Health Equity and Social Determinants of Health Jennifer Weitzel, MS, RN Public Health Madison & Dane County Original presentation by: Paula Tran Inzeo,

Health Equity and Social Determinants of Health Jennifer Weitzel, MS, RN Public Health Madison & Dane County Original presentation by: Paula Tran Inzeo, MPH, PhD Candidate

OVERVIEW Health Equity What does it mean? Why does it matter? Healthiest WI 2020 Wisconsin Center for Health Equity What can be done?

WHAT MAKES US HEALTHY? (Robert, Booskee, Rigby, & Rohan, 2008)

America leads the world in medical research and medical care For all we spend on health care, we should be the healthiest people on Earth

2000, UC Atlas of Global Inequality http://ucatlas.ucsc.edu/spend.php $4,500/ person 77 yrs, ranked 27th $4,500/ person 77 yrs, ranked 27th $186/ person 76.9 yrs, ranked 28th $186/ person 76.9 yrs, ranked 28th $3,300/ person $3,300/ person

Socioeconomic Factors ~ 40% of Health Outcomes Access to healthy food, exercise/recre ation, liquor stores, fast food, crime Providers, quality of care, trust, insurance Where you live and work

Wisconsins Disparity grades

WORKING-AGE ADULTS

HEALTH EQUITY IS NOT ONLY Health Disparities: any differences in health outcomes between groups of people Male babies are generally born at a heavier birth weight than female babies Health Inequities: differences in health outcomes between groups of people that are considered preventable or unfair Babies born to Black women are more likely to die in their first year of life than babies born to White women ASTHO, 2000

HEALTH EQUITY, a Vision Fairness in the distribution of resources and the freedom to achieve healthy outcomes between groups with differing levels of social status Health should not be compromised or disadvantaged because of an individual or population groups race, ethnicity, gender, income, sexual orientation, neighborhood or other social condition. ASTHO, 2000

PRINCIPLES OF HEALTH EQUITY Health equity is a cross-cutting broad issue associated with fundamental social values and well-being Health equity is connected to all aspects of public health work and the most basic influences on the health of populations Working to achieve health equity requires multidisciplinary approaches and a more holistic, comprehensive view of health and coordinated strategies (Troutman, 2009)

HEALTH EQUITY AS A DEVELOPMENT OUTCOME The development of a society can be judged by: The quality of its populations health The fairness in the distribution of health The degree of protection provided from disadvantage due to ill-health

HEALTH EQUITY IS GOOD FOR THE ECONOMY Costs between 2003-2006 Combined costs of health inequities and premature death in the U.S.= $1.24 trillion 30.6% of direct medical care expenditures for people of color were EXCESS costs due to health inequities Raising the health of all Americans to that of college educated Americans would result in annual gains of over $1 trillion worth of increased health Healthy workforce = productive workforce. Raising the health status of employees has a positive impact on individual companies and the economy as a whole (HHS 2011) LaVeist, Gaskin, and Richard, 2009; Dow and Schoeni, 2008

WHAT ABOUT INDIVIDUAL BEHAVIOR? Very important to health (30%) HOWEVER, Everyone does not begin in the same place or has the same tools and environments (OPPORTUNITIES) to support individual choices that maximize their health potential Racial and ethnic health inequities exist at every income level, not just among the poorest Americans (IOM, 2003)

INTERNATIONAL CONSENSUS THAT HEALTH IS NEITHER CREATED NOR MAINTAINED SOLELY WITHIN THE HEALTH SECTOR

SHIFTING FROM CONSEQUENCES TO ROOT CAUSES Race, Class, Gender, Disability Sexual Orientation Immigration

SOCIAL CONDITIONS Social Determinants of Health (Social and Economic Factors) Circumstances shaped by distribution of money, power, and resources All levels: local, state, national, global Drive health inequities Where one is born, lives, learns, works, and plays matters (Marmot, 2008) Unemployment Stress Early life Social exclusion Work life Social support Food Transport

Social Determinants Root Causes

Wisconsin Center for Health Equity (WCHE) Statewide focus Founded in 2006 by the Milwaukee Health Department Collaboration with WPHA since 2009 Strong partnerships Emphasis on social justice

Wisconsin Center for Health Equity Aims to improve social and economic conditions that influence health through three main strategies: Education Policy makers and the general public Policy Development Partnerships to improve community civic capacity

CORE FUNCTIONS OF PUBLIC HEALTH Assessment Monitor health status and identify community problems Diagnose and investigate health problems Evaluate effectiveness, accessibility, and quality of services Policy Development Develop policies and plans that support health Enforce laws and regulations Research new insights and innovative solutions Assurance Link people to needed services Assure a competent public health workforce Inform, educate, and empower people about health issues Mobilize community partnerships

WI CHILDHOOD LEAD POISONING PREVENTION Assessment Monitor blood lead levels (INEQUITIES), rates of childhood lead poisoning Policy Development Housing abatement programs Assurance Blood lead testing Inform, educate, and empower communities Implementation and Oversight Committee for Childhood Lead Poisoning Prevention

TAKE ACTION 1. Educate public, other professionals, elected officials and the media about what makes a healthy community: Health is beyond the doctors office.

TAKE ACTION 2. Support policies that will create healthier communities Remember: education policy is health policy; economic policy is health policy; child-care policy is health policy; housing policy is health policy; transportation policy is health policy. Harvard Epidemiolgist David WIlliams

TAKE ACTION 3. Analyze policies that come before you for the potential health impact (both positive and negative), paying close attention to inequitable impacts.

Thank you! Question/Comments/Resources Jennifer Weitzel, MS, RN Public Health Madison & Dane County [email protected] Geof Swain, MPH, MD Chief Medical Officer and Medical Director City of Milwaukee Health Department [email protected] Raisa Koltun, PharmD, MPH Associate Director, WI Center for Health Equity [email protected]

REFERENCES Jones, C. (2009). Social determinants of health and equity: the effects of racism on health [PowerPoint slides]. Retrieved from: http://www.slideshare.net/vahealthequity/social-determinants-of-health-and- equity-the-impacts-of-racism-on-health http://www.slideshare.net/vahealthequity/social-determinants-of-health-and- MacDorman, M., & Mathews, T.J. (2009). Behind international rankings of infant mortality: how the United States compares with Europe. Retrieved from: www.cdc.gov/nchs/data/databriefs/db23.htm www.cdc.gov/nchs/data/databriefs/db23.htm Organisation for Economic Co-operation and Development. (2008). Per capita total current healthcare expenditures, U.S. and selected countries. Retrieved from: www.oecd.org/health/healthdatawww.oecd.org/health/healthdata Robert, S.A., Booske, B.C., Rigby, E., & Rohan, A. (2008). Public views on determinants of health, interventions to improve health and priorities for government. Wisconsin Medical Journal 107(3) p. 124-130. Troutman, A. (2009). Creating health equity; social justice human rights and the social determinants of health [PowerPoint slides]. Retrieved from: http://www.slideshare.net/unitedwaypdx/social-determinants-of-health-dr- adewale-troutmanhttp://www.slideshare.net/unitedwaypdx/social-determinants-

Health Equity and Social Determinants of Health Jennifer Weitzel, MS, RN Public Health Madison & Dane County Original presentation by: Paula Tran Inzeo,

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distribution of health

health of populations

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health disparities

overview health equity

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