October 31, 2014 Jenny Miller DrPH MS MPH Interdisciplinary Approaches to Health Issues in Alaska: Social Determinants of Health October 31, 2014 Jenny Miller DrPH MS MPH

Objectives Provide an overview of the social determinants of health Present the social determinants of health as an overarching framework for health issues in Alaska Explore how the social determinants of health are applied in health research

Healthy People 2020: One of four overarching goals for the decade Create social and physical environments that promote good health for all

Health begins in our: Homes Schools Workplaces Neighborhoods Communities

World Health Organization Closing the gap in a generation: Health equity through action on the social determinants of health, 2008

Social Determinants of Health

Institute of Medicine Model: A guide to thinking about the determinants of population health

Five Key Areas (Determinants) Economic Stability Education Social and Community Context Health and Health Care Neighborhoods and the Built Environment

Examples of Social Determinants Availability of resources to meet daily needs e.g., food markets, safe housing Access to educational, economic and job opportunities Quality of education and job training Availability of community resources and opportunities for recreational activities Transportation options Public safety

Examples of Social Determinants (2) Social support Exposure to crime, violence, etc. Socioeconomic conditions Residential segregation Language/literacy Culture

Examples of Physical Determinants Housing Schools, worksites Exposure to toxic substances and other physical hazards Physical barriers, especially for people with disabilities

Economic Stability Poverty Employment Status Access to Employment Housing stability (homelessness, foreclosure)

Education Policies that Support Health Promotion School Environments that are Safe and Conducive to Learning High School Graduation Rates Enrollment in Higher Education

Social and Community Context Family Structure Social Cohesion Perceptions of Discrimination and Equity Civic Participation Incarceration/Institutionalization

Health and Health Care Access to Health Services: Clinical and preventive care Access to Primary Care: Community-based health promotion and wellness programs Health Technology

Neighborhood and Built Environment Quality of Housing Crime and Violence Environmental Conditions Access to Healthy Foods

Healthy People 2020 (HP 2020): Background data related to economic stability In 2010 15.1 percent of persons were living below the poverty threshold 22 percent of children ages 0 to 17 were living below the poverty threshold in 2010 71 percent of children ages 0 to 17 were living with at least one parent employed full time, year round

Healthy People 2020 (HP 2020):Objectives related to economic stability Increase use of alternative modes of transportation for work Eliminate very low food insecurity Reduce past-month use of illicit substances

HP 2020:Objectives related to education Increase the proportion of the population that completes high school education Reduce the number of new schools sited within 500 ft of an interstate/federal/state highway Increase the proportion of elementary, middle and senior high schools that require school health education

HP 2020:Objectives related to health and health care Increase the proportion of persons with health insurance Increase the proportion of persons with a usual primary care provider Reduce the proportion of persons engaging in binge drinking during the past 30 days

HP 2020:Objectives related to neighborhoods and the built environment Reduce the number of days the air quality index is poor Reduce hospitalizations for asthma Increase the proportion of persons served by community water systems who receive water that meets standards of the Safe Drinking Act Reduce homicides Reduce physical assaults

HP 2020:Objectives related to social and community context Reduce adolescent and young adult perpetration of, and victimization by, crimes Increase the proportion of adults with disabilities who report sufficient social and emotional support Reduce the suicide rate Reduce the proportion of persons who experience major depressive episodes

Place Matters: Life Expectancy by Zip Codes