COMPENDIUM: Review of evidence linking social determinants of health to chronic disease epidemic

[Marisel Brown]

There is agreement among public health and medical practitioners that the chronic disease epidemic will affect many facets of American life.  Local health departments (LHDs) need to re-invent themselves in order to become organizations capable of influencing policies and practices in sectors ranging from transportation to food marketing.  In addition,  LHDs need new strategies and tactics to move the social determinants of health agenda forward in several arenas.  A challenging fiscal environment and the increasingly polarized political climate make organizational change of this magnitude a tall order.

 The Review of Social Determinants of Health for Public Health Departments is an important contribution to the development of a strong foundation to support the work of public health practitioners and university-based epidemiologists as the discipline begins to probe  the influence of race/ethnicity, income, education, and immigration status on health outcomes, particularly chronic disease.  

 The report was prepared by David Rehkopf, Stanford University School of Medicine and Nancy Adler, University of California, San Francisco.  S

 

 

 

 

[Beatrice Yearwood]

HEALTH EQUITY INDEX-Post continued

I forgot to add this link from the Knowledge Center-a project of   Data Haven   http://www.ctdatahaven.org/know/index.php/HEA_Framework

[Beatrice Yearwood]

HEALTH EQUITY INDEX-Seems a better fit than health impact assessment

The report is a good quick overview of social determinants for the those who are new to the topic.  The health impact assessment section seems to be an add-on.  I think a health equity index or at least a discussion about measures that can be used to describe the degree of inequity would be a better fit and more useful. 

The state of Connecticut's health equity index. 

The presentation in the document below is an explanation of the index.

http://www.jointcenter.org/hpi/sites/all/files/Health%20Equity%20In...

 

 

 

[Jeff Meer]

Among the other intruiguing and complex findings discussed in the compendium is the effect of moving into a new neighborhood on health.  Social scientists have long noted that individuals and families who live in more upscale neighborhoods tend to have better health than those who live in more socio-economically deprived ones.  And a variety of theories have been developed to explain these differences -- everything from biological/chemical exposure, to the "built environment" to the social network in a neighborhood.

The compendium cites one very interesting program, known as "Moving to Opportunity," which provided vouchers to some residents of poorer neighborhoods in New York, Boston, Chicago, Baltimore and Los Angeles to move to better neighborhoods. A review of 13 different studies showed that in general, the families moving to better neighborhoods did improve their short-term health, on average.  But the effects were stronger in children than in adults -- there were fewer childhood injuries and accidents, behavior problems, asthma attacks, and lower obesity rates, for example.

However, the report also showed  a negative effect: greater smoking among teenage boys.  So once again, the relationship is not as simple as it might seem at first blush. 

[Jeff Meer]

As a relative newcomer to the field of social determinants of health, I must say I was surprised by a couple of the study's conclusions, which seem at first blush counter-intuitive.  For example, the research shows conclusively that within all ethnic groups, recent immigrants tend to live longer than US-born individuals of the same ethnicity. A casual observer might think that recent immigrants, having grown up in places with food insecurity, violence or political turmoil, would be more ill in general or might die earlier. Some social observers have opined, apparently incorrectly, that recent immigrants probably impose large health burdens on the U.S. healthcare system. Why might the opposite be the case?
The compendium's authors note there is "substantial evidence that immigrants arrive with healthier patterns of behavior [than comparable individuals of the same ethnicity already living in the United States]..," and present similar evidence that "healthier individuals are more likely to migrate to the U.S., and that individuals return to their country of origin if they become ill." Clearly there is a lot more to this subject than first meets the eye.
 

[Cecil Verley]

Forgot to add this site from Victoria, Australia.  It is another good one-stop shop for social determinants  The WHO has reissued its report Social Determinants of Health-The Solid Facts.

http://www.health.vic.gov.au/healthpromotion/what_is/determinants.htm

[Cecil Verley]

This is a good update on what has been done; however, as a junior college instructor, I have been using the "quick & dirty" draft from the CDC.  It is fairly old, but not ultra dated. It is a good two-page document for anyone who is relatively new to the topic and needs a quick overview to be informed. 

 Social determinants of health information sheet-CDC Draft