INTRODUCTION TO SOCIALDETERMINANTS OF HEALTHDETERMINANTS OF HEALTHBy: Travis Howlette B.S., Jeff Wisniowski B.S., MPH and Kelsey Anilionis B.S.

Health Equity Peer Educator Training (HEPE)

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SPONSORSSPONSORS

STUDENT SPEAKER

Travis Howlette, Health Science ,Major (2011), Northeastern University. ORISE Research Fellow at the CDC Pre MD/MPHat the CDC. Pre-MD/MPH.

Jeff Wisniowski B.S./MPH Candidate

Kelsey Anilionis, Health Science B.S., 2011

Aim and Purpose of This Lecture Series

Be able to define health disparities and identify current trends in disparities among populationsdisparities among populations

Understand what social determinants are and how they can impact your health

Feel empowered as students who can do something about these i j iinjustices

TAKE-AWAYS FROM THIS LECTURE

D fi S i l D t i t f H lth d Define Social Determinants of Health and list at least three that impacts your personal healthp

The impact that racism in the US has had The impact that racism in the US has had on health

Understand what SES stands for and its implications to health in the US implications to health in the US

ACTIVITY: THE GAME OF LIFEPick a Piece (announce your piece):( y p )

ACTIVITY: THE GAME OF LIFEBlue: Lives in a 2-bedroom leased apartment, with a family of five (no family of five (no spouse, a retired grandparent, and

)three children)Blue: Went to school but did not finish high but did not finish high school because the first child was born.

ACTIVITY: THE GAME OF LIFERed: Lives in a 3-bedroom condo, alone.Red: Has a high school di l ll diploma, no college degree

ACTIVITY: THE GAME OF LIFEGreen: Lives in a four bedroom house, family of five (spouse and five (spouse, and three children)Green: Has a high school diploma, some college

ACTIVITY: THE GAME OF LIFERemember your piece, we will come back to this y p ,activity at the end.

SOCIAL DETERMINANTS OF HEALTH

What are What are they?they?

Can you li t f Can you li t f list a few

you know?list a few

you know?

DEFINITION

World Health Organization (WHO): The social g ( )determinants of health are the conditions in which people are born, grow, live, work and age, including the health systemincluding the health system.

In our words- Breaking down the wordIn our words Breaking down the wordSocial: your interactions with the external environment (your friends, family, places, and different systems)different systems)Determinants: Affecters or indicators… something that is determined or influenced by…H l h ll k h h l h i b i i Health: we all know what health is, but we put it in the context of physical, social, spiritual, and mental health.

SOME EXAMPLES

EducationIncome and/or Wealth

EnvironmentAccess to Health

Care/Specific Services

RaceWealth Services

S i l D t i t f H lthSocial Determinants of Health

EXPLANATION OF RACISM

Our context: Similar to Dr. Camara Jones three forms of racism:

Internalized: this is the view you have on yourself. Limiting yourself based on your own personal Limiting yourself based on your own personal perceptions to your race (ex: oreo: white on the inside, black on the outside)P ll M di t d thi i th i Personally- Mediated: this is the one everyone is familiar with. Believing something or acting according to racial perceptions from one person to anotheranother.Institutional: this is a systems approach to racism. Much broader. (ex: voting rights in the 60’s, historical

i diff t th )economic differences amongst the race)

ACTIVITY 1: FLOWER POT

Please choose one of the following pots (announce g p (your pot number):

Flower Pot 1

Flower Pot 2

Flower Pot 31 2 3

ACTIVITY 1: FLOWER POT

Flower Pot 1 Flower Pot Flower Pot 1 Flower Pot

2Flower Pot 3

ACTIVITY 1: FLOWER POT

Flower Pot 1 Flower Pot

3

POST FLOWER POT ACTIVITY

SUMMARY/REASON FOR ACTIVITY

Pot 1: represents what would be considered white pin America (perceived to have better health outcomes, as we learned in the previous webinar) The provision of soil was the emphasis webinar). The provision of soil was the emphasis on historical happenings in the U.S. (right to vote, better paying jobs, etc.)

Pot 2: represents the pother minorities that tend to be “forgotten” in the discussion of in the discussion of race in America. While the most dynamic and

ff extreme differences are amongst black/white… the concepts of racism pare not just a white vs. black battle.

Pot 3: represents the result of inequity, or p q y,inequality. Bad soil= bad growing conditions.

QUESTIONS/COMMENTS

So…. Who is responsible?

DIFFERENT APPROACHESBehavior approach to health

Systems approach to health

o Different influences based on behavior

o Different influences based on systems or based on behavior

(more internal)based on systems or society (more external)

o healthy eatingo Access to healthy foods

EDUCATION AND HEALTH

GRAPH 1: EDUCATION AND LIFEEXPECTANCY

GRAPH 1 SUMMARY

Those with high school or less: 75 years oldg y

Those with at least “some college”: 82 years old

Difference of 7 years

EDUCATION’S IMPACT ON HEALTH

Education can also be correlated with behaviorsSmoking ratesTeen pregnancyD Drug usage

Education can be associated with systemsFinances access to health careFinances access to health careEmployment stability

Game of LIFE

INCOME (SOCIOECONOMIC STATUS)Socioeconomic Status (SES): is an economic and ( )sociological combined total measure of a person's work experience and of an individual's or family’s economic and social position relative to others economic and social position relative to others, based on income, education, and occupation.

In other words: Your social status and economic status fused together in one word in respect to your power or assets in society.Example: Lawyer vs. JanitorGame of LIFE example

SES is a big factor in healthWh ?Why?

FACTS ON ECONOMIC THEORY

Capitalist: the means and production are p pprivately owned and operated for profit

This is a popular form of both medical care and medical insurance in the USmedical insurance in the US

Socialist: A more cooperative or public ownership in business.

Focuses on the abolition of hierarchal structuresFocuses on the abolition of hierarchal structuresMedicaid and Medicare

WHAT WOULD YOU CLASSIFY YOURSELFAS?

THE UNITED STATES AND SESWhy Economic Theories for this lecture?y

Neither capitalism or socialism is the answer, but the two are important to understand and respect in the US when talking about Social Determinants of Health.Determinants of Health.

THE ENVIRONMENT AND HEALTH

Where you live as a factor of your health.y yType of housing: apartment, house, public housingSuburban, urban (city), rural (farms)

E i l h dEnvironmental hazards.PollutionConstructionConstructionNoiseViolence/Crime

VIOLENCE AND CRIME (ENVIRONMENT)

Violence

C i

St

Crime

Stress

STRESS

We all know what stress is.But how does it affect you other than making you stay up long hours in the night trying to finish a paper?paper?Fight or Flight Response Concept (Dr. Michael Lu, UCLA)

WHAT WOULD YOUR REACTION BE?Type what you would do?yp y

Would you pet the big kitty?Would you just accept your fate?W ld hit d ?Would you hit and run?

Those who wish to pet the tiger…. Your either p gcrazy, love pets, or feel that petting the big angry cat will make him/her like you.Th h i h t t th i f t ll Those who wish to accept their fate… well your not crazy, but you are probably going to get what you wish.Those who wish to hit and run… This is the most realistic response when you are “frightened”… This is the fight or flight responseThis is the fight or flight response.

STRESS AND THE ENVIRONMENT

Think about when you are giving a speech or y g g ppresentation in front of the class.

Heart is racing, you feel butterflies in your stomach, your palms get sweatyyour palms get sweaty.This is a biological response or your body’s way of saying “get me out of here!”

STRESS AND VIOLENCE

Stress is the same feeling, and has the same g,affect.

Chronic stressW th i b d Weathering on your body

Those that live in areas of crime and violence tend to be more stressed then those in safer neighborhoods Stress leads to chronic disease (CVD, hypertension, and obesity)Th f LIFEThe game of LIFE

ACCESS TO HEALTH CARE/SERVICES

Our Health Care system is yflawed… to say the least

Privately runLeft open to similar Left open to similar marketing influences as businessMore service, more money, y

This social determinant does not really have much behavioral influence it is behavioral influence, it is mainly systemic.

TransportationFinancesFinancesFacilities/Service Locations

ACCESS IS NOT THE ONLY ISSUE

Access is just a piece.j pQuality/Equal Care

Famous study by Harvard: “U l T ”“Unequal Treatment”

Four patients (Black/White) who were actually actorsDifferences in diagnosis, difference in prescribed treatment… solely based on raceyWhat does this say about what is called “provider bias”?Is bias something that people can Is bias something that people can over come?

ACTIVITY 2: THE GAME OF LIFEDo you remember your piece?y y p

ACTIVITY 2: THE GAME OF LIFEBlue: Lives in a 2-bedroom leased apartment, with a family of five (no family of five (no spouse, a retired grandparent, and

)three children)Blue: Went to school but did not finish high but did not finish high school because the first child was born.

ACTIVITY 2: THE GAME OF LIFERed: Lives in a 3-bedroom condo, alone.Red: Has a high school di l ll diploma, no college degree

ACTIVITY 2: THE GAME OF LIFEGreen: Lives in a four bedroom house, family of five (spouse and five (spouse, and three children)Green: Has a high school diploma, some college

ACTIVITY 2: THE GAME OF LIFE

Blue/Red/Green: Due to the economic crisis, all three loss their jobs.

At the same time, they all had to go for surgery to At the same time, they all had to go for surgery to remove their appendix due to appendicitis (infection of the appendix)

ACTIVITY 2: THE GAME OF LIFEBlue: No insurance, had ,not filed for medicaid(insurance coverage for those who are below a certain poverty level)Blue: Loses the apartment and is forced apartment and is forced into public housing (projects).Blue: Remains in public Blue: Remains in public housing (the projects), one child falls victim to a violent crime in the violent crime in the neighborhood

ACTIVITY 2: THE GAME OF LIFERed: No insurance (does (not meet the poverty level of medicaid).R d L th d i Red: Loses the condo, is homelessRed: Eventually…Picked Red: Eventually…Picked up a managerial job and now lives in a apartment.

ACTIVITY 2: THE GAME OF LIFEGreen: Covered by Blue yCross Blue Shield health insurance (a popular private insurance company)insurance company)Green: Spouse provides financial support of the household Green: Remains searching for a job comparable to the for a job comparable to the previous job, while the spouse supports the financial needs of the household

POST GAME OF LIFE ACTIVITY

What happened to each person as they went pp p ythrough the exact same issues?

How did it affect their health?

C th l ti b t d ti Can you see the relation between education, environment, social support, and finances when it comes to health?

WHAT I HOPED YOU LEARNED

D fi S i l D t i t f H lth d Define Social Determinants of Health and list at least three that impacts your personal healthp

The impact that racism in the US has had The impact that racism in the US has had on health

Understand what SES stands for and its implications to health in the US implications to health in the US

CONTACT

For a free presentation presented by youth to a p p y ygroup via webinar please email (with the subject heading “HEPE presentation”):

healthdisparitiesstudentco@gmail.com

For more information or follow up to anything presented in this slide please contact:

Travis Howlette: thowlette.b@gmail.com