The Social Determinants of Health: Why “Place Ma,ers”

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TheSocialDeterminantsofHealth:Why“PlaceMa,ers”

AaronJDiehr,PhD,CHES

DepartmentofHealthEduca-on&[email protected]


•  Howdowedefinehealthin2016?

– Astateofcompletephysical,mental,andsocialwell-being,andnotmerelytheabsenceofdiseaseorinfirmity.

– Healthdispari.esrefertodifferencesacrossracialandethnicgroupsinhealthcondi-ons,riskandprognoses.


•  However,theabilitytoachieveop-malhealthinvolvesmanyfactorsbeyondjustindividualdecisions.

•  The“condi-onsinwhichpeopleareborn,grow,work,live,andage,andthewidersetofforcesandsystemsshapingthecondi<onsofdailylife”haveapowerfuleffectonhealthinmanydifferentways(WHO,2016).

Ø Socialdeterminantsofhealth


HEALTH

MedicalCare

PersonalBehavior

Living&WorkingCondi.onsinHomes&Communi.es

Economic&SocialOpportuni.es&Resources(e.g.

Income,educa.on,racialinequality)

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

The Social Determinants of Health: The “causes of the causes”


DOWNSTREAM:Nearwherehealtheffectsareseen

UPSTREAM:Atornearthesourceofacauseofillhealth


•  ThefieldofpublichealthisshiZingfocus.– Individualbehavior?

or– Popula-onhealth?

•  Publichealthresearchersarenowable(andexpected)tolookatawidevarietyofvariablesthatimpactpopula-onhealth(i.e.,thesocialdeterminantsofhealth).


•  Myresearchinvolvesvariousissuesrelatedtothesocialdeterminantsofhealth:– Theroleofstateofficesofminorityhealth,includingins-tu-onalandpoli-calbarriers– Theroleofstate-levelracialsegrega<ononvic-m-offenderracialconcordanceforhomicides(i.e.,“blackonblackcrime”)


•  Racialsegrega-oninmanymajorAmericanci-es,includingNewYork,Chicago,MilwaukeeandDetroit,approachesthatofSouthAfricaunderapartheid.

•  OnestudybyGaleaandothers(2011)foundthat,in2000,176,000deathswereaaributabletoracialsegrega<on.–  Inperspec-ve,thatnumberishigherthanthenumberofdeathsfromCOPD,the#3leadingcauseofdeath.


•  Alongwithacolleagueofmine(arecentPhDgraduatefromourprogramhereatSIU),wehavefound:– Greaterlevelsofstatewideracialsegrega-onarepredic-veofgreaterlevelsof“blackonblack”crime,evenaCer“controllingfor”variablessuchasincome,propor-onofminoritypopula-on,andeduca-onlevel.


•  However,theconnec-onbetweenracialsegrega-onand“blackonblack”crimebecomesfarlessprominentwhenstatesscorehigheronacommunitypolicingindex.

•  Whatdoesthismean?–  It’sverydifficult(nottomen-on-me-consuming)tofixaproblemlikesegregatedcommuni-es.


•  Ourresearchsuggeststhatmorecommunitypolicingmightleadtolowerlevelsof“blackonblack”crime.Someexamplesinclude:– Mee-ngsbetweenpoliceandadvocacygroups,businessgroups,churches,neighborhoodassocia-ons.

– Collabora-veproblem-solvingteamsincommuni-es.– Developmentofacommunitypolicingplan.


•  IwouldliketoacknowledgemycolleagueJus-nMcDaniel,PhD,MBA,AssistantProfessoratCharlestonSouthernUniversity.

•  Currentlyintheprocessofpreparingmul-plepresenta-onsandamanuscripttopresentthisimportantresearch.


•  Howcanyouhelp?– Thesocialdeterminantsare,bydefini-on,socialissues.– Thatmeans,withoutinputandhelpfromthecommunity,researchersalonewillneverbeabletosolvetheseissuesandhelpbuildasocietyinwhicheverybodyhasequalopportunitytoliveahealthy,happylife.


•  Iwelcomeyourinput,sugges-ons,andhelp:

AaronJ.Diehr,PhD,CHES(618)[email protected]

Thankyou!

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The Social Determinants of Health: Why “Place Ma,ers”