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Social Determinants of Health

and. Social Determinants of Health. Social Determinants of Equity. The Impacts of Racism on the Health of our Nation. Camara Phyllis Jones, MD, MPH, PhD Research Director on Social Determinants of Health and Equity Emerging Investigations and Analytic Methods Branch

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Social Determinants of Health

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  1. and Social Determinants of Health Social Determinants of Equity The Impacts of Racism on the Health of our Nation

  2. Camara Phyllis Jones, MD, MPH, PhD Research Director on Social Determinants of Health and Equity Emerging Investigations and Analytic Methods Branch Division of Adult and Community Health National Center for Chronic Disease Prevention and Health Promotion Coordinating Center for Health Promotion Centers for Disease Control and Prevention The views expressed in this presentation are those of the author, and do not necessarily represent the policies of the Centers for Disease Control and Prevention.

  3. Levels of health intervention

  4. Addressing the social determinants of health Primary prevention Safety net programs and secondary prevention Medical care and tertiary prevention

  5. But how do disparities arise? • Differences in the quality of care received within the health care system • Differences in access to health care, including preventive and curative services • Differences in life opportunities, exposures, and stresses that result in differences in underlying health status

  6. Through inequities How do disparities arise?

  7. Through inequities How do disparities arise? Exposures and opportunities

  8. Through inequities How do disparities arise? Access to care Exposures and opportunities

  9. Through inequities Quality of care How do disparities arise? Access to care Exposures and opportunities

  10. Differences in exposures and opportunities Differences in access to care Differences in quality of care (ambulance slow or goes the wrong way)

  11. Addressing the social determinants of equity: Why are there differences in resources along the cliff face? Why are there differences in who is found at different parts of the cliff?

  12. Individual behaviors Determinants of health

  13. Social determinants of health (contexts) Individual behaviors Determinants of health

  14. Social determinants of health (contexts) Individual behaviors Determinants of health Determinants of health and illness that are outside of the individual Beyond genetic predispositions Beyond individual behaviors

  15. Social determinants of health (contexts) Individual behaviors Determinants of health Determinants of health and illness that are outside of the individual Beyond genetic predispositions Beyond individual behaviors The contexts in which individual behaviors arise

  16. Social determinants of health (contexts) Individual behaviors Determinants of health Individual resources Education, occupation, income, wealth

  17. Social determinants of health (contexts) Individual behaviors Determinants of health Individual resources Education, occupation, income, wealth Neighborhood resources Housing, food choices, public safety, transportation, parks and recreation, political clout

  18. Social determinants of health (contexts) Individual behaviors Determinants of health Individual resources Education, occupation, income, wealth Neighborhood resources Housing, food choices, public safety, transportation, parks and recreation, political clout Hazards and toxic exposures Pesticides, lead, reservoirs of infection

  19. Social determinants of health (contexts) Individual behaviors Determinants of health Individual resources Education, occupation, income, wealth Neighborhood resources Housing, food choices, public safety, transportation, parks and recreation, political clout Hazards and toxic exposures Pesticides, lead, reservoirs of infection Opportunity structures Schools, jobs, justice

  20. Individual behaviors Determinants of health Societal determinants of context Social determinants of health (contexts)

  21. Individual behaviors Determinants of health Determine the range of observed contexts Societal determinants of context Social determinants of health (contexts)

  22. Individual behaviors Determinants of health Determine the range of observed contexts Societal determinants of context Social determinants of health (contexts) Determine the distribution of different populations into those contexts

  23. Individual behaviors Determinants of health Determine the range of observed contexts Include capitalism, racism, and other systems of power Societal determinants of context Social determinants of health (contexts) Determine the distribution of different populations into those contexts

  24. Individual behaviors Determinants of health Determine the range of observed contexts Include capitalism, racism, and other systems of power Societal determinants of context Social determinants of health (contexts) Determine the distribution of different populations into those contexts The social determinants of equity

  25. Addressing the social determinants of health • Involves the medical care and public health systems, but clearly extends beyond these • Requires collaboration with multiple sectors outside of health, including education, housing, labor, justice, transportation, agriculture, and environment

  26. Addressing the social determinants of equity • Involves monitoring for inequities in exposures and opportunities, as well as for disparities in outcomes • Involves examination of structures, policies, practices, norms, and values to answer, “How are these inequities being maintained?” • Requires intervention on societal structures and attention to systems of power

  27. We need to do both • Address the social determinants of health, including poverty, in order to achieve large and sustained improvements in health outcomes • Address the social determinants of equity, including racism, in order to achieve social justice and eliminate health disparities

  28. Levels of racism • Institutionalized • Personally-mediated • Internalized

  29. Institutionalized racism • Differential access to the goods, services, and opportunities of society, by “race” • Examples • Housing, education, employment, income • Medical facilities • Clean environment • Information, resources, voice • Explains the association between SES and “race”

  30. Personally-mediated racism • Differential assumptions about the abilities, motives, and intents of others, by “race” • Prejudice and discrimination • Examples • Police brutality • Physician disrespect • Shopkeeper vigilance • Waiter indifference • Teacher devaluation

  31. Internalized racism • Acceptance by the stigmatized “races” of negative messages about our own abilities and intrinsic worth • Examples • Self-devaluation • White man’s ice is colder • Resignation, helplessness, hopelessness • Accepting limitations to our full humanity

  32. Levels of Racism: A Gardener’s Tale

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