Key Strategies for Enhancing the Social Environment. Presentation provided by Dr Cynthia Morrow County of Onondaga Health Commissioner

1. Unnatural Causes Poverty causes ill health AND Ill health causes poverty

3. BARHII Framework The Bay Area Regional Health Inequities Initiative (BARHII) is a unique undertaking by local health departments in the San Francisco Bay Area to confront health inequities. All of the following slides are adopted from a presentation to NYSACHO by Anthony Iton, Director and Health Officer, Alameda County Public Health Department. May 2008.

4. Infant mortality Mortality Life expectancy

5. Chronic disease Infectious disease Injury (intentional and unintentional) Disease Access to and Mortality health care Injury 10-15% Genetics 10-15%

6. Smoking Medical Model Nutrition Physical activity Individual health Disease Risk knowledge and Mortality Behaviors Injury 70% ?? Violence

7. Physical environment Social environment Neighbor- Disease Risk hood and Mortality Behaviors Conditions Injury Residential segregation

9. Schools Corporations and businesses Neighbor- Disease Institutional Risk hood and Mortality Power Behaviors Conditions Injury Government agencies

10. Race/ethnicity Class Gender Neighbor- Disease Social Institutional Risk hood and Mortality Inequalities Power Behaviors Conditions Injury Immigration status

11. Socio-Ecological (society) Medical Model (individuals) Diseased Biased Societal Community Behaviors Behavior Disease Death Decision Death Processes Comm. Policy Health Clinics Emergency Capacity Advocacy Education Rooms Building

12. “ Services Overkill?” How Government Human Service Agencies Behave $$ $$$$ $$$$$

13. Life Expectancy High school grads: 90% Unemployment: 4% Poverty: 7% >80 Home ownership: 64% Non-White: 49% High school grads: 81% Unemployment: 6% Poverty: 10% 74.3 - 80 Home ownership: 52% Non-White: 59% High school grads: 65% Unemployment: 12% <74.3 Poverty: 25% Home ownership: 38% Non-White: 89%

14. In Oakland, African American and Latino 7 th graders read below the level of White 3 rd graders 700 687 675 656 650 631 625 625 600 575 White 3rd Grade White 7th Grade Black 7th Grade Latino 7th Grade CAT/6 2005 Source: California Department of Education, http://data1.cde.ca.gov/dataquest/

15. Cost of Poverty in Alameda County ‘ Every additional $12,500 in household income buys one year of life expectancy ‘ (Benefit appears to plateau at household incomes above $150,000)

16. Results of the statistical comparison of weather and deaths over 12 years show that blacks and those with a high school education or less are most likely to die on extremely hot days. - Harvard School of Public Health study of almost 8 million deaths in 50 cities from 1989 to 2000.

17. Socio-Ecological Medical Model Bay Area Regional Health Inequities Initiative

19. The Social Determinants of Health at the Neighborhood Level Physical Environment Social Environment Economic Environment Services Environment

20. Key Strategies for Enhancing the Social Environment ‘ Community capacity building - Organizing - Increases social capital/connectedness - Increases civic engagement ‘ Youth development - Risk vs. resiliency

21. Definitions Community Capacity Building/Empowerment “ Aims to strengthen characteristics of communities to plan, develop, implement & maintain effective community programs that positively affect broader community conditions that determine health and well being” -adapted from the W. K. Kellogg Foundation

22. HP 2010 Healthy People 2010 recognizes that communities, States, and national organizations will need to take a multidisciplinary approach to achieving health equity—an approach that involves improving health, education, housing, labor, justice, transportation, agriculture, and the environment.

23. Unnatural Causes: Is Inequality Making Us Sick? ‘ Prediction: You will ‘ A very different feel overwhelmed with portrait of health than the scope, scale and we are used to seeing profundity of the issues in the media. raised AND their implications for you as a PH official and as an American.