1. Social Support Social support is a type and degree of help that is provided from others to a person, group, neighborhood, city, organization, or community throughout the lifespan. There is a relationship between social support, maintenance of well-being, and the ability to manage crisis, illness, recovery, loss, or the influence of negative social determinants.

2. Emotional Appraisal Support Support Informational Instrumental Support Well- Being & Recovery

4. Definitions of Social Determinants MethodKey Terms & Approach GlasgowGradient & Inverse Relationship Whitehall StudyGradient & Frequency Woolf & BravemanRoot Cause & Upstream/Downstream Factors South Australia CouncilWell being & Dahlgren’s Rainbow WHOPolicy Links & Ten Factors Marmot8 Defining Factors RWJDisparities & Knowledge of Policy/Decision Makers

5. Social Determinants WHO FactorsMarmot and WilkinsonDahlgren & Whitehead Place on the gradientPovertyHousing Stress Early life experiencesEarly life & life course Social exclusionLabor market conditionsWater & sanitation Work environment Unemployment Social supportSocial support/cohesionHealth care services AddictionEducation FoodFood supplyAgriculture/food production Transportation

6. Social determinants are multiple factors and conditions operating within a social environment that collectively influences the health status, behavior, choices, risks, and mortality of individuals and groups within a specific geographical area [nation, region, county, neighborhood, or community]. Davis, 2012

7. Social Determinants Poverty Income & Wealth Distribution Employment - Unemployment Education Housing Social capital Isolation Discrimination Accessibility

8. Social Determinants Availability Social status Crime Safety Functional social institutions Nutrition – availability of food Place on a social gradient Clean water Health/mental health literacy

9. Social Determinants Recreation Public policies Population density Transportation Health insurance Trauma

10. Well- Being Emotional Appraisal Support Informational Instrumental Support Well-being & Recovery Social Determinants Social Determinants Family Friends Neighbors Organizations Leaders History & Tradition Churches Social Network/Capital ProvidersMedia

11. Death Rates in 1900 by Race

12. Causes of Mortality African American 1990 2004 American Indian 1990 2004 Asian American 1990 2004 Euro-American 1990 2004 Latino American 1990 2004 Heart Disease1 4 5 2 3 Homicide1 3 4 55 42 Suicide4 53 4 51 2 Cerebrovascular Disease 1 5 3 4 2 Malignancy1 5 3 2 4 Respiratory Disease 2 33 24 51 5 4 Influenza1 3 4 52 5 4 Liver Diseases3 41 4 35 2 Diabetes1 2 5 4 3 HIV/AIDs1 5 34 53 52 Accidents2 31 5 3 43 2 Table 2. Changes in Ranking of mortality by race, Hispanic origin, and year

13. No community or group chooses poverty No community or group chooses hunger No community or group chooses danger or fear No community or group chooses early death or suicide No community or group chooses homelessness No community or group chooses mental illness No community or group chooses disease No community or group chooses crime No community or group chooses addiction No community or group chooses drought! My Working Assumptions