georgia grantmakers alliance 2011

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Social Determinants of Health Equity and Levels of Potential Impact in the System: Opportunities for Leverage Karen J. Minyard, Ph.D. Executive Director Georgia Health Policy Center Georgia State University

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Karen Minyard, GHPC Director, presented "Social Determinants of Health Equity and Levels of Potential Impact in the System: Opportunities for Leverage" at the Georgia Grantmakers Alliance in Macon, GA on August 25, 2011.

TRANSCRIPT

Page 1: Georgia Grantmakers Alliance 2011

Social Determinants of Health Equity and Levels of Potential Impact in the System:

Opportunities for Leverage

Karen J. Minyard, Ph.D.Executive Director

Georgia Health Policy CenterGeorgia State University

Page 2: Georgia Grantmakers Alliance 2011

Georgia Health Policy CenterA Research Center at Georgia State University

• Provides evidence-based research, program development, and policy guidance locally, statewide, and nationally

• Focuses on solutions to the most complex issues facing health care today including: insurance coverage, children’s health,

health care reform, and the development of urban and rural health systems

• Works in more than 200 communities across the U.S.

Page 3: Georgia Grantmakers Alliance 2011

Health

Page 4: Georgia Grantmakers Alliance 2011

How Healthy Are Georgians?Health Status by County

Page 5: Georgia Grantmakers Alliance 2011

Georgia’s Health Ranking Among States: 2010

5

DETERMINANTS - Personal Behaviors2010Rank

2008 Rank

2007Rank

2003 Rank

Prevalence of Obesity (Percent of population) 28 40 38 36

DETERMINANTS - Community and Environment

High School Graduation (Percent of incoming 9th graders) 45 48 48 49

Infectious Disease (Cases per 100,000 population) 47 47 46 46Children in Poverty (Percent of persons under age 18) 40 41 40 37Air Pollution (Micrograms of fine particles per cubic meter) 46 50 50 47

DETERMINANTS - Public and Health PoliciesLack of Health Insurance (Percent without health insurance) 44 41 40 37

HEALTH OUTCOMESInfant Mortality (Deaths per 1,000 live births) 41 40 43 43Cardiovascular Deaths (Deaths per 100,000 population) 40 40 41 -

Page 6: Georgia Grantmakers Alliance 2011

Factors Influencing Health Status

Schroeder, Steven A., We Can Do Better -- Improving the Health of the American People, N Engl J Med 2007 357: 1221-1228

Page 7: Georgia Grantmakers Alliance 2011

Social Determinants of Health Equity

Page 8: Georgia Grantmakers Alliance 2011

Health Disparities

The unequal burden in disease morbidity and mortality rates

experienced by ethnic/racial groups as compared to the dominant group.

Source: Healthy People 2010, US HHS, 2000

Page 9: Georgia Grantmakers Alliance 2011

Social Determinants of Health

The conditions in which people are born, grow, live, work and age,

including the health system. These circumstances are shaped by

the distribution of money, power and resources at global, national and local levels, which are themselves influenced

by policy choices.

Source: World Health Organization, 2008

Page 10: Georgia Grantmakers Alliance 2011

Community-Level Determinants of Health Equity

Social Environment

Physical Environment

Economic Environment

Service Environment

Social Cohesion & Trust

Housing & Neighborhood Conditions

Employment Health & Human Services

Collective Efficacy Transportation Home Ownership Public Safety & Emergency Services

Civic Engagement HEAL Promoting Structures

Local Business Development

Education

Cultural Characteristics & Norms

Natural Resource Quality

Product Availability

Community-based Organizations

Aesthetics Cultural/Artistic Opportunities

Source: Grantmakers in Health, 2009; Institute of Medicine, 2008; PolicyLink, 2002; Prevention Institute, 2003

Page 11: Georgia Grantmakers Alliance 2011

Health Equity Best Practices

CDC’s The Community Guide:– Community Preventive Services Task Force– Identified 200 community-based interventions in six areas– Reviews in three areas complete• Early childhood development = effective• Affordable and safe housing = effective• Access to culturally competent healthcare systems = insufficient

evidence

Evidence-based interventions:– Housing Mobility Policies– Early Childhood Development

Source: Anderson et al., 2003; CDC, 2009; Williams et al., 2008

Page 12: Georgia Grantmakers Alliance 2011

Nurse-Family Partnership • Nurse home visit program for low-income, first-time parents• Significant outcomes:

– Reduced risks for antisocial behaviors for children– Reduced childhood injury– Reduced child abuse, maternal crime & substance abuse– Improved prenatal outcomes– Increased school readiness for children– Increased maternal employment & father involvement

• ROI=$5 for every $1 spentSource: http://www.nursefamilypartnership.org

National Examples of Early Childhood Development Best Practices

Page 13: Georgia Grantmakers Alliance 2011

Harlem Children’s Zone • 97 block-area in Central Harlem, New York• Promise Academy Charter schools & 22 birth-to-college community

programs – Baby College, The Three Year Old Journey, Get Ready for Pre-K, Harlem

Gems• Significant outcomes:

– 100% of Harlem Gems school ready for 6 consecutive years– 97-100% of 3rd graders at-level in math & English language arts– 97% of 8th graders at-level in math

• vs 7% avg for Black 8th graders

– Closing Black-White achievement gap Source: Dobbie & Fryer, 2009

National Examples of Early Childhood Development Best Practices

Page 14: Georgia Grantmakers Alliance 2011

A Lesson in North Karelia

• In the 1970’s, North Karelia, Finland was plagued by exceedingly high deaths from cardiovascular disease

• “It was a question of general lifestyle of the community - not just some people with high risk factors. The whole environment had to change - the food industry, restaurants, cafeterias, supermarkets.”

- Pekka Puska, Project Director

Page 15: Georgia Grantmakers Alliance 2011

A Lesson in North Karelia

What they did:– Towns were pitted against each

other in cholesterol-lowering competitions.

– Food-labeling laws were changed – The national school-lunch program

got a major overhaul – They convinced bread companies

to use less salt and replace butter with vegetable oil

– They made sure walking paths were clear

– They passed laws to provide facilities for their citizens to get exercise

Results:– The smoking rate dropped

from 52% to 31%– Coronary heart disease

mortality fell by 73%– Lung cancer mortality

dropped by 71% – All-cancers mortality dropped

by 49%– Overall mortality declined 45%– 6 to 7 extra years of life

expectancy were added

Page 16: Georgia Grantmakers Alliance 2011

Levels of Impact

Page 17: Georgia Grantmakers Alliance 2011

Sustainability Institute, adapted from other versions from the organizational learning field

Page 18: Georgia Grantmakers Alliance 2011

Philanthropic Collaborative for a Healthy Georgia

• Individual Providers

• Incentives for Collaboration

• Change the System/Policy/Environment

Page 19: Georgia Grantmakers Alliance 2011

Opportunities for Leverage

Page 20: Georgia Grantmakers Alliance 2011

Strategic AlignmentTriple-Layer Chess

Local

National

State

Page 21: Georgia Grantmakers Alliance 2011

Visit www.gsu.edu/ghpc or follow us on Facebook for more information and

resources.