Social Determinants of Health: What Can We Do? Rebecca H. Reeve, PhD, CHES Senior Advisor for Healthy Schools, NC DHHS

NC IOM Prevention Plan Reduce Socioeconomic Health Disparities Priority Recommendations Increase economic security by increasing the State Earned Income Tax Credit Increase enrollment in the Supplemental Nutrition Assistance Program Increase High School Graduation rates

Socioeconomic Indicators & Social Determinants MATCH HS Graduation College Degrees Unemployment Children in Poverty Income Inequality Single Parent Households Homicide Rates Healthy NC 2020 Decrease % Living in Poverty Decrease % Spend >30% income on rental housing Increase 4-yr Graduation Rate Reduce % Uninsured <Age 65

21 st Century Coordinated School Health Education Health Wealth Eliminate Health Disparities & Achievement Disparities

Four-Year Cohort Graduation Rates by Student Subgroup (DPI 2010) All Students74.2% Asian85.2 % White79.6 % Female78.9% Multi-Racial71.2 % Male69.6% American Indian67.9% Black66.9 % Economically Disadvantaged66.3% Hispanic61.4 % Students with Disabilities57.5% Limited English Proficient48.3% *U.S. Department of Education, National Center for Education Statistics, Common Core of Data (CCD), “Local Education Agency Universe Dropout and Completion Data File: School Year 2000–01 +$10K per Year = +$99.2 Million per Year +$10K per Year =$40.7 Million per Year Up from 63% ’01* =12,599 more grads Up from 55% ’01* =4,065 more grads

7 Educationally Relevant Health Disparities Vision Asthma Teen Pregnancy Aggression and Violence Physical Activity Breakfast Inattention and Hyperactivity Develop NC Evidence

Addressing Teen Pregnancy Nationally 31-33% of pregnant teens graduate on time. NC Adolescent Parenting Program in ’06- ’07 enrolled 785 teens from 31 Counties. Only 35 (4%) of them dropped out of school. Expected Dropouts = 526 Actual Dropouts = 35 Additional graduates X $10K = $4.9M

Health Risk Behaviors & Academic Grades NC High Schools 2007 YRBS

8 Components of a Coordinated School Health Approach Family & Community Involvement Physical Education & Physical Activity Nutrition Services Counseling, Psychological & Social Services Comprehensive School Health Education Healthy School Environment School-site Health Promotion for Staff School Health Services 1.5 Million Children 180,000+ Employees 2,500 Schools

We Can Work Together To: Promote Collaboration Between Health and the Education Agencies & Groups. Advocate for school level assessment of the Coordinated School Health components. Use 2010 Profiles & SLIMs data to plan. Advocate for 2011YRBS participation.

Healthy Schools Contact Info Vacant- DPI Section Chief for Healthy Schools – Rebecca Reeve – Sr. Advisor- DHHS – Tanya Bass- HIV – Johanna Chase - Healthful Living – NakishaFloyd- PANT – Chris Minard – Allied Health – Melody Hudson - Administrative Assistant –

CSHP/HE SLIM #3 The % of schools that have ever assessed their policies, activities and programs by using the School Health Index or similar self-assessment Baseline34% 2010 SLIM 26% 2013 Goal >39% NC Healthy Schools Coordinated School Health Priority SLIMs *three areas Physical Activity, Nutrition, tobacco

NC IOM Prevention Plan Reduce Tobacco Use Priority Recommendation: Increase North Carolina’s Tobacco Taxes Other recommendations include funding and implementing the Comprehensive Tobacco Control Program; expanding tobacco-free policies; and expanding access to cessation services, counseling, and medications for smokers who want to quit.

NC Healthy Schools Priority SLIM Tobacco SLIM #5 The % of schools that provide tobacco-use cessation services to faculty, staff and students through direct service at school or arrangements with providers not on school property 2008 Baseline 48% 2010 SLIM 43% 2013 Goal > 53%