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“Targeting the Social Determinants of Health” Atlanta, GA March 7, 2013. Urban Health Disparities Summit Shaping Action to Reduce Disparities Georgia State University. David Satcher, M.D., PhD. Director, The Satcher Health Leadership Institute and - PowerPoint PPT Presentation
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“Targeting the Social Determinants of Health”
Atlanta, GAAtlanta, GAMarch 7, 2013March 7, 2013
David Satcher, M.D., PhD.
Director, The Satcher Health Leadership Institute and
The Center of Excellence on Health Disparities
Poussaint-Satcher- Cosby Professor of Mental Health
Morehouse School of Medicine
16th U.S. Surgeon General
Urban Health Disparities SummitUrban Health Disparities SummitShaping Action to Reduce DisparitiesShaping Action to Reduce Disparities
Georgia State UniversityGeorgia State University
Satcher Health Leadership Institute Satcher Health Leadership Institute MissionMission
The mission of the Satcher Health Leadership Institute (SHLI) is to develop a diverse group of exceptional health leaders, advance and support comprehensive health system strategies, and actively promote policies and practices that will reduce and ultimately eliminate disparities in health.
www.satcherhealthleadershipinstitute.orgwww.satcherhealthleadershipinstitute.org
““Today, the need for leaders is too Today, the need for leaders is too
great to leave their emergence to great to leave their emergence to chancechance.”.”
Institute of Medicine Report, 1988
LEADERSHIP LESSONS FROM THE LEADERSHIP LESSONS FROM THE SATCHER HEALTH LEADERSHIP SATCHER HEALTH LEADERSHIP
INSTITUTE INSTITUTE
• Leadership Responds to Opportunities, Challenges and CrisesLeadership Responds to Opportunities, Challenges and Crises
• Leadership is a Team SportLeadership is a Team Sport
• Leadership is Not Position DependentLeadership is Not Position Dependent
• Effective Leadership Transforms communitiesEffective Leadership Transforms communities
• Leadership Requires a Global PerspectiveLeadership Requires a Global Perspective
• Leadership is like a Relay RaceLeadership is like a Relay Race
Reports of the 16th
Surgeon GeneralReports of the 16th
Surgeon General
Best available science
HEALTHY PEOPLE 2010:HEALTHY PEOPLE 2010:OVERARCHING GOALSOVERARCHING GOALS
• Increase Years and Quality of
Healthy Life
• Eliminate Racial and ethnic Health Disparities
HEALTH DISPARITIESHEALTHY PEOPLE 2010
DEFINITION
Differences that occur in health by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation.
Infant Mortality Rates By Race and Hispanic Origin, 1999
Infant deaths per 1,000 live births
5.8
14
9.3
4.85.7
0
2
4
6
8
10
12
14
White Black AI/AN A/PI Hispanic
Disparities: Infant Mortality
DISPARITIES: CARDIOVASCULAR DISPARITIES: CARDIOVASCULAR DISEASEDISEASE
AGE-ADJUSTED TOTAL PREVALENCE OF DIABETES IN AGE-ADJUSTED TOTAL PREVALENCE OF DIABETES IN PEOPLE AGED 20 YEARS OR OLDER, BY PEOPLE AGED 20 YEARS OR OLDER, BY
RACE/ETHNICITY—RACE/ETHNICITY—UNITED STATES, 2002UNITED STATES, 2002
Source: 1999-2001 National Health Interview Survey
and 1999-2000 National Health and Nutrition Examination Survey
WHAT IF WE HAD ELIMINATED WHAT IF WE HAD ELIMINATED DISPARITIES IN THE LAST CENTURY?DISPARITIES IN THE LAST CENTURY?
Fewer Black Deaths…Fewer Black Deaths…
In 2000In 2000
83,500 overall83,500 overall• 24,000 from heart disease24,000 from heart disease• 7,000 from HIV / AIDS7,000 from HIV / AIDS• 4,700 infant deaths4,700 infant deaths• 22,000 from diabetes22,000 from diabetes• 2000 fewer Black women from breast cancer2000 fewer Black women from breast cancer
More Health Insurance Coverage…More Health Insurance Coverage…• 2.5 million Blacks, including 620,000 children2.5 million Blacks, including 620,000 children
Source: D. Satcher et al, Health Affairs, March/April 2005
WHAT IF WE WERE EQUAL?WHAT IF WE WERE EQUAL?
Source: D. Satcher et al, Health Affairs, March/April 2005
Difference in Child Mortality Rate ChangesDifference in Child Mortality Rate ChangesUnder-five mortality rate by regionUnder-five mortality rate by region
Source: UNICEF 2001Source: UNICEF 2001
CSDH: Fig. 2.2CSDH: Fig. 2.2Under-5 Mortality Rate Per 1000 Live Births by Under-5 Mortality Rate Per 1000 Live Births by
Levels of Household WealthLevels of Household Wealth
Source: Gwatkin et al. (2007), using DHS data; WHO Commission Final
Report, 2008.
Source: Gwatkin et al. (2007), using DHS data; WHO Commission Final
Report, 2008.
Determinants of HealthDeterminants of Health
Source: Healthy People 2010Source: Healthy People 2010
Fig. 4.1 D. Satcher, R. Pamies, F. Dunston 2006
Community Factors Associated withRacial and Ethnic Health Disparities
Environmental toxins Alcohol or drug
additionSubstandard
education
Violence
PovertySubstandard
housing
Poor Health Outcomes
HEALTHY PEOPLE 2020:HEALTHY PEOPLE 2020:OVERARCHING GOALSOVERARCHING GOALS
• Attain high quality, longer lives free of preventable disease, disability, injury, and premature death
• Achieve health equity, eliminate disparities, and improve the health of all groups
• Create social and physical environments that promote good health for all
• Promote quality of life, healthy development, and healthy behaviors across all life stages
WHAT ARE THE SOCIAL WHAT ARE THE SOCIAL DETERMINANTS OF DETERMINANTS OF HEALTH?HEALTH?
• The conditions in which people are born, grow, live, work and age.
• They are shaped by the distribution of money, power and resources at global, national and local levels.
• Changes in the Social Determinants of Health often require policy changes.
HEALTH DISPARITIES & HEALTH DISPARITIES & THE AFFORDABLE CARE ACTTHE AFFORDABLE CARE ACT
Preventive care Coordinated care Diversity and cultural competency Health care providers for underserved
communities Ending insurance discrimination Affordable insurance coverage
NATIONAL PREVENTION NATIONAL PREVENTION STRATEGYSTRATEGY
Establish the National Prevention, Health Promotion and Public Health Council to coordinate federal prevention, wellness, and public health activities.
Establish a Prevention and Public Health Fund for prevention, wellness, and public health activities.
Establish a grant program to support the delivery of evidence-based and community-based prevention.
LIFESTYLE INDICATORS AND LIFESTYLE INDICATORS AND THE 16THE 16THTH SURGEON SURGEON GENERAL’S RXGENERAL’S RX
“ “In order to eliminate In order to eliminate disparities in health, we disparities in health, we need leaders who care need leaders who care
enough, know enough, will enough, know enough, will do enough and are do enough and are
persistent enough.”persistent enough.”
“Targeting the Social Determinants of Health”
Atlanta, GAAtlanta, GAMarch 7, 2013March 7, 2013
David Satcher, M.D., PhD.
Director, The Satcher Health Leadership Institute and
The Center of Excellence on Health Disparities
Poussaint-Satcher- Cosby Professor of Mental Health
Morehouse School of Medicine
16th U.S. Surgeon General
Urban Health Disparities SummitUrban Health Disparities SummitShaping Action to Reduce DisparitiesShaping Action to Reduce Disparities
Georgia State UniversityGeorgia State University