1. Determinants of Health
Catalysts Towards Community Health
June 2, 2008

3. Biological Determinants
Genes: much to learn
Immunities or disposition
Varying estimates of “nature”- effect on longevity.
Age

4. US Mortality by Age
(per 100,000)
Source: National Center for Health Statistics,CDC: 2005

5. Health Care Determinants
CDC estimates that 10% of premature mortality is due to inadequate health care.
98% of health $$$ are for health care instead of prevention.
Increasing differences in access based on deductibles, co-pays, etc.
Lower access to tests, specialty care for low income patients.

6. Environmental Determinants
Biochemical effects (lead paint, diesel fumes.)
Often overlooked rural-based pollutants
New interest in the effects of the “Built Environment”: the use, layout & design of a community’s physical structures
Urban: high crime and traffic
Suburban: pedestrian “unfriendly”
Rural: ?

10. Behavioral Determinants
Tobacco (400,000 deaths)
Nutrition and Physical Activity (325,000)
Alcohol (85,000)
Violence
What is the origin or cause of behavior?
Source: Mokdad, et. al. JAMA

11. Cigarette Smoking by Education

12. Physical Activity
Blacks (19%), Hispanics (24%) and Asians (38%) less likely to engage in physical activity than Whites.
Men 30% more likely than women.
Married individuals 19% less likely than single individuals.

13. Physical Activity/Nutrition
Source: USDA, 2006

14. Social Determinants Gender Race Marital status
Physical abilities (also biological)
Education

15. U.S. Mortality by Gender
(per 100,000)
Source: National Center for Health Statistics, CDC, 2005

16. U.S. Mortality by Race
(per 100,000)
National Center for Health Statistics, CDC, 2005

17. Social Determinant: Education
Source: National Health interview Survey, Robert Wood Johnson Foundation, 2008

18. Education and Mortality

19. Parent Education and Children’s Health

20. “The Big Sort” Social and geographic segregation
People have migrated to socially isolated areas.
Divided by race, income, social perspectives.
Possible adverse health effects?

22. Economic Determinants
Intersection between social (e.g. job) and economic (income) determinants is fuzzy.
Concept of “social class” is less accepted here.
Social status is more than income, though income is an important determinant.
“Status Syndrome” (Marmot)

23. Premature mortality by Income

24. Health and Wealth

25. Income Gap Widens

27. Income Changes

28. Effects of Disparities
Complex relationship between determinants and outcomes.
Some “determinants” are likely outcomes of others.
Parental income associated with educational attainment and health of child. Low education associated with high tobacco use. Tobacco use associated with…..

29. Social effects of Disparities
Discrimination?
Stress?
Low self-esteem?
High-risk behaviors ??