Racine LIHF Social Determinants of Health June 25

Racine LIHF Social Determinants of Health June 25, 2010

Pull yourself up by your bootstraps?

A conceptual framework for addressing disparities: Broadening the focus Economic & Social Opportunities and Resources Living & Working Conditions in Homes and Communities Medical Care Personal Behavior HEALTH Robert Wood Johnson Foundation Commission to Build a Healthier America www. commissiononhealth. org

A Life Course Approach: Overarching Strategies (Lu, Kotelchuk, Hogan, Jones, Halfon, 2008) n n n Improve Heath Care for African American Women Strengthen African American Families and Communities Reduce Allostatic Load

Improve Health Care for African American Women n n Provide Interconception care for women with prior adverse outcomes Increase access to preconception care n n Improve the quality of prenatal care Expand healthcare access over the life course

Strengthen African American Families and Communities n n Strengthen father involvement Enhance systems coordination and integration for family support services n n Create reproductive social capital in African American communities Invest in community building and urban renewal

Reduce allostatic load n n Close the education gap Reduce poverty among African American families n n Support working mothers and families Undo racism

Public Views: Determinants of Health (Robert, Booske, Rigby, Rohan, 2008, WMJ) n n n WI public believes that health practices, access to health care and health insurance are the most important factors affecting health. WI public believes that health insurance should be a high government priority. Social determinants seen as less important to health and public may be less likely to support government policies to improve social determinants.

External Factors Vs. Right Choices (Aubrun, Brown, Grady, Research Report for the Louisville Center for Health Equity, 2007) n n n Qualitative evaluation to understand what “average” Louisville residents think about health, health disparities and needed actions. Sought to understand discrepancies between what PH wants people to understand, and what the public currently believes. Right choices = People’s health -outcomes are determined by their own choices and actions

ABC’s for Healthy Babies n n Campaign designed to ignite a paradigm shift in how individuals & communities respond to disparities in birth outcomes Funded by DHFS with support from WPP n n Focus groups in 5 local areas with highest AA Infant Mortality 65% mothers, 23% fathers, 11% grandmothers

Key Findings n n Mothers and fathers believe that during pregnancy the role of the father is to help reduce stress in the mother’s life. Fathers in Milwaukee believe that jobs/employment are important changes needed to help African American women have healthier babies.

Prevention is more than access to healthcare n “Everyone is focused on health behaviors these days, but the environment people are constrained within far exceeds the effect of any individual change. Our program can link kids to asthma specialists and ensure they have the right medicines and resources like bed covers, but at the end of the day, if they go home to neglected buildings that are roach infested, and moldy housing, we will not be able to stabilize their asthma. ” Jacqueline Martinez, Northern Manhattan Community Voices Joint Center For Political and Economic Studies

What really makes us healthy? n n n Environmental quality Built Environment and Infrastructure Public safety Geographic Access to Opportunities throughout a region Health Services Community and Public Support Services Employment, Income, Wealth and Assets n Neighborhood Economic Characteristics n Cultural Characteristics n Social Support and Networks n Community Leadership and Organization n Reputation of the Neighborhood Joint Center for Political and n Economic Studies

Preventive Care is: Creating Compassionate and Reciprocal Environments (CARE) n n Emphasis must be on CARE Rebuilding bonds between people is a powerful tool to promote health and well being

Definitions: Compassionate and Reciprocal -Compassionate: Deep awareness of the suffering of another coupled with the wish to relieve it; sympathetic consciousness of others' distress together with a desire to alleviate it (Merriam-Webster Online. 15 September 2009) -Reciprocal: Shared, felt, or shown by both sides

100 Acts of Intentional Acts of Kindness: Building Reproductive Social Capital in Los Angeles (Jones, Lu, et al. 2010) n n n Maternal stress is an important risk factor for LBW and preterm birth Social support has been proposed as a strategy to offset maternal stress, but has shown only mixed outcomes Social capital extends support to include networks, civic engagement, local identity and solidarity and trust/reciprocal help

Reproductive Social Capital n n n The features of social organization that facilitate reproductive health in a community The degree of social connectedness of the pregnant woman to her community The quantity and quality of social connections Jones, Lu et al Ethnicity and Disease 2010

Methods n n n 55 pregnant or postpartum AA women in Los Angeles, CA were recruited from local clinics, CBO’s and FBO’s 6 focus groups for initial discussion and 9 focus groups for confirmation of themes and final selection Participants were asked to “name 5 things you wish someone close to you would do (would have done) to make your pregnancy better and 5 things a strange could do…”

Results n n n About half (53%) wished that someone close, particularly their husband or partner, could be more supportive Requests for support also included attendance at prenatal appts (22%), walking (16%), talking (15%), or massages (9%) Instrumental support was requested including meal prep (26%), housecleaning (22%), transportation (22%) and childcare (11%)

Dissemination n Posters and fans with 100 Acts of Intentional kindness printed and distributed to churches, beauty and barber shops and clinics. 100 Acts for New Mothers and 100 Acts Toward Oneself were completed using similar methods. Feedback from community conference attendees indicated 86% endorsement

How do we experience stress in our bodies? APA 2008 Survey Stress in America

PARENTING AND STRESS n n n Mothers report higher stress levels and poorer stress management skills than fathers. More than half of all mothers (54 percent) report extreme stress levels during periods of high stress compared to 46 percent of fathers. Two-thirds of mothers (69 percent) say family responsibilities are a significant source of stress compared to 52 percent of women without children.

“Race/Ethnicity” and Stress n n Hispanics and Blacks are more likely than Whites to say the economy, housing costs and job stability are significant sources of stress. Whites are more likely to say they manage their stress extremely well (31 percent versus 24 percent of Hispanics and 27 percent of Blacks)

Part 3: Some ideas n n n n n Ask me how was my day Ask me is there anything I need Be supportive and faithful Don’t stare at other girls in front of me Don’t offer me extra food Don’t talk about my weight Fix me a meal Take me to the doctor Don’t break up with me during my pregnancy Let me sit down at the bank until its my turn at the teller line

Keys to Happiness n n Social Connections: Having 5 or more friends beyond immediate family Optimism: Optimistic explanatory styles Appreciation: Gratitude, expressing appreciation, and savoring/mindfulness Purpose: Having a life purpose, especially one that is broader than self. OHanlon, B (2009 - Positive Psychology Practical Apps)

3 Good Things n Participants are asked to write down three things that went well each day, every night, for one week. Participants are asked to provide a causal explanation for each good thing. Seligman et al

The Buddha is reported to have said n "It is possible to travel the whole world in search of one who is more worthy of compassion than oneself. No such person can be found. "

Step Back/Step Forward

DISCUSSION n n What has the exercise demonstrated about the starting line? What does the exercise reveal about the role of government in wealth accumulation? How does the exercise help me rethink my own beliefs about my economic status and that of my family? What connections can I make between health and wealth now?

How work shapes health Physical aspects of work and the workplace Psychosocial aspects of work and how work is organized Work-related resources and opportunities Exposure to hazards Stress Access to nutrition, physical activity, housing, medical care Physical and mental health

How income shapes health Income represents resources and opportunities: n n n Medical care Nutrition & physical activity Housing and neighborhood conditions Social support Ways to reduce/buffer stress Children’s education RWJ Social Determinants Commission

How education shapes health Educational attainment Health knowledge, literacy & behaviors Working conditions § Exposure to hazards § Control / demand imbalance § Stress Workrelated resources § Health insurance § Sick leave § Retirement benefits § Other benefits Income Educational attainment § Nutrition § Exercise § Drugs & alcohol § Health/disease management HEALTH § Housing § Neighborhood environment § Nutrition § Stress Sense of control § Work-related factors § Health-related behaviors § Stress Social standing § Social & economic resources § Stress Social support § Social & economic resources § Health-related behaviors § Family stability § Stress HEALTH

How social advantage shapes health in childhood and later in life Higher levels of parents’ education Increased family income Good role models for children and lower exposure to unhealthy conditions such as secondhand smoke Healthier behaviors by parents Better jobs and increased family income Resources to cope with stressors (e. g. , child care, transportation, health insurance Affordability of good housing, a safe neighborhood with access to recreational opportunities and nutritious diet Decreased levels of chronic stress experienced by children RWJ Social Determinants Commission Positive effects on neuroendocrine systems that can lead to lesser risks for developing chronic disease such as heart disease and diabetes

What’s missing? n Assets and wealth

Considering income and education is not enough: the impact of racism n Structural racism tracks people by race into different socioeconomic opportunities n n Job opportunities Educational opportunities Options for where to live schools, jobs, housing quality In addition, living in a society with a legacy of discrimination can harm health through pathways involving stress n n Not only overt incidents Constant vigilance RWJ Social Determinants Commission

Levels of Racism n n n Internalized Personally Mediated Institutionalized: structures, policies, practices, and norms resulting in differential access to the goods, services, and opportunities of society by “race. ” Institutionalized racism is normative, sometimes legalized, and often manifests as inherited disadvantage. Jones CP. Confronting Institutionalized Racism. Phylon 2003; 50(1 -2): 7 -22.

KEYS TO SUCCESS n n n n n Trust Empowerment Culture and History Focus on Causes Community Investment and Expertise Trusted Organizations Community Leaders Ownership Sustainability Hope Reach U. S. -Finding Solutions to Health Disparities, CDC 2008

Decline of the Manufacturing Sector n n Between 1970 and 1990, Black were just as likely as other racial/ethnic groups to have manufacturing jobs. Since the early 1990’s and by 2007, Blacks were 15% less likely to have a job in manufacturing.

Simply put… n Love is patient; love is kind; love is not envious or boastful or arrogant or rude. It does not insist on its own way; it is not irritable or resentful; it does not rejoice in wrongdoing, but rejoices in the truth. It bears all things, believes all things, hopes all things, endures all things, love never fails. (1 Corinthians 13: 4 -7)