Social Support• Social support is a type and degree of help that is

provided from others to a person, group, neighborhood, city, organization, or community throughout the lifespan. There is a relationship between social support, maintenance of well-being, and the ability to manage crisis, illness, recovery, loss, or the influence of negative social determinants.

Emotional Appraisal Support Support

Informational InstrumentalSupport Support

Well- Being

& Recovery

Definitions of Social DeterminantsMethod Key Terms & ApproachGlasgow Gradient & Inverse RelationshipWhitehall Study Gradient & FrequencyWoolf & Braveman Root Cause & Upstream/Downstream FactorsSouth Australia Council Well being & Dahlgren’s RainbowWHO Policy Links & Ten FactorsMarmot 8 Defining FactorsRWJ Disparities & Knowledge of Policy/Decision Makers

Social DeterminantsWHO Factors Marmot and Wilkinson Dahlgren & Whitehead

Place on the gradient Poverty Housing

Stress Stress

Early life experiences Early life & life course

Social exclusion Labor market conditions Water & sanitation

Work environment Work environment Work environment

Unemployment Unemployment Unemployment

Social support Social support/cohesion Health care services

Addiction Education

Food Food supply Agriculture/food production

Transportation Transportation

Social determinants are multiple factors and conditions operating within a social environment that collectively influences the health status, behavior, choices, risks, and mortality of individuals and groups within a specific geographical area [nation, region, county, neighborhood, or community].

Davis, 2012

Social Determinants• Poverty• Income & Wealth Distribution• Employment - Unemployment• Education• Housing • Social capital• Isolation• Discrimination• Accessibility

Social Determinants• Availability• Social status• Crime• Safety• Functional social institutions• Nutrition – availability of food• Place on a social gradient• Clean water• Health/mental health literacy

Social Determinants• Recreation• Public policies • Population density• Transportation• Health insurance• Trauma

Well- Being

Emotional AppraisalSupport Support

Informational InstrumentalSupport Support

Well-being &

Recovery

Social Determinants

Social Determinants Family Friends

Neighbors

Organizations

LeadersHistory & Tradition

Churches

Social Network/Capital

ProvidersMedia

Death Rates in 1900 by Race

Causes of Mortality

African American1990 2004

American Indian1990 2004

Asian American1990 2004

Euro-American1990 2004

Latino American1990 2004

Heart Disease 1 1 4 4 5 5 2 2 3 3Homicide 1 1 3 3 4 5 5 4 2 2Suicide 4 5 3 3 4 5 1 1 2 2CerebrovascularDisease

1 1 5 5 3 3 4 4 2 2

Malignancy 1 1 5 5 3 3 2 2 4 4Respiratory Disease

2 3 3 2 4 5 1 1 5 4

Influenza 1 1 3 3 4 5 2 2 5 4Liver Diseases 3 4 1 1 4 3 5 5 2 2Diabetes 1 1 2 2 5 5 4 4 3 3HIV/AIDs

1 1 5 3 4 5 3 5 2 2

Accidents 2 3 1 1 5 5 3 4 3 2

Table 2. Changes in Ranking of mortality by race, Hispanic origin, and year

No community or group chooses povertyNo community or group chooses hungerNo community or group chooses danger or fearNo community or group chooses early death or suicideNo community or group chooses homelessnessNo community or group chooses mental illnessNo community or group chooses diseaseNo community or group chooses crimeNo community or group chooses addictionNo community or group chooses drought!

My Working AssumptionsMy Working Assumptions