1. Social Determinants of Health
and How We Can Organize Together to Improve Them
MA Statewide Independent living council September 27, 2019
Maddie ribble

2. Outline 1. What are SDOH and why do they matter?
2. Hold up. Are HRSN the same as SDOH? Now I’m confused.
3. OK, got it. Can we get on with changing things?
4. What do we want to change?
5. Let’s take action
… but WAIT! don’t get ahead of yourself without a plan
6. Developing a campaign plan at your table. Yes, right now.

3. Social Determinants of Health
The social determinants of health are the environments in which people are born, grow up, live, work and age. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.
~ Adapted from the World Health Organization

4. State Prioritized SDOH classism xenophobia
racism
Massachusetts
State Prioritized SDOH
Built Environment
Education
Employment
Housing
Social Environment
Violence
State
Prioritized
SDOH
classism
xenophobia
ableism
power
homophobia
sexism
ageism
Source: Massachusetts State Health Assessment, 2017

5. WHAT MAKES US HEALTHY?
the majority of what contributes to our health is the social, economic, behavioral, and physical factors that we experience where we work, live and play
Source: Tarlov AR. Public policy frameworks for improving population health. Ann N Y Acad Sci. 1999;896:

6. The Great Spending Mismatch
What contributes to our Health
How we spend our resources
Source: NEHI & UCSF, 2013

7. Comparison Social Service and Medical Care Spending
E.H Bradley and L.A Taylor, The American Health Care Paradox: Why Spending More is Getting Us Less, Public Health Affairs, 2013.

8. Number of Deaths from Preventable Conditions per 100,000
Source: European Observatory on Health Systems and Policies 2017 (L.A. Times Graphics)

10. Health-Related Social Needs Social Determinants of Health
The health-related impacts of the social and economic factors in patients’ lives
The underlying social structures that impact the health of patients
Ex: Food insecurity, housing instability, exposure to violence
Ex: Lack of access to healthy food in a neighborhood, insufficient affordable housing opportunities
To alleviate:
Housing search assistance, SNAP enrollment support, safety assessment and planning
Systems and policy changes, such as increasing the number of affordable housing units
HRSN vs. SDOH?
Further Reading: John Auerbach and Brian Castrucci, “Meeting Individual Social Needs Falls Short Of Addressing Social Determinants Of Health,” Health Affairs, January 16, 2019:

12. Now what?

13. Improving SDOH?
Clinical Care?
NO!
Education?
NOPE!

14. State Prioritized SDOH
Massachusetts
State Prioritized SDOH
Built Environment
Education
Employment
Housing
Social Environment
Violence
State
Prioritized
SDOH
Source: Massachusetts State Health Assessment, 2017

15. Problem
Vague, overwhelming, and have no one person who is accountable
Issue
Issues are specific, winnable, and have a clear decision maker(s) with responsibility
Problems vs. Issues

16. Health Equity Assessment Questions
What is the policy under consideration?
What are the equity impacts of this policy? Who is most impacted?
Who will benefit from or be burdened? Are there potential negative impacts or unintended consequences?
Have affected community members been engaged in the development or vetting of the proposal?
Can the policy be successfully implemented and evaluated for impact?
Adapted from Government Alliance on Race and Equity

17. What Now?

18. Primary Target(s) Secondary Targets
The person or people who have the power to give you what you want. Never an institution or elected body.
Secondary Targets
People that have influence on your primary target(s).
Targets

19. Tactics
Tactics are actions that seek to influence your targets. These could include things such as:
petition drives or letter writing
turnout events (like rallies or pickets)
visits with public officials
public hearings or accountability sessions
educational meetings and teach-ins
civil disobedience
legal action

20. Source: M+R Strategic Services

21. Skeleton of a Campaign Plan
Problem:
Issue:
Primary target(s):
Two tactics:

22. Thank you! Maddie Ribble Director of Public Policy & Campaign Strategy
Massachusetts Public Health Association
@MAPublicHealth
(857)