Public Health Center Roosevelt Institute at Yale Addressing the Social Determinants of Health in New Haven: Challenges and Solutions Public Health Center Roosevelt Institute at Yale

Introduction Question: How do we address the social determinants of health in New Haven?

Summary of Major Health Issues Facing New Haven Residents Community Report Identified the Most Important Health Issues: *Obesity *Heart Disease *Asthma *Mental Health *Diabetes *STDs

Obesity Adults: In 2012: 66% of adults in Greater New Haven were overweight or obese. In low-income neighborhoods within New Haven, 69 percent of adults are overweight and 43 percent are obese Children: Maintaining healthy weight among children is of particular concern in New Haven: 2011: 50% of middle school students in the city’s public schools did not meet guidelines for healthy weight.

Although unhealthy body weight is a health issue for the whole Greater New Haven region, it is much more of a challenge for low-income individuals and people who live in areas with limited economic resources. The percentage of people who were considered obese was considerably higher in low income neighborhoods than in high income neighborhoods. In 2010-2011, school districts with more students who are eligible for free and reduced lunch had a lower proportion of students meeting physical fitness standards. Why? Areas have lower access to resources that support good health including healthy food. Physiological and mental stress associated with financial insecurity (i.e. Food Insecurity). In Greater New Haven in 2012, 20% of adults said that they did not have enough money to buy food in the last year. 44% of adults living in New Haven low-income neighborhoods worried that their food would run out before they got more money 40% said they were not always able to afford to buy vegetables, fruit, healthy oils or whole grains. Barriers to physical activity safety lack of recreational facilities/parks

Heart Disease Premature heart disease/heart attack is higher in New Haven than in the Inner Ring or Outer Ring Suburbs. Large disparities in mortality rate (relating to heart disease) by neighborhood. Mortality rate highest in low income neighborhoods and lowest in high income neighborhoods.

Asthma New Haven emergency room visits and hospitalizations for childhood asthma are 2-3 times the state level and have been increasing. Asthma inpatient treatment is also increasing. Black and Latino/New Haven children showing steadier increases in care needs. The prevalence of asthma is somewhat higher in New Haven than in the other communities. Potential causes: barriers to primary care poor medical management of asthma greater exposure to environmental triggers (pollutants, transportation-related emissions, and airborne allergens).

Mental Health 9% of New Haven residents reported having poor mental health for 15 or more days in the past month between 1998 and 2003, a rate slightly higher than Connecticut (8%). Current data shows that substantial disparities exist in mental health when the city is compared to surrounding area. Disparities exist between low-income and high-income communities in New Haven.

Diabetes 2006-2009: age adjusted death rate from diabetes was considerably higher for New Haven and Inner Ring communities than residents of the Outer Ring. BUT percentage of people with diabetes in the different communities was similar. Suggests that people in New Haven and the Inner Ring communities have greater challenges managing the harmful effects of diabetes. Potential Causes: poorer access to health care, high quality food, environments to exercise.

Insurance Coverage in New Haven Health Insurance Among Adults (18+) (Fall 2012) High Income: 94% Medium Income: 88% Low Income (less than $30,000): 86% *Access to health care has been identified as a priority issue by the Partnership for a Healthier New Haven + State Department of Public Health. Note: Data before implementation Affordable Care Act.

Health Leads Increases access to health and healthcare services by addressing the social and economic factors that contribute to illness Providers prescribe basic resources like food and heat and volunteers stationed in clinics help patients access community resources and public benefits 2010: volunteers secured a needed resource within 90 days in 57% of cases Proposed to be implemented in New Haven by Yale-New Haven Hospital

What Resources Already Exist in New Haven CT 2-1-1 comprehensive phone-based service that provides information and referrals to health and human services programs could be advertised more broadly? Get Healthy CT coalition dedicated to preventing and reducing obesity by removing barriers to healthy eating and physical activity could be expanded to other health issues? Why aren’t these resources and others like them being used?

Partners Advisor: Mary Alice Lee Institution: Yale-New Haven Hospital senior policy fellow at Connecticut Voices for Children lecturer at Yale School of Public Health Institution: Yale-New Haven Hospital Lindsey Greene-Upshaw (strategic planning) hybrid “Health Leads” program with EPIC capabilities

Future Research Obtain access to urgent care demographics and identify patient population. Interview healthcare providers and social workers: are patients using resources? Create a list/map/brochure of existing resources in New Haven Expand scope of research Yale-New Haven Hospital St. Raphael’s Campus, Fair Haven Community Health Center