Racine LIHF

Racine LIHF

Social Determinants of HealthJune 25, 2010

Pull yourself up by your bootstraps?

Economic & SocialOpportunities and Resources

Living & Working Conditionsin Homes and Communities

PersonalBehavior

Medical Care

HEALTH

A conceptual framework for addressing disparities: Broadening the focus

Robert Wood Johnson Foundation Commission to Build a Healthier America www.commissiononhealth.org

A Life Course Approach: Overarching Strategies (Lu, Kotelchuk, Hogan, Jones, Jones, Halfon, 2008)

Improve Heath Care for African American Women

Strengthen African American Families and Communities

Reduce Allostatic Load

Improve Health Care for African American Women Provide

Interconception care for women with prior adverse outcomes

Increase access to preconception care

Improve the quality of prenatal care

Expand healthcare access over the life course

Strengthen African American Families and Communities Strengthen father

involvement Enhance systems

coordination and integration for family support services

Create reproductive social capital in African American communities

Invest in community building and urban renewal

Reduce allostatic load

Close the education gap

Reduce poverty among African American families

Support working mothers and families

Undo racism

Public Views: Determinants of Health (Robert, Booske, Rigby, Rohan, 2008, WMJ)

WI public believes that health practices, access to health care and health insurance are the most important factors affecting health.

WI public believes that health insurance should be a high government priority.

Social determinants seen as less important to health and public may be less likely to support government policies to improve social determinants.

External Factors Vs. Right Choices(Aubrun, Brown, Grady, Research Report for the Louisville Center for Health Equity, 2007)

Qualitative evaluation to understand what “average” Louisville residents think about health, health disparities and needed actions.

Sought to understand discrepancies between what PH wants people to understand, and what the public currently believes.

Right choices = People’s health --outcomes are determined by their own choices and actions

ABC’s for Healthy Babies

Campaign designed to ignite a paradigm shift in how individuals & communities respond to disparities in birth outcomes

Funded by DHFS with support from WPP

Focus groups in 5 local areas with highest AA Infant Mortality

65% mothers, 23% fathers, 11% grandmothers

Key Findings Mothers and fathers believe that

during pregnancy the role of the father is to help reduce stress in the mother’s life.

Fathers in Milwaukee believe that jobs/employment are important changes needed to help African American women have healthier babies.

Joint Center For Political and Economic Studies

Prevention is more than access to healthcare

“Everyone is focused on health behaviors these days, but the environment people are constrained within far exceeds the effect of any individual change. Our program can link kids to asthma specialists and ensure they have the right medicines and resources like bed covers, but at the end of the day, if they go home to neglected buildings that are roach infested, and moldy housing, we will not be able to stabilize their asthma.” Jacqueline Martinez, Northern Manhattan Community Voices

Joint Center for Political and Economic Studies

What really makes us healthy? Environmental quality Built Environment and

Infrastructure Public safety Geographic Access to

Opportunities throughout a region

Health Services Community and Public

Support Services

Employment, Income, Wealth and Assets

Neighborhood Economic Characteristics

Cultural Characteristics Social Support and

Networks Community Leadership

and Organization Reputation of the

Neighborhood

Preventive Care is: Creating Compassionate and Reciprocal Environments (CARE)

Emphasis must be on CARE Rebuilding bonds between people is

a powerful tool to promote health and well being

Definitions: Compassionate and Reciprocal

-Compassionate: Deep awareness of the suffering of another coupled with the wish to relieve it; sympathetic consciousness of others' distress together with a desire to alleviate it (Merriam-Webster Online. 15 September 2009)-Reciprocal: Shared, felt, or shown by both sides

100 Acts of Intentional Acts of Kindness: Building Reproductive Social Capital in Los Angeles (Jones, Lu, et al. 2010)

Maternal stress is an important risk factor for LBW and preterm birth

Social support has been proposed as a strategy to offset maternal stress, but has shown only mixed outcomes

Social capital extends support to include networks, civic engagement, local identity and solidarity and trust/reciprocal help

Jones, Lu et al Ethnicity and Disease 2010

Reproductive Social Capital

The features of social organization that facilitate reproductive health in a community

The degree of social connectedness of the pregnant woman to her community

The quantity and quality of social connections

Methods 55 pregnant or postpartum AA women in

Los Angeles, CA were recruited from local clinics, CBO’s and FBO’s

6 focus groups for initial discussion and 9 focus groups for confirmation of themes and final selection

Participants were asked to “name 5 things you wish someone close to you would do (would have done) to make your pregnancy better and 5 things a strange could do…”

Results About half (53%) wished that someone

close, particularly their husband or partner, could be more supportive

Requests for support also included attendance at prenatal appts (22%), walking (16%), talking (15%), or massages (9%)

Instrumental support was requested including meal prep (26%), housecleaning (22%), transportation (22%) and childcare (11%)

Dissemination Posters and fans with 100 Acts of

Intentional kindness printed and distributed to churches, beauty and barber shops and clinics.

100 Acts for New Mothers and 100 Acts Toward Oneself were completed using similar methods.

Feedback from community conference attendees indicated 86% endorsement

APA 2008 Survey Stress in America

How do we experience stress in our bodies?

PARENTING AND STRESS Mothers report higher stress levels and poorer

stress management skills than fathers. More than half of all mothers (54 percent)

report extreme stress levels during periods of high stress compared to 46 percent of fathers.

Two-thirds of mothers (69 percent) say family responsibilities are a significant source of stress compared to 52 percent of women without children.

“Race/Ethnicity” and Stress

Hispanics and Blacks are more likely than Whites to say the economy, housing costs and job stability are significant sources of stress.

Whites are more likely to say they manage their stress extremely well (31 percent versus 24 percent of Hispanics and 27 percent of Blacks)

Part 3: Some ideas Ask me how was my day Ask me is there anything I need Be supportive and faithful Don’t stare at other girls in front of me Don’t offer me extra food Don’t talk about my weight Fix me a meal Take me to the doctor Don’t break up with me during my pregnancy Let me sit down at the bank until its my turn at

the teller line

OHanlon, B (2009 - Positive Psychology Practical Apps)

Keys to Happiness Social Connections: Having 5 or more

friends beyond immediate family Optimism: Optimistic explanatory styles Appreciation: Gratitude, expressing

appreciation, and savoring/mindfulness Purpose: Having a life purpose,

especially one that is broader than self.

Seligman et al

3 Good Things

Participants are asked to write down three things that went well each day, every night, for one week. Participants are asked to provide a causal explanation for each good thing.

The Buddha is reported to have said

"It is possible to travel the whole world in search of one who is more worthy of compassion than oneself. No such person can be found."

Step Back/Step Forward

DISCUSSION What has the exercise demonstrated about

the starting line? What does the exercise reveal about the

role of government in wealth accumulation? How does the exercise help me rethink my

own beliefs about my economic status and that of my family?

What connections can I make between health and wealth now?

Work-related resources and opportunities

Physical and

mental health

Physical aspects of work and the

workplace

Stress

Access to nutrition, physical activity, housing,

medical care

Psychosocial aspects of work and how work

is organized

Exposure to hazards

How work shapes health

RWJ Social Determinants Commission

How income shapes health

Income represents resources and opportunities:

Medical care Nutrition & physical activity Housing and neighborhood conditions Social support Ways to reduce/buffer stress Children’s education

Educational attainment


HEALTHHEALTH

Exposure to hazards Control / demand imbalance Stress

Work-related

resources

Housing Neighborhood environment Nutrition Stress

Work

Health insurance Sick leave Retirement benefits Other benefits

Working conditions

Income

HEALTHHEALTH

HEALTHHEALTH

How education shapes health Nutrition Exercise Drugs & alcohol Health/disease management



Sense of control Work-related factors Health-related behaviors Stress

Social standing

Social support

Social & economic resources Stress

Social & economic resources Health-related behaviors Family stability Stress

HEALTHHEALTH

Health knowledge, literacy & behaviors




How social advantage shapes health in childhood and later in life

Higher levels of parents’

education

Healthier behaviors by

parents

Good role models for children and

lower exposure to unhealthy

conditions such as secondhand smoke

Better jobs and increased family

income

Higher levels of parents’ education

Affordability of good housing, a safe

neighborhood with access to

recreational opportunities and

nutritious diet

Increased family income

Resources to cope with stressors (e.g.,

child care, transportation,

health insurance

Decreased levels of chronic stress

experienced by children

Positive effects on neuroendocrine

systems that can lead to lesser risks for

developing chronic disease such as heart disease and diabetes

What’s missing?

Assets and wealth


Considering income and education is not enough: the impact of racism

Structural racism tracks people by race into different socioeconomic opportunities

Job opportunities Educational opportunities Options for where to live schools, jobs, housing

quality In addition, living in a society with a legacy of

discrimination can harm health through pathways involving stress

Not only overt incidents Constant vigilance

Levels of Racism

Internalized Personally Mediated Institutionalized: structures, policies,

practices, and norms resulting in differential access to the goods, services, and opportunities of society by “race.” Institutionalized racism is normative, sometimes legalized, and often manifests as inherited disadvantage.

Jones CP. Confronting Institutionalized Racism. Phylon 2003;50(1-2):7-22.

KEYS TO SUCCESS Trust Empowerment Culture and History Focus on Causes Community Investment and Expertise Trusted Organizations Community Leaders Ownership Sustainability Hope

Reach U.S. -Finding Solutions to Health Disparities, CDC 2008

Decline of the Manufacturing Sector

Between 1970 and 1990, Black were just as likely as other racial/ethnic groups to have manufacturing jobs.

Since the early 1990’s and by 2007, Blacks were 15% less likely to have a job in manufacturing.

Simply put…

Love is patient; love is kind; love is not envious or boastful or arrogant or rude. It does not insist on its own way; it is not irritable or resentful; it does not rejoice in wrongdoing, but rejoices in the truth. It bears all things, believes all things, hopes all things, endures all things, love never fails. (1 Corinthians 13: 4-7)

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