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Elaine Arkin, Consultant, Robert Wood Johnson Foundation What Shapes Health? A New Way of Talking About Social Determinants of Health August 10, 2011.

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Presentation on theme: "Elaine Arkin, Consultant, Robert Wood Johnson Foundation What Shapes Health? A New Way of Talking About Social Determinants of Health August 10, 2011."— Presentation transcript:

1 Elaine Arkin, Consultant, Robert Wood Johnson Foundation What Shapes Health? A New Way of Talking About Social Determinants of Health August 10, 2011

2 The mission of the Robert Wood Johnson Foundation is to improve the health and health care of all Americans.

3 3 © 2008 Robert Wood Johnson Foundation. All rights reserved. Theres More to Health than Health Care

4 4 Area-based measures of poverty and deprivation have been found to be associated with health outcomes after adjustment for individual- level factors. Additional studies have suggested that neighborhood- level variables may also shape the distribution of health-related behaviors, although other studies have found little evidence of area effects. (Diez-Roux AV. Bringing Context Back into Epidemiology: Variables and Fallacies in Multilevel Analysis. American Journal of Public Health, 88(2):216-22, 1998

5 5 Area-based measures of poverty and deprivation have been found to be associated with health outcomes after adjustment for individual-level factors. Additional studies have suggested that neighborhood-level variables may also shape the distribution of health-related behaviors, although other studies have found little evidence of area effects. In the overall population, observed patterns were clearly consistent with a socioeconomic gradient in life expectancy at age 25, health status, and activity limitation due to chronic disease; for these indicators, better health outcomes were seen at each higher level of income or education and the confidence intervals did not overlap. Throughout this century, average life expectancy for all persons in the United States has been increasing… but data show that during 1979–89, 45-year-olds with the highest incomes could expect to live 3 to 7 years longer than those with the lowest incomes. If SES effects are due to poverty and its correlates, one would expect to find a threshold effect above which SES would show little or no association with health outcomes. Studies at both the individual and aggregate levels challenge this expectation. An association of SES and mortality occurs throughout the SES hierarchy. Through a combination of latent effects and pathways of living, child development affects health, well-being, and competence throughout the life cycle.

6 6 Where we live, learn, work and play can have a greater impact on how long and well we live than medical care.

7 7 7

8 8

9 9 Ensure that all children have high-quality early developmental support. 1 4 Feed children only healthy foods in schools. 3 Create public-private partnerships to open and sustain full-service grocery stores in communities without access to healthful foods. 2 Fund and design WIC and SNAP (Food Stamps) programs to meet the needs of hungry families with nutritious food. The Commissions Recommendations

10 10 5 7 6 Create healthy community demonstrations to evaluate the effects of a full complement of health-promoting policies and programs. Become a smoke-free nation. Eliminating smoking remains one of the most important contributions to longer, healthier lives. Require all schools (K-12) to include time for all children to be physically active every day. The Commissions Recommendations

11 11 8 10 9 Integrate safety and wellness into every aspect of community life. Ensure that decision-makers in all sectors have the evidence they need to build health into public and private policies and practices. Develop a health impact rating for housing and infrastructure projects that reflects the projected effects on community health and provides incentives for projects that earn the rating. The Commissions Recommendations

12 12 Qualitative Audience Research –6 focus groups with swing voters and opinion elites Quantitative Audience Research –National voter poll on messages derived from focus groups –Two rounds of message-effectiveness testing using online surveys Interactive Messaging Workshop Story Development Message Development Approach

13 13 DemocratsRepublicans Imbalance in levels of health is natural. Equality should be our goal. - Equal distribution of resources - Equal treatment for all - Equal outcomes We need to level the playing field Equality is unrealistic and unfair. - Tailor the distribution of [limited] resources to particular needs, not the same for all - Individuals will never have equal outcomes. Imbalance in levels of health is unjust. We need to raise the bottom. Society bears primary responsibility for inequality, thus to fix it requires more change in society than in the individual. Olsen Zaltman Associates, 2007 Both society and individual choices create disparities, thus social aid must be balanced against individual responsibility. DemocratsRepublicans

14 14 Initial Health Status Access to Health Care System Access to Health Care System BARRIER GOOD HEALTH GOOD HEALTH Poor Nutrition Environmental Hazards Poor Education Racism Poverty Inadequate Transportation Less Parental Supervision Cant Exercise Violence Stress Lack of insurance Difficult to maneuver through health care system Not enough easily accessible facilities BARRIER Racial discrimination Gender discrimination Discrimination based on sexual orientation Cultural hesitancy to see a doctor Language barriers prevent same level of care Cant afford some treatments BARRIER Democrats Discrimination within Health Care System

15 15 Initial Health Status Access to Health Care System Access to Health Care System Discrimination within Health Care System GOOD HEALTH GOOD HEALTH BARRIER Lack of money Lack of knowledge - Parents less involved - Poor public education about options Bad choices Challenges Lack of insurance Difficult to maneuver through health care system Cultural hesitancy to see a doctor CHALLENGES Republicans

16 16 % Favorable Message 35 There are often obstacles or barriers that make it harder for some people to stay healthy than others. Providing people resources and information on diet and exercise and creating healthy policies can help people make healthy choices. 58 Staying healthy is a personal choice and is determined by individual behaviors such as diet, exercise, not smoking, and getting regular doctor checkups. Anyone can make the right choices to stay healthy if they want to. From National voter survey, 2011 Follow-up: 2011: National Voter Survey

17 17 Implication for messages Republicans had negative reactions to the idea of creating equal levels of health: Any variation of equal, equality, or equalizing Leveling the playing field Bringing everyone to the same point or the same health outcomes Raising the bar for everyone -Setting a fair and adequate baseline of care for all -Lifting everyone up Giving everyone a chance to live a healthy life Letting no person fall through the cracks/ below a decent level of health Instead, the following terms may resonate more with Republicans and would not alienate the Democrats:

18 18 Using common vernacular that speaks to core values resonated better than academic language Respondents preferred messages that included action items or examples of ways to get to a solution What We Learned:

19 19 Messages that referred to disparities based on race or ethnicity fared poorly with all but Black respondents Respondents related to messages based on Americas core values What We Learned:

20 20 Respondents related to metaphors/concepts that are ubiquitous –Journey –Connections –Limited Resources What We Learned:

21 21 Journey

22 22 Storytelling helps make the connections Connections

23 23 Limited Resources

24 24 Good health requires individuals to make responsible personal choices and requires a societal commitment to remove the obstacles preventing too many Americans from making healthy choices, even when their motivation is great. Pair personal responsibility with social responsibility:

25 25 Start with something most Americans already believe: The United States is one of the wealthiest nations in the world. We should be one of the healthiest, but we are not.

26 26 Make the information clear and compelling without oversimplifying: Break through to gain attention: Make theories tangible: Connect with a target audience: Make it timely and relevant: Headline whats most important. Challenge conventional wisdom with unexpected facts. Use real stories, analogies and everyday language. Stories about people like me make the connection. Provide a call to action. Considerations for Message Framing:

27 27 Our zip code may be more important to our health than our genetic code. For the first time, we are raising a generation of children who may live sicker and shorter lives than their parents. Unexpected Facts:

28 28 Health Disparities: The health of America depends on the health of all Americans. Despite enormous investment, America is not achieving its full health potential.

29 29 Health Beyond Health Care: Health care reform is essential, but improving the health of all Americans requires broadening our view beyond medical care. We must find ways to enable more people to lead healthy lives and avoid getting sick in the first place.

30 30 Where we live, learn, work and play can have a greater impact on how long and well we live than medical care. Social Determinants:

31 Robert Wood Johnson Foundation: How We Talk About Health

32 32 Health starts in our families and its nurtured in our schools and workplaces, on our playgrounds and in our neighborhoods. How healthy we are and how long we live depends on many factors, including education, income, our local communities, whether we smoke, how active we are and what and how much we eat.

33 33 To improve Americas health, we need solutions that look at where people live, learn, work and play to get at the factors that shape health even more profoundly than health care.

34 34 Working together, we can meet this challenge. We can build a healthier America. Improving Americas health requires leadership and action from every sector, including people who work in public health and health care, education, transportation, community planning, corrections, private business and other areas. It is time for everyone to work together and build on what we already know is working.

35 35 Resources Available:

36 36 Message Guides:

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39 39 Connect with Us: What Shapes Health Home: http://rwjf.ws/j9vmjn Follow us on Twitter: @RWJF @RWJF_PubHealth www.commissiononhealth.org www.rwjf.org www.newpublichealth.org


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