Category Archives: Social determinants of health
“Of all the forms of inequality, injustice in health care is the most shocking and inhuman,” said the Rev. Dr. Martin Luther King Jr. in 1966 at the Convention of the Medical Committee for Human Rights, which was organized to support civil-rights activists during Mississippi's Freedom Summer. Those words are part of the Health is a Human Right: Race and Place in America exhibit on display at the David J. Sencer Centers for Disease Control and Prevention (CDC) Museum in Atlanta. The museum, located at the CDC’s Visitor Center, mounts several exhibits each year. The timing for the Health as a Human Right exhibit coincides with National Minority Health Month, observed each April to raise awareness of health disparities in the U.S. among ethnic and racial minorities.
The CDC exhibit, curated by museum director Louise Shaw, is organized by social determinants of health such as housing and transportation. Photographs, like those of teeming settlements in urban cities, are a key tool to show museum goers and online viewers the health disparities in U.S. history and present day.
Among the items in the exhibit:
- Mexican men sprayed with DDT on their arrival for a guest worker program in the 1950s.
- A corroded sanitation pipe and bottles of unsafe drinking water from the Community Water Center in the San Joaquin Valley, California.
- An inventive and cheap air sampler from New Orleans that people used to catalogue pollution levels and share with law makers.
- A Chinese version of the "Be Certain: Get Tested for Hepatitis B," campaign.
- A March of Dimes poster depicting an African American child with polio from the late 1950s. (For a long time after the polio epidemic began, many believed African Americans could not contract the virus. As a result, precaution campaigns were rare and late among that population.)
The exhibition is sponsored by CDC's Office of Minority Health and Health Equity, the CDC's Office of the Associate Director for Communication and the California Endowment.
NewPublicHealth spoke with Louise Shaw in Atlanta.
NewPublicHealth: What made you decide to mount and curate this exhibit?
Louise Shaw: Three years ago the CDC Museum was approached by CDC’s Office of Minority Health and Health Equity (OMHHE) to organize an exhibition to commemorate its 25th anniversary. As curator of the Museum, I was excited by the possibilities and conceived of a project that extended beyond just honoring OMHHE accomplishments. Dr. Leandris Liburd, OMHHE director, and her terrific staff, quickly jumped on board, and we all agreed to develop a historic exhibition framed by the social determinants of health.
NPH: What are some of the most striking issues you found in disparities between whites and minorities when it comes to social determinants of health?
Louise Shaw: Although we have made progress in many areas, we are still tackling similar issues in the 21st century that were debated 100 years ago. For instance, how we provide quality education to all children, regardless of race, ethnicity, or income status, was and is one of the greatest challenges facing our country. As the Robert Wood Johnson Foundation has documented, education and the optimum health outcomes are closely linked. Ultimately, education is the pathway to eliminating health disparities. Income equality/inequality is another complex issue that is being hotly debated today. One more specific example: although pre-term birth rates have greatly declined over the past century among all groups, the disparities of those rates between whites and minorities stubbornly remain, and are yet to be eliminated. We need to ask ourselves why that is so. Collectively, we have still not resolved what it means to live in a diverse, multicultural society.
NPH: Do you know of any outcomes that have come from the exhibit?
Louise Shaw: Internally at CDC, the exhibition has been an important touchstone for discussion and debate. I have received incredible feedback about the honesty of the exhibition, thanking me for connecting the dots visually among race, place, and health. By the time it closes on April 25th, over 30,000 people will have seen the show. I don’t think we have ever mounted an exhibition that has been visited by so many college and university students — some even virtually. A consortium of faculty members from the University of Connecticut, Emory University, and Georgia State University, have developed a formal evaluation tool. In addition, there is a local and national movement underfoot to figure out how the show can live on whether online or in another form.
The County Health Rankings and Roadmaps, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, will celebrate its fifth anniversary next month. In the last few months, NewPublicHealth has been reporting on the work of programs grantees that are making changes in their communities to help improve population health.
Utah’s Salt Lake County ranks 20th out of 27 counties in social and economic factors. Its high school graduation rate is 72 percent, below the state rate of 76 percent. Approximately 19 percent of the county’s children live in poverty, compared with 16 percent state wide.
South Salt Lake, a city in Salt Lake County, has many resources and assets that make it a great place to live. However, the city’s residents also deal with challenges similar to those faced by individuals living in the elsewhere in the country. Nearly half of South Salt Lake’s residents live in homes with annual household incomes less than $35,000. Among similar-sized communities in Utah, South Salt Lake has some of the highest rates of obesity, chronic cigarette smoking, binge drinking, mental illness and prescription drug abuse. In previous years, South Salt Lake has had the highest rate of violent crime in Utah, but over the past three years the city has noticed a 76 percent decrease in gang-related juvenile crime and a drop in overall crime of 23 percent.
In spite of these challenges, the schools, community partners and the City of South Salt Lake share a common goal to ensure all of the city’s kids are performing on grade level, graduating high school and pursuing a post-secondary opportunity. To create a foundation to allow children to achieve these goals, United Way of Salt Lake, the City of South Salt Lake and numerous other partners have created the Early Learning Network, a comprehensive, integrated early learning system for children from birth to age five. The program is critical because research shows that evidence-based investments in children from birth to age five improve school readiness; lower rates of crime, teen pregnancy, substance abuse and obesity; are essential to academic achievement; and have a direct impact on people’s health and financial well-being.
The goal of the Early Learning Network is to make sure that by the time a child enters kindergarten, he or she will be ready to learn.
The Early Learning Network is a recipient of a County Health Rankings and Roadmaps community grant. Grantees are funded to work with diverse coalitions of policy-makers, business, education, health care, public health and community organizations to improve the education system in ways that also better the health of the community. Roadmaps to Health grants support more than two dozen projects across the United States that aim to create healthier places for individuals and families to thrive. The Roadmaps to Health Community Grants project is a critical component of the County Health Rankings & Roadmaps program.
NewPublicHealth recently spoke with Elizabeth Garbe and Chris Ellis of United Way of Salt Lake.
NewPublicHealth: Tell us about the Early Learning Network.
Chris Ellis: The Early Learning Network is a coalition of early childhood providers, basic needs groups, government agencies and health organizations. The primary goals of the group are to ensure that kids are demonstrating age-appropriate development and entering kindergarten ready to learn. The Early Learning Network is focused on a specific geography, the City of South Salt Lake. It is a great example of collective impact, as non-profits, businesses and government agencies are working together to determine the most effective way to support children ages 0-5 in this community.
The Network has discussed baseline measures to better understand what services are needed to support the community. Collecting data to set a baseline is essential in order to demonstrate whether we are making any progress on our two goals.
Many of the sessions at the National Association of Counties (NACo) Health Initiatives Forum meeting in San Diego this week have been moderated by Nick Macchione, director of San Diego’s Health and Human Services Agency and vice chair of the Healthy Counties Initiative Advisory Board. Macchione is a key architect of Live Well San Diego, a program voted in by the San Diego Board of Supervisors that is a long term, comprehensive and innovative strategy on wellness with a goal of helping all San Diego County residents become healthy, safe and thriving.
NewPublicHealth spoke with Nick Macchione ahead of the forum. Senior Policy Advisor Julie Howell and Dale Fleming, director of strategic planning and operational support, joined the conversation.
NewPublicHealth: The buzz about San Diego is that you’re working hard toward population health improvement.
Nick Macchione: I think the excitement about San Diego is that we have earned a reputation as a health innovation zone by having a collective impact on health and wellness. Our deeds demonstrate our words because over the past decade there have been five major broad-based population health improvements: reduction of heart disease and stroke; reduction of cancer rates; reduction of childhood obesity; reduction of infant mortality; and reduction of children in foster care. That reduction is extremely important to population health because we also look at the social determinants of health and not just pure health care.
We've taken an ecological approach to population health—working with partners across all sectors and coming together not just from traditional health care but beyond that to public health, social services, business, community, schools and the faith community.
And we’ve done that in the context of optimizing existing resources to improve outcomes. We’ve been blessed with a lot of competitive federal grants and philanthropy investments, but really the framework is how we leverage and optimize what we have first before we go and seek to augment with other resources. That has worked exceptionally well and that’s earned us that innovation zone reputation.
NPH: Tell us about Live Well San Diego.
Macchione: Live Well San Diego is a comprehensive public health initiative that involves widespread community partnerships to address the root causes of illness and rising health care costs. The tagline is healthy, safe and thriving. We think it’s a great template that communities can use, it’s transferable because San Diego has every imaginable bio-climate except a tropical rainforest. So we have desert towns, we have rural communities, we have mountain villages, we have beach towns and everything in between urban core. We also call it Project 1 Percent because 1 percent of San Diego represents the nation both in its diversity and its population. So, if we can achieve what we're achieving on advancing population based health in a broad scale it can be demonstrated throughout the country.
The U.S. Department of Housing and Urban Development (HUD) recently posted an interview with Teresa Bainton, director of the New York Multifamily HUB, which manages multifamily housing programs in the Northeast. Bainton’s job puts her in constant contact with families, veterans, seniors, developers, elected officials and building owners and managers. Bainton says the work, though so rewarding, is especially challenging in the Northeast, where housing prices are often higher than average costs for the rest of the United States.
>>Read the full interview.
A conference in St. Paul, Minn., earlier this month examined ideas and emerging examples for building a healthier Minnesota by promoting the integration of health-related programs and community development to address health where we live, learn, work and play. The conference was convened by the Federal Reserve Bank of Minnesota and Wilder Research, the research arm of the Amherst H. Wilder Foundation. The gathering, which was a follow-up to an initial conference on the intersection of health and community development held in Minnesota a year ago, highlighted current successful cross-sector efforts throughout the state.
Elaine Arkin, manager of the Robert Wood Johnson Foundation Commission to Build a Healthier America, was a keynote speaker at the conference. Her remarks included the announcement that the Commission’s recommendations on early childhood and supporting healthy communities will be released in early 2013.
The highlighted projects included a task force on increasing access to healthier foods, often an obstacle in poorer communities; locating needed services alongside senior housing; a stable housing concept for people at risk of homelessness following a hospital stay; and a project underway to give kids living in trailer parks a safe place to play.
“The strategy that we used this year in engaging people with actual examples...was very effective in really acknowledging that this work is messy, that it does take time and that in order to keep people enthusiastic about it sometimes it does require giving people a pat on the back even just for the small progress that they’ve made,” said Ela Rausch, community development project manager of the Federal Reserve of Minnesota.
Following the conference, NewPublicHealth spoke with Ela Rausch and Paul Mattessich, PhD, Executive Director of Wilder Research.
NewPublicHealth: What were the key goals of this year’s meeting?
Paul Mattessich: The overarching goal is at the national level to bring together public health with community development finance in order to better address health issues, social determinants of health and improved community health. But what we did the first time a year ago was to try to get the two sectors to understand what each other does, what their vocabulary was, how best to work together and to start some networking.
This year the goal was to take the next step and highlight some examples where this cross-sector collaboration occurred, and to use that to try to further that even more and to underscore the fact that the two sectors really do address the same end goal, even though they do it in different ways. And if they team up they can do it more effectively.
Bithlo, Fla. is a town of 8,000 that is just 30 minutes outside Orlando and not much farther from the “happiest place on Earth” — but is beset by poverty, illiteracy, unemployment and toxic dumps that have infiltrated the drinking water. The water is so bad that it has eroded many residents’ teeth, making it that much harder for them to find jobs. Streets filled with trash, frequent road deaths and injuries from a lack of transportation options and safe places to walk, and dropping out before 10th grade were all the norm.
In just a short time, a collection of partners and volunteers have begun to reverse some of the decades-old problems Bithlo has faced. And earlier this week, the town that had been forgotten for almost a century was the scene of a hubbub of activity as hundreds of volunteers descended on the town to continue work on “Transformation Village,” Bithlo’s future main street, which will sport a combination library/coffee shop, schools, shops and many other services, all long missing from Bithlo.
Over the last few months, NewPublicHealth has reported on initiatives of the participating members of Stakeholder Health, formerly known as the Health Systems Learning Group. Stakeholder Health is a learning collaborative made up of 43 organizations, including 36 nonprofit health systems, that share innovative practices aimed at improving health and economic viability of communities.
>>Read more on the Stakeholder Health effort to leverage health care systems to improve community health.
One of the Stakeholder Health members is the Adventist Health System, a not-for-profit health care system that has hospitals across the country. Recently, Adventist’s flagship health care provider, Florida Hospital in Orlando, began supporting United Global Outreach (UGO), a non-profit group aimed at building up communities in need, in their four-year-long effort to transform the town of Bithlo.
NewPublicHealth recently spoke with Tim McKinney, executive vice president of United Global Outreach, and Verbelee Neilsen-Swanson, vice president of community impact at Florida Hospital, about the partnerships and commitment that have gone into Bithlo’s transformation into a town that is looking forward to new housing stock, jobs, stores, better education and improved health outcomes for the its citizens.
Atlantic Cities recently reported on a ride sharing program called Lyft, which requires riders to join up and input credit card information to be eligible for the carpool-like rides. Lyft’s licensed drivers are pinged to pick up passengers whom the system tracks as headed in the same direction as other riders already in the car.
The article focuses on the "cool" factor, and the potential for building social relationships, making it a great solution for college kids or young adults looking for a safe way to get home on nights out—a critical public health service, particularly when research released earlier this year found that more than one-third of designated drivers end up drinking.
But another potential future use could be to help alleviate massive transportation challenges in rural areas, particularly for those with limited income or no access to a car for other reasons. One Department of Transportation study found, "Close to 40 percent of all rural counties are not served by rural transit, while another 28 percent have limited service. And, nearly 57 percent of the rural poor do not own a car, while 1 in every 14 households in rural America has no vehicle." In the future, perhaps ride sharing programs could catch on as a viable transportation option in rural towns far away from the neon lights.
>>Bonus Link: A second transportation article in Atlantic Cities this week finds that despite the growth in ridership of bike share programs across the country, PBSC, a Montreal-based major supplier of city bikeshare equipment and software faces major transportation woes. PBSC bike share customers include London, D.C. and Chicago, the city with the largest bike-share program in the nation.
“For too long, we’ve thought of health as something that happens to you in a doctor’s office,” explained Howard Koh, U.S. Department of Health and Human Services Assistant Secretary for Health on Monday at the American Public Health Association (APHA) 2013 meeting. “We have about 20 leading health indicators that we look at closely, one of them is high school graduation.”
Koh went on to describe social efforts such as boosting graduation rates as among the most important things we can do to improve health for the future. He also discussed the important role that learning plays in being healthy—and that being healthy can also free kids up to focus and get a better education. The assistant secretary’s sentiments kicked off a panel on the indelible connection between the nation’s drop-out crisis and public health, and the ways in which we can achieve success in both.
Robert Balfanz of the Johns Hopkins School of Education began by describing the drop out epidemic: the overall graduation rate in the United States is as low as 78 percent and is far lower in some communities with the greatest inequities. In fact, one third of all schools produce 85 percent of the country’s drop outs. Chronic absenteeism, often related to student health, is the leading cause of the issue. For example, 25 percent of students in one city missed a year or more of schooling over a five-year period.
Health factors have a significant impact on academic success and graduation rates. According to Charles Basch of Teachers College at Columbia University, health issues such as poor vision, asthma and teen pregnancy inhibit student success, disproportionately so in children of urban, minority communities. Left unaddressed, these issues can form causal pathways to the increased likelihood of dropping out.
GUEST POST by Virgie Townsend, JD, associate editor at the Association of State and Territorial Health Officials (ASTHO)
About 40 percent of the health care dollars spent in New York State come from Medicaid. Realizing that the rate was climbing far too fast, the state brought together health care advocates, physician representatives, elected officials, management and unions to solve the growing financial issue by addressing the social determinants.
And they were effective. Last year the state saved $4 billion while adding approximately 154,000 people to its Medicaid program.
One of the key figures behind the public health improvements was New York State Health Commissioner Nirav R. Shah, MD, MPH, who last week moderated the panel discussion âMedicaid and Public Health: Improving Partnershipsâ at the Association of State and Territorial Health Officialsâ (ASTHO) 2013 Annual Meeting.
>>Read more in a NewPublicHealth Q&A with Shah.
>>Read more on New York Stateâs Health Improvement Plan.
>>Follow continued ASTHO Annual Meeting coverage on NewPublicHealth.org.
In addition to Shah, the panel included Vermont Department of Health Commissioner Harry Chen, MD; Executive Director of the National Association of Medicaid Directors Matt Salo; and Chief Medical Officer for Center for Medicaid and CHIP Services Stephen Cha, MD, MHS. Shah and Chen discussed how their states are improving population health through greater integration with Medicaid, while Cha and Salo presented their views from the Medicaid perspective.