour
 Time remaining at home/away from work = 11.5 hrs/day
 In the remaining hours, how much time is left for:
Preparing meals? Eating?
Resting? Relaxing? Exercising?
Errands? Helping kids with homework?
Attending kids activities?
Taking care of pets?
Household chores?
 If sleeping 7 hours, only 3.5 hours per day remain for all of the
above!
In Conclusion: Health starts where?
 Health starts in strong, loving families who live in decent homes that are
in neighborhoods that are safe for walking.
 It starts in jobs we can get to without hours of commuting and workplaces
free of unnecessary hazards.
 Health starts in schools that educate out children for jobs in the 21st
century, so that they can compete in the world economy, that feed them
healthy meals rather than junk foods, and that send them home safe at the
end of the day.
 It starts in having the time and financial resources to play at the end of a
hard day’s work because unrelieved stress takes a toll on our hearts and
our immune systems.
 Health starts when we all can afford to see a doctor but are less likely to
need to because it is possible to stay well in the places that we live, learn,
work and play.
Activity Instructions
 Draw a personal profile from the baskets being passed around
 Gather into groups of 3-5
 Introduce your “new self” to your group using the personal profile you have
drawn
 After all are introduced, answer the following questions:
1)
What factors in each person’s life (where they live, learn, work and/or play)
might help this person’s health? How and why?
2)
What factors in each person’s life might harm this person’s health or put
them at risk for poor health? What social determinants of health are
contributing to these risks?
3)
If Raul, Connie, Roger, Steven, Ben, Jessica, Ellen, Alex or Brady were part
of a family that had been selected to be a Habitat homeowner, what social
determinants of their health might you, in your role with your affiliate, be
able to impact in working with this person and/or their family? List these on
the flip chart.
Marybeth Beall, M.S. Health Instigator and
System Developer It take
QUESTIONS?
 Thank you!
Marybeth Beall, M.S. Health Instigator and
System Developer. It Takes a Neighborhood